View From Washington

Raising Awareness About Infant Mortality

By Brent Ewig, MHS
Director of Public Policy & Government Affairs, AMCHP

I recently had the honor of representing AMCHP in a congressional briefing, cosponsored by AMCHP and organized by our colleagues at the American College of Obstetricians and Gynecologists. The focus was on raising awareness among congressional staff, press and interested organizations about America’s standing on infant mortality.

I shared the following three key messages:

  • Infant mortality is the sentinel measure of how well society is protecting and promoting the health of women and children, and the lack of significant progress over the past decade should concern us all
  • State public health agencies use the Title V Maternal and Child Health Services Block Grant as the foundation for efforts to move the needle on this critical indicator
  • Past and projected budget cuts will inhibit progress, we need Congress to help to sustain critical funding

Despite the well-known challenges, the presentation kicked off with a positive, highlighting how the long-term view reveals tremendous progress over the past century. This shows that improvement is possible and helps us remember that, while infant mortality and related disparities have not improved significantly in the past decade and sometimes may seem almost intractable, it has dropped by more than 90 percent in the last century. That is why the Centers for Disease Control and Prevention (CDC) declared healthier mothers and babies as one of the 10 greatest public-health achievements in the 20th century.

More recently, states, like South Carolina, Virginia, Delaware, and communities such as Harlem, have shown that dedicated leadership and targeted initiatives can make a difference. I shared the following state highlights:

  • South Carolina reduced its infant mortality by 6 percent from 2007 to 2008 to its lowest rate in 20 years by engaging partners such as the March of Dimes, private physician practices and faith-based organizations to ensure pregnant women have access to needed services.
  • The Virginia infant mortality rate dropped 13 percent from 2007 to 2008. As part of a comprehensive initiative, Virginia distributed grants to local health jurisdictions with the highest infant mortality, increased enrollment in State Children’s Health Insurance Program (SCHIP) for pregnant women, and formed partnerships with key organizations and community members through a Health Commissioner’s Infant Mortality Work Group.
  • Delaware recently reported a 10 percent reduction in their infant mortality rate since 2004 thanks to development of a Healthy Mother and Infant Consortium that implemented programs aimed at decreasing the number of children born prematurely or too small to survive the first year of life. Some of the key components of their comprehensive effort include, embracing preconception care and recognizing the way to healthy infants is through healthy women, and promoting early prenatal care and support for women with previous poor birth outcomes.
  • Finally, in central Harlem, the Northern Manhattan Perinatal Partnership – a Healthy Start grantee – developed and executed a community plan that reduced the infant mortality rate in central Harlem from 27.7 deaths per one thousand live births in 1990 to 6.1 deaths in 2008. Their efforts include a Title V supported Comprehensive Prenatal-Perinatal Services Network whose role is to coordinate perinatal services in Northern Manhattan and is committed to providing pre- and post-natal care that is accessible, family-centered, high-quality and addresses the central Harlem community needs.

These examples show that progress is possible, but we know that nationally progress has stalled and disparities are appalling.

How the State Title V MCH Block Grant Makes a Difference

I also shared a brief overview of how Title V is a 76-year-old program that supports a fundamental partnership between the federal government and states to improve maternal and child health (MCH). It provides resources to all states and territories with a fair amount of flexibility but a sets framework for states to deliver services in essentially four standard areas – direct gap filling care, enabling services, population-based programs and infrastructure or systems building. Those familiar with our jargon recognize this as the MCH pyramid.

More specifically to the issue of infant mortality, I highlighted how practically all state MCH programs:

  • Link uninsured women to available prenatal services
  • Closely coordinate with state Medicaid programs to improve outreach/enrollment to eligible women
  • Assess and work to ensure systems capacity to meet the needs of women and infants in their state
  • Develop regionalized systems to care for low birth weight and medically fragile newborns, and support newborn screening and follow-up programs serving nearly all infants
  • Ensure data collection/performance monitoring in order to examine/positively impact the incidence of preterm birth, infant mortality, and factors that may contribute to maternal mortality and morbidity
  • Increasingly focus on preconception health by working to improve women’s health prior to pregnancy in order to improve pregnancy related outcomes

Budget Challenges

I then stated the obvious – that all of this work is endangered by the grim budget outlook.

We used the event to highlight release of the new AMCHP report, Critical Condition: How Federal and State Budget Cuts are Hurting the Health of Our Nation’s Mothers and Children, warning that over $313 million in state cuts, combined with $74 million in federal cuts, along with record-high poverty and uninsurance rates are creating a perfect storm for the health of moms and kids.

I concluded by asking for the help of everyone in the room to use their voice in the debate on budgets, confronting the myth that we can do more with less.

I talked about how the Title V MCH Block Grant, in our view, represents the best hope for a funding relationship that supports a federal-state-local partnership providing states with the flexibility needed. I highlighted our statutory mandate to address infant mortality, and built-in accountability/performance measures to ensure this is addressed with a system rather than the silo approach.

Yet, the Title V MCH Block Grant has slowly eroded over the past decade. We need your leadership to reinvigorate this core source of state funding and emphasize what is needed to reestablish progress. It is folly to think we can do this on the cheap or absorb the kind of cuts we have beat back so far without losing progress and we need to say so.

I also shared my view that the cost-effectiveness data speak for themselves – when you consider the Institute of Medicine estimates that prematurity costs society $26 billion annually, it should not be a hard sell to convince policymakers that investing an incremental percentage to address this will provide a huge pay off. But reality is that this is a terrifically hard sell in this environment.

We also ended on a positive, noting that the Health and Human Services Secretary’s Advisory Committee on Infant Mortality (SACIM) is reconvening and organizing some of the best minds on this issue to make recommendations. I also highlighted that the Association of State and Territorial Health Officials – who also co-sponsored the briefing – will soon announce an exciting initiative to help raise awareness/catalyze progress.

The presentation ended with this quote from public health hero Bill Foege that captures the need to act now but while also taking in the long-term view:

"One thousand years ago, as tools improved, as building materials improved, we saw new creativity in architecture. At that point resources from churches, royal families and communities, were invested to build cathedrals, some taking hundreds of years to complete. Artisans were assembled who knew they would never see the completed cathedral and yet there is no evidence that it decreased the quality of their work. Likewise you and I are investing in a work for the future." - William Foege – Former CDC Director

Thank you for being committed to this work for the future.