The Alaska Infant Safe Sleep Initiative
By Debbie Golden, RN, BC, MS
Perinatal Nurse Consultant
State of Alaska
Division of Public Health
Section of Women's, Children's and Family Health
A high and stable rate of postneonatal mortality in Alaska (3.6/1000 live births in 2008[i]), and the belief that the majority of these deaths are preventable, have led the Alaska Section of Women’s, Children’s and Family Health (WCFH) to focus recent research and outreach on this tragic outcome. Alaska Native infants have a postneonatal mortality rate 2.3 times higher than the rate for non-Native infants, yet one WCFH study found that this increased risk was almost all explained by higher proportions among Alaska native mothers of women with less than 12 years of education, women who were unmarried and did not indicate a father on the infant birth certificate, and women who reported prenatal alcohol or tobacco use.[ii] Mothers with these three characteristics experience postneonatal mortality rates that are up to 20 times higher than women with none. These characteristics are not genetic, and point to causes of infant death other than biologic factors.
After reviewing the circumstances of almost every infant death in Alaska 1992-2004, the Maternal and Infant Mortality Review committee has consistently recommended safer sleep environments to prevent many postneonatal deaths. In response, WCFH started the Alaska Infant Safe Sleep (ISS) Initiative in 2009. The ISS initiative will:
- Build on work done by the National Institutes of Health-approved Healthy Native Babies program to develop a relevant Alaskan infant safe sleep policy statement and social marketing message
- Design educational products
- Help plan and execute an Alaska Infant Safe Sleep Summit
- Promote integration of safe sleep messages and activities among key groups
A planning group has met to outline the initiative. In preparation, the group conducted a statewide health facility assessment on infant safe sleep. They found a lack of policies and standardized up-to-date education materials and practices. In particular, information about risk reduction while bed sharing, which 43 percent of Alaskan mothers of newborns practice always or almost always,[iii] is conspicuously absent from most educational materials.
The initiative will be launched at a half-day statewide task force meeting on September 29, 2009, to coincide with Infant Mortality Awareness Month. Plans are underway to do a media story that will include an interview of the mother of an infant who died as a result of an unsafe sleep environment. We hope to bring attention to Alaska’s high postneonatal mortality rates, risk reduction practices, and the need for participation by diverse stakeholders in the Alaska Infant Safe Sleep Task Force.
[i] Provisional data from the Alaska Bureau of Vital Statistics. Subject to change.
[ii] Blabey MH, Gessner BD. Three maternal risk factors associated with elevated risk of postneonatal mortality among Alaska Native population. Matern Child Health J. Vol 13 (2009).
[iii] Schoellhorn KJ, Perham-Hester KA, Goldsmith YW. Alaska Maternal and Child Health Data Book 2008: Health Status Edition. MCH Epidemiology Unit, Section of Section of Women’s, Children’s and Family Health, Division of Public Health, Alaska Department of Health and Social Services. December 2008.
Wisconsin Launches Several New Initiatives
By Patrice Mocny Onheiber, MPA
Director, Disparities in Birth Outcomes
Bureau of Community Health Promotion
Wisconsin Division of Public Health, Department of Health Services
Millie Jones, PA, MPH
Family Health Clinical Consultant
Wisconsin Division of Public Health
Wisconsin’s African American infant mortality rate in 2004 was the highest in the nation, at 19.2 per 1,000 live births, (a black-white infant mortality rate of 4.3, nearly twice the United States ratio). A sense of urgency has resulted in a number of new initiatives for Wisconsin’s MCH program, local officials and community advocates.
Due to the commitment of Wisconsin’s Title V Program, eliminating racial and ethnic disparities in birth outcomes became a priority for the Department of Health Services. The initiative’s Framework for Action and the statewide advisory committee’s recent report are available here.
In September 2008, Wisconsin’s MCH program was one of 13 states funded for two years by the Health Resources and Services Administration (HRSA) First Motherhood/New Parents Initiative. Wisconsin’s project, ABCs for Healthy Families, will launch its Journey of a Lifetime: Healthy Babies through Healthy Families campaign in September in Milwaukee, with Lorraine Lathen, CEO, Jump at the Sun Consultants. Trained community members gathered information on the public’s knowledge of the life-course perspective, including the effects of racism, and on the social media habits of urban African Americans. The technical advisory group is fortunate to include Mr. Mario Drummonds of the Manhattan Perinatal Partnership; Dr. Michael Lu of UCLA; Dr. James Collins of Northwestern University; and Dr. Kumea Shorter-Gooden of the Alliant International University in California.
In the fall of 2008, CityMatCH, the Association of Maternal and Child Health Programs (AMCHP), and the National Healthy Start Association (NHSA), with funding from the W.K. Kellogg Foundation, created the Partnership to Eliminate Disparities in Infant Mortality for the United States urban areas. Wisconsin was one of six states funded.
The team is focusing in Milwaukee on one key issue in the link between racism and infant mortality: the role of men and fathers. This focus evolves directly from the voices and wisdom of African American men, women and support persons in Wisconsin who participated in focus groups regarding healthy pregnancy and birth.
Finally, a long-term funding initiative of the Wisconsin Partnership Program and the University of Wisconsin School of Medicine and Public Health will be launched this fall. Comprehensive strategies will be funded, based on the commissioned white paper by Richard Aronson, MD, MPH. A steering committee of state and local representatives, including Wisconsin’s Title V Chief Medical Officer, Murray L. Katcher, MD, PhD, has been formed to guide these recommendations. To learn more, visit here.
For further information, please contact Patrice M. Onheiber, MPA, Director, Disparities in Birth Outcomes or Millie Jones, PA, MPH, Family Health Clinical Consultant.
Fetal and Infant Mortality Review (FIMR): Addressing Local Health Disparities and Providing Insight for State Program and Policy Development
By Kathleen Buckley, MSN
Director, National Fetal and Infant Mortality Review Program
American College of Obstetricians and Gynecologists
Addressing Local Disparities
Community based FIMR is an action-oriented continuous quality improvement process leading from review of cases to community action that improves service systems and resources for all women, infants and families, but especially those in communities with disparities in infant outcomes. Three components of the FIMR process are especially valuable in addressing disparities: 1) the diverse coalition/community partnership building component of the process itself; 2) inclusion of the voice of local families who experienced an infant loss and 3) the outcome interventions. The three components are described below:
1. The coalition/community team partnership building component of the process itself.
Typically FIMR engages about 30 – 50 active community team members including policymakers, representatives of organizations, institutions, health care providers, public health officials, businessmen, families, community leaders and consumer advocacy groups. Bringing all these entities together to address community issues is a success story in itself. FIMR is a community coalition/ partnership building strategy that can bring together all ethnic and cultural views in the community and becomes a model of respect and understanding for all involved.
2. Inclusion of the voice of local families who have experienced an infant loss.
The FIMR process includes a home interview with the mother who has suffered a loss, if she agrees. For many mothers, this may be the first and, perhaps, only opportunity to talk to another person about the loss of her infant. The interview provides an opportunity to offer emotional support as well as referrals for needed services.
The home interviewer then conveys the de-identified mother’s story to the FIMR case review team members. Thus, the home interview lets the true voice of the bereaved parent speak to the community at large. The mother’s input is extremely important to the understanding of whether or not services and community resources are available, accessible and culturally appropriate to the community.
3. The outcome interventions – based on the real needs of the community and the families who live there.
The actions and interventions that are developed by the local community FIMR coalitions in response to case review recommendations have two important characteristics relevant to identifying and addressing disparities:
· Because of the maternal interviews, the actions FIMR implements arise from a family advocacy perspective. The actions are also able to address the needs of culturally diverse local families.
· Because of the inclusive team membership, FIMR implements local interventions that are culturally sensitive and community specific. The actions represent a broad base of collective wisdom and expertise within the community..
FIMR: Providing Insight to State Title V
Vital statistics data that documents local infant health disparities will not necessarily show state Title V representatives the way forward to meaningful local community action to improve outcomes. The FIMR process has current information and action agendas addressing gaps in care, access to services and unique cultural and social issues affecting local families. Where appropriate, state Title V can build on and expand the culturally competent actions already underway through FIMR. Partnership between state Title V and local FIMR programs that serve these high risk communities can further strengthen the state’s efforts because:
· Unique findings from one high risk, underserved FIMR community may provide insights that can enhance the ability of the state to better target technical assistance or funding to that community.
· Common findings and recommendations of all local FIMR programs within a state about health disparities may clarify or enhance overall statewide needs assessment or program and program development.
· Common findings and recommendations of local FIMR teams include the voices of women who have experienced an infant loss, as well as community advocates, consumers and many other team members. Thus, the state can be assured of the broadest, inclusive community input to inform state policy development.
For states that would like to begin or expand their local FIMR reviews, technical assistance is available through the National Fetal and Infant Mortality Review Program (NFIMR). NFIMR is a collaborative effort between the American College of Obstetricians and Gynecologists and the federal Maternal and Child Health Bureau. To learn more, visit NFIMR or email.