From the CEO

Improving Birth Outcomes for All

By Michael R. Fraser, PhD CAE          

AMCHP joins the National Healthy Start Association and other local, state, and national partners in marking Infant Mortality Awareness Month. Infant mortality highlights many critical maternal and child health issues and pulls us all together around a single shared goal: preventing infant death and supporting families to assure a healthy start for all children. 

Why are babies dying? Experts point to several reasons, but congenital malformations, disorders related to short gestations and low birth weight, and sudden infant death syndrome account for almost half of all infant deaths. Maternal and child health programs have been successful in addressing infant mortality and reducing infant deaths in many ways. These include: 

·         Working to assure pregnant women have access to and utilize prenatal health care services. We know that early and continuous access to prenatal care helps prevent and address health conditions and behaviors that result in poor birth outcomes, including premature birth.

·         Supporting health promotion and disease prevention campaigns that address infant mortality and healthy pregnancy, for example programs that encourage the use of folic acid to prevent birth defects and the “Back to Sleep” campaign that has dramatically reduced the incidence of unexpected infant death nationwide.

·         Partnering with other groups to address infant mortality at the local, state and national levels. For example, many state Title V programs partner with local Healthy Start programs to address infant mortality in communities nationwide with higher-than-average infant mortality rates and use lessons learned though Healthy Start with other communities in their states.

Prenatal care, health promotion campaigns and partnerships: these are classic maternal and child health interventions that have made a huge difference in improving birth outcomes over time. But there is so much left to do – and much that focuses beyond our core competencies in prenatal care and health education. How else are maternal and child health programs addressing infant mortality? 

First, we have seen many state programs increase their focus on addressing the root causes of health disparities and health inequities. The unfortunate reality is that infant mortality disproportionally impacts the economically disadvantaged, and racial and ethnic minorities. For example, according to CDC data, the African American infant mortality rate is more than twice that of white Americans. Despite declines in the infant mortality rate overall the gap between white and black persists. Addressing this gap means dealing with the complex issues of racism and inequality. Difficult? Yes. Impossible? No.  

Through innovative programs, including Kellogg Foundation funded work in which AMCHP has participated with CityMatCH and the National Healthy Start Association, we are bringing members together to discuss how to address racism and eliminate disparities in birth outcomes. New Kellogg Foundation investments in racial healing work at the local level will also provide excellent examples from which we all can learn. I am excited by the opportunities to replicate these kinds of programs nationwide as best practices emerge from Kellogg’s ground-breaking work in this area and similar work by many others. We have a long way to go, but we are committed to promoting programs that address health inequities and promote good health for all. 

Second, the emerging focus on the “life course” perspective is an exciting opportunity to address a host of MCH issues, including infant mortality. We all realize that attempting to undo the impact of a lifetime of poor health and stress in the nine months preceding birth is next to impossible. Instead, by optimizing health across the life course MCH professionals can help promote better health outcomes at all stages of life. How exactly we do this in state MCH programs is still being defined, but my guess is that in the next several years we will see tremendous leaps forward in our understanding of how to integrate MCH interventions at all life stages leading to better health for women, children, and families. And that will translate into better health outcomes for all women. 

So, as we acknowledge the pressing reality of infant mortality this month – and all year – let’s look both at what we know works in improving birth outcomes as well as those innovative and potentially difficult areas that call for increased attention by MCH programs nationwide. AMCHP looks forward to sharing those with you as we recommit ourselves to addressing infant mortality with our partners in the states and nationwide.