“Infant mortality is the most sensitive index we possess of social welfare.”
— Julia Lathrop, Children’s Bureau, 1913
Why are so many Lane County babies dying?
In 2007, the Lane County Public Health Department issued a special report devoted to this question. Soon, additional fetal-infant mortality data will be reported to the Healthy Babies, Healthy Communities Initiative‘s Perinatal Health Team (PHT). (HBHC fact sheet) I have participated with HBHC’s PHT over the past year. The Register-Guard recently published my opinion piece on the need for civic engagement with the work of HBHC.
In anticipation of the new data, I outline here my understanding of the problem we face, key 2007 findings and the local response thus far. With this post, I hope to stimulate sensitive and productive community-wide discussion focused on ending avoidable fetal-infant mortality in Lane County.
Understanding the problem
The fetal-infant mortality rate includes both fetal (24 weeks gestation and 500 grams) and infant deaths through the first year of life. It is a sensitive gauge of a community’s health as well as of its social and economic wellbeing. Why? Because, tragically, these losses can be just the tip of an “iceberg.” Beneath the surface there can be a near-miss continuum of sickness and suffering. Sickness and loss among a community’s families makes for troubled homes, schools, and industry.
Lane County’s fetal-infant mortality and infant mortality rates are significantly higher than those of comparable counties as well as of the state and nation as a whole. Regarding fetal-infant mortality, Lane County Public Health reports:
“At 9.5 deaths per 1,000 live births for 1999-2003, Lane County’s fetal-infant mortality rate was 20 percent higher than the rate for Oregon (7.9) and 28 percent higher than Multnomah County (7.4). For the same period, at 7.3 deaths per 1,000 live births, the Lane County infant mortality rate was 30 percent higher than the rate for Oregon (5.6) and 40 percent higher than Multnomah (5.2).” See graphic 1. (Page 2, 2007 report)
At 6.9 deaths per 1,000 live births, the national infant mortality rate trails 29 nations, including many with far fewer resources. High rates of prematurity drive national infant mortality. Prematurity’s causes are many, including poor maternal health, lack of access to prenatal and postpartum care as well as overuse of induction and cesarean section. Based on 2006 data, Lane County Public Health reports:
“At 7.0 deaths per 1,000 live births, the county’s infant mortality rate was 27 percent higher than Oregon’s rate (5.5) and 35 percent higher than Multnomah’s (5.2).”
Not an isolated problem
All Lane County women experience higher rates of fetal-infant mortality rates. There are three findings in the 2007 report foundational to understanding and reducing local rates. I expect them to remain central even as new data are made public.
Key Finding #1: All socio-economic, age, and education-level groups have unacceptably high rates of fetal-infant mortality. See graphic 2. (Page 2, 2007 report)
Key Finding #2: Lane County women with characteristics associated with optimal pregnancy outcomes experience higher rates of fetal-infant mortality than the nation’s women as a whole with these same characteristics. Characteristics include being non-Hispanic white with 20 or more years of age and 13 or more years of education.
- Lane County reference group rate: 8.5 deaths per 1,000 live births
- National reference group rate: 5.8 deaths per 1,000 live births
Key Finding #3: Lane County has a statistically significant higher rate of post-neonatal infant mortality than the rest of Oregon. “Post-neonatal” refers to 29 days to one year. Ill-defined causes (includes SIDS) and external causes (includes accidents) were responsible for more than half of post-neonatal mortalities. This is important because SIDS and accidents are potentially preventable causes of mortality. (page 3, 2007 report)
The HBHC Perinatal Health Team members support and are actively engaged with two strategies for addressing fetal-infant mortality locally:
1. Fetal-Infant Mortality Review (FIMR)
FIMR reduces infant-mortality through (1) identifying community-level factors (social, economic, health) through case review; (2) planning and implementing community-based interventions to change harmful practices and policies; and (3) regularly evaluating progress and effectiveness of interventions. The forthcoming data, mentioned at the beginning of this post, is a result of the FIMR process having been initiated four years ago. See graphic 3 for a description of the FIMR process.
2. Home Visiting Work Group
Mother and infant outcomes are positively influenced when social, economic and health (mental and physical) factors influences overall wellbeing are addressed. HBHC’s Home Visiting Project is identifying and coordinating across local home-visiting programs to collaborate on and support consistent messaging and outreach supportive of optimal mother-baby practice.
The HBHC Perinatal Health Team anticipates receiving FIMR data in May. Based on findings, recommendations for community action will be discussed. These suggested actions will be shared at community-wide meeting on Friday, June 11th from 8-10 am at Lane County Mental Health. Please attend to learn about and participate in developing a community action plan for improving the health and wellbeing of mothers and babies in our community.