Delaware’s Efforts to Reduce the Infant Mortality Rate
By Walt Mateja
Director, Child Health Programs
Delaware Health and Social Services
For the past five years, the Delaware Healthy Mother and Infant Consortium (DHMIC) has been working toward implementing 20 recommendations aimed at reducing infant mortality in Delaware. The recommendations were originally issued in 2006 by a governor appointed Infant Mortality Task Force. The DHMIC and its working subcommittees are composed of a consortium of public health professionals including neonatalogists, maternal-fetal medicine specialists, registered nurses, internists, hospital administrators, nonprofit organization directors, federally qualified health care center directors, state legislators, concerned citizens, researchers and staff at the Delaware Division of Public Health. The Infant Mortality initiative is allocated state general funds dedicated to research and support of evidence-based interventions aimed at reducing infant mortality.
Since the initiative began, the Delaware Division of Public Health (DPH) has worked toward implementing evidence-based interventions during the preconception prenatal, postpartum and interconception periods for women considered high-risk (i.e., uninsured or underinsured, member of a minority, residing in a ZIP code identified as having a high proportion of infant deaths, living with a chronic disease, or experienced a previous poor birth outcome such as premature delivery, low birth weight delivery, stillbirth, fetal or infant death). These interventions provide preconception and interconception wellness visits for women and supplemental care during pregnancy and up to two years postpartum for mothers and infants. The high-risk criteria were developed through research using state vital records data, CDC recommendations for preconception care, and Fetal Infant Mortality Review pilot data. As of June 2009, the prenatal and postpartum program has served more than 4,700 pregnant women in Delaware. In a state that averages about 13,000 births per year, the program has impacted almost 20 percent of all live births. During the same time period, almost 25,000 women have been served in the preconception component of the program. Evaluation of the effectiveness of both programs is in progress; however, preliminary results suggest significantly lower rates of pregnancy complications and infant deaths among these high risk women. Statewide, the infant mortality rate has dropped from 9.2 per 1,000 live births during the 2001-2005 time period to 8.5 per 1,000 in the 2003-2007 time period.
Kentucky’s Efforts to Reduce the Infant Mortality Rate
By Ruth Ann Shepherd, MD, FAAP, CPHQ
Director, Division of Maternal and Child Health
Kentucky Department for Public Health
Tracey D. Jewell, MPH
Division of Maternal and Child Health
Infant mortality is a reflection of the health status of a population as well as an indication of maternal health, quality of care, access to care, socioeconomic conditions and public health interventions. Several of the strategies utilized in Kentucky to address infant mortality include the Health Access Nurturing Development Services (HANDS) program, Healthy Babies are Worth the Wait (HBWW) and the Jefferson County Infant Mortality Project.
HANDS: This statewide home visitation program provides services to first time parents that are at-risk or overburdened. Established in 1998 to address high rates of child abuse, the program goals are to increase positive pregnancy and child health outcomes, optimize child growth and development, reduce child maltreatment and improve family functioning. Previous outcome studies have shown lower rates of preterm birth, child abuse/neglect, and infant mortality among participants. In state fiscal year 2009, 11,171 families received HANDS services.
HBWW: This program, a partnership between the Kentucky Department for Public Health, March of Dimes and Johnson and Johnson Pediatric Institute, provides an innovative approach to prematurity prevention by addressing the multiple determinants of preterm birth, a leading cause of infant mortality. The project goal is to demonstrate a 15 percent reduction in preventable singleton preterm births. Community health leaders implement multiple interventions to reduce preterm birth and improve systems of care. Materials include a Community Toolkit for Prematurity Prevention available here. Preliminary evaluation indicates a reduction in preterm birth among the intervention sites.
Jefferson County Project: The Jefferson County Infant Mortality Pilot Project was coordinated by the Kentucky Office of Health Equity and the Center for Health Equity at Louisville Metro Public Health and Wellness. It was developed to address the role of contextual factors in the increasing infant mortality rates among African Americans. Focus groups were conducted with participants from the West End of Jefferson County in Louisville. Numerous priority themes emerged including safety, neighborhood appearance/environmental hazards, poverty, housing, local assets, social services, teenage pregnancy/parenting, health access, education, physical fitness opportunities and substance use. The pilot results will be used to inform future programming focused on eliminating health disparities in infant mortality.
Maajtaag Mnobmaadzid Michigan Inter-tribal Council Healthy Start Project Partners with Michigan Title V to Address American Indian Infant Mortality
By Elizabeth Kushman, MPH
Maajtaag Mnobmaadzid Healthy Start
Inter-tribal Council of Michigan
Prior to funding of the Inter-tribal Council of Michigan Healthy Start project in 1997, no state or federally funded maternal and child health (MCH) programs in Michigan had targeted the American Indian population. Data on American Indian birth outcomes were generally lumped into and reported under a racial category called “Other” in state analyses and reports. Indian Health Service Statistics for Michigan Tribes reflected only a small portion of the American Indian population and were not available by county. This lack of data and lack of programmatic focus was all the more compelling given that American Indian infants in Michigan die at two to three times the rate of white infants, and the rate of SIDS and SUID deaths was four to six times higher. The Inter-tribal Council of Michigan Healthy Start project provided a new opportunity to explore and address these disparities. The program provides home visiting to at-risk families and also builds awareness of American Indian maternal and child health issues. Collaboration with the state continues to grow as a successful and important aspect of the program.
The project has made great strides toward increasing awareness and institutional commitment, as well as toward building capacity at its eight Tribal and Urban Indian service delivery sites across the state. “Our capacity and sophistication in using data to provide population surveillance, needs assessment and program evaluation has increased greatly, in large part due to our collaboration with representatives from the Michigan Department of Community Health. They are a critical partner in the overall success of our project,” said Elizabeth Kushman, the project’s Director. Engaging with partners to address structural and policy-related issues that impact infant mortality is a key strategy of the Healthy Start national model. Over the past 12 years, examples of collaboration with Title V include:
- Establishment of a statewide Fetal and Infant Mortality Review (FIMR) Committee to review selected American Indian infant deaths in Michigan. While project staff coordinate and manage data related to FIMR, the state has supported this effort through training, technical assistance, access to records, and financial contribution toward medical case abstraction costs.
- Membership of a State Infant Mortality program staff member on the Healthy Start project consortium to facilitate communication;
- Presentation of American Indian data by Healthy Start staff at state-sponsored Infant Mortality and Maternal Mortality meetings;
- Inclusion of American Indian infant mortality as a priority issue and goal in the Michigan Title V Needs Assessment and Five Year Plan;
- Signing of data use agreements with the State Vital Records Division to provide access to de-identified birth and infant death records to enhance surveillance of American Indian birth outcomes, maternal risk factors and infant deaths as part of Healthy Start project evaluation.
For more information about the Maajtaag Mnobmaadzid Michigan Inter-tribal Healthy Start Project, please visit: http://itcmi.org/services/child-and-family-services/healthy-start.
Virginia’s Commissioner’s Working Group on Infant Mortality
By Karen Remley, MD, MBA, FAAP
State Health Commissioner
Virginia Department of Health
State Health Commissioner Karen Remley, MD, MBA, FAAP formed the Commissioner’s Working Group on Infant Mortality in 2008 to address Virginia’s infant mortality rate. The workgroup brings together leaders from the health care industry, community and faith organizations, the business community, insurers, educators and associations such as AARP, March of Dimes and NAACP. The goal of the workgroup is to improve Virginia’s infant mortality rate by engaging key stakeholders to work jointly with the Virginia Department of Health (VDH) through the development and implementation of creative/innovative prevention.
The workgroup has used a number of innovative approaches to improve Virginia’s infant mortality rate. In the beginning, a social networking site was used to gain members and keep them informed. Once the group was well established, a link on the Virginia Department of Health’s website was created to facilitate the sharing of current resources and post workgroup activities. Slides were made available to all members who were encouraged to make local presentations and increase awareness of infant mortality in their localities. In addition, the presence of AARP on the workgroup evolved into a project focused on grandparents as caregivers and trusted sources of information for their daughters and granddaughters. The grandmothers’ campaign resulted in fact sheets developed by VDH being placed on AARP’s website addressing such topics such as talking to your daughter about pregnancy, infant safe sleep and SIDS, and injury prevention for children. Likewise, AARP launched an online forum, “Ask the Commissioner,” in which forum members were able to ask the State Health Commissioner questions about child and maternal health. The workgroup came together to support and implement text4baby, a new free mobile information service providing timely health information to pregnant women and new moms through a baby’s first year. Members of the workgroup with other key stakeholders formed the implementation team and participated in the testing of the service prior to the national launch.
The workgroup continues to meet regularly and is dedicated to not only reducing the overall infant mortality rate but also the racial disparities. Efforts to improve access to early and timely prenatal care, increasing professional and families’ knowledge of available resources, and engaging the historically black colleges and universities as key partners are continuing.
Wisconsin's Efforts to Eliminate Racial and Ethnic Disparities in Birth Outcomes
By Patrice Mocny Onheiber, MPA
Director, Disparities in Birth Outcomes
Bureau of Community Health Promotion
Division of Public Health
Wisconsin Department of Health Services
Wisconsin’s initiative to eliminate racial and ethnic disparities in birth outcomes continues to gain momentum. A new legislative special committee on infant mortality begins September 8, 2010. The committee will examine the causes of infant mortality; evaluation of public and private efforts; coordination between public health and Medicaid; successful programs in other states; the public health costs of not addressing the problem; and developing a strategic proposal, including any necessary legislation, addressing in particular disparity rates in different geographic areas of the state.
The Title V MCH Program has been instrumental in keeping infant mortality as a priority in the state. The recently released Healthiest Wisconsin 2020 state plan includes an overarching focus on health disparities. The Healthy Growth and Development section describes the life-course approach, including the contributors to poor outcomes, and the interventions needed in our work. Reducing racial and ethnic disparities in birth outcomes, including infant mortality has become a 2020 objective and one of the departmental priorities that is tracked and monitored.
Other recent developments in the state include the funding of 4 MCH Collaboratives in the communities of Beloit, Kenosha, Milwaukee, and Racine. The Wisconsin Partnership Program of the University of Wisconsin School of Medicine and Public Health has begun its $10 million Life-course Initiative for Healthy Families (LIHF) to address the high incidence of African-American infant mortality in the state. The Title V Program is an active partner in these efforts.
Through our social marketing efforts, we continue to expand the reach of messages for healthy birth outcomes. We partnered with text4baby at the outset of this national campaign and are incorporating text4baby in our Journey of a Lifetime campaign. We have increased our social media networking activities and will extend these into September, during Infant Mortality Awareness month. Finally, we will be presenting our ABCs for Healthy Families and Journey of a Lifetime campaign this year at the American Public Health Association meeting in November. To learn more, visit here.