View From Washington

Brent EwigOf all the measures of our nation’s health status, it is striking how well the national infant mortality rate can serve as an overall proxy measure of how our society is doing to meet the needs of moms, children and families. The loss of a child in infancy is a tragedy no family or community should have to endure, and we should never forget the suffering behind these statistics. 

So how are we doing? Despite great progress, it is clear we have much room for improvement. This September, we observe National Infant Mortality Awareness Month just as Congress reconvenes for a brief session before turning their full attention to the November elections. With a debate about health care reform getting underway, AMCHP has the opportunity now to spread our message about what is needed to improve our nation’s standing on this crucial measure, and advocate for what the next Administration and Congress can do to help partner with states and communities to spur progress.

The good news is that we have much success to build upon. The improvement we’ve made over the past century is a national public health success story. For most of the 20th century we saw dramatic declines in the national infant mortality rate. Since 1900, infant mortality has decreased 90 percent, and maternal mortality has decreased 99 percent. This led the Centers for Disease Control and Prevention to declare “healthier mothers and babies” one of the 10 great public health achievements of the 20th century. This success resulted from better hygiene and nutrition, availability of antibiotics, greater access to health care, and advances in maternal and neonatal medicine.

Yet we are all too aware that in the past decade this progress has stalled. At the same time, funding for the MCH Block Grant has been reduced significantly over the past six years while the costs of providing health services has gone up. Similarly, funding for the federal Healthy Start program only reaches one of every three eligible communities. This reduced investment comes at a time when low birth weight and preterm births are increasing, and the United States ranks 28th internationally in infant mortality rates. Additionally, racial and ethnic disparities persist across several indicators, with the black infant mortality rate double the rate for whites.

So what is to be done, and what is AMCHP doing to promote policies to jump start progress? For one, we are discussing infant mortality in every one of our visits with Appropriators on Capitol Hill as one of the primary reasons to fully fund the Title V MCH Block Grant. We are also spreading the word that state MCH programs have provided leadership to implement many of the things we know make a difference, including expansion of Medicaid eligibility; implementation of family planning waivers; building systems that promote early entry into prenatal care; expanding networks of school-based health centers; promoting efforts to reduce teen pregnancy; expanding home visiting programs for families at-risk of poor outcomes; building pregnancy risk assessment monitoring systems (PRAMS) data systems; instituting both infant and maternal mortality review teams; and more recently, embracing the concept of preconception and interconception care. Each of these efforts need increased resources to be sustained and expanded.

Another step we are taking is advocating to expand access to quality, affordable health insurance for all and developing messages about how this can impact infant mortality rates. Despite significant Medicaid expansions, approximately 13 percent of all pregnant women in the United States are still uninsured, and one in five women of childbearing age were uninsured in 2006. AMCHP is in the process of refining principles for health reform, including:

1) The need to cover everyone;
2) The need to assure an adequate benefit package that meets the special needs of women and children; and
3) The need for adequate federal support for state and community-wide public health prevention and promotion services to be included in any health reform package.

But we also know that health insurance coverage alone is essential but not sufficient to improve the overall health of populations. This third reform principle therefore opens the door for the MCH community to talk with policymakers about how to assure that the enabling, population-based and infrastructure building services needed to complement medical care for women and infants are included in any reform effort.

Title V is at the forefront of providing these critical enabling, population-based and infrastructure building services. And because reducing infant mortality is one of the primary purposes of the Title V MCH Block Grant authorization, we will continue to spread the message that health care is essential but not sufficient to reduce infant mortality. The needs of women and children — and the future of state MCH programs serving them — need to be explicitly considered in the health care reform debate.