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December 3, 2013

STANCZYKIEWICZ: Making infant mortality the priority

Too many Hoosier babies are being mourned at funerals instead of being celebrated on their first birthdays, prompting a new statewide initiative aimed at eliminating infant mortality.

Indiana’s infant mortality rate — the number of children who die before their first birthday — is 25 percent higher than the national average. According to the updated Kids Count in Indiana Data Book, in 2011 the number of babies who died in the first year of life was 643, similar to the number of students in two elementary schools.

In terms of percentages, 7.6 of every 1,000 babies died before turning 1 year old.

“Infant mortality in Indiana is a huge challenge,” said Dr. William VanNess, commissioner of the Indiana State Department of Health. “We’ve been below 7 [per 1,000] only once in the last 113 years.  That’s why we’re putting this as our No. 1 priority at the Indiana State Department of Health.”

While many risk factors are associated with infant mortality, VanNess said smoking during pregnancy tops the list. In 2011, 16.6 percent of Indiana mothers reported smoking while pregnant, almost double the national average. Younger moms smoke the most, with nearly one-fourth of expectant mothers between the ages of 18 to 24 lighting up.

According to the Association of State and Territorial Health Officials (ASTHO), nicotine is not what a healthy baby should expect while mom is expecting.

“Nicotine levels can be higher for a fetus than for the mother,” ASTHO writes, increasing the likelihood of birth defects, low birth weight and Sudden Infant Death Syndrome (SIDS), the top three causes of infant mortality.

The association recommends that health care providers spend up to 15 minutes of each medical visit talking with mom about smoking, although waiting until mom is pregnant can be too late. Almost half of all pregnancies are unplanned, which is why ASTHO emphasizes the need for doctors to warn women about the dangers of smoking even before conception occurs.

This assumes that mom is able to have medical visits. One-third of pregnant moms do not receive first trimester prenatal care, with expectant mothers between the ages of 10 and 24 the least likely to visit a doctor during the first months of pregnancy. Babies born without the benefit of prenatal care are five times more likely to die during their first 12 months of life.

Other risk factors, VanNess explained, include obesity — especially if mom is diabetic — and a lack of breastfeeding. In addition, infant mortality is twice more likely for infants who are being raised in a single-parent home.

Dr. Deborah McMahan, health commissioner of the Fort Wayne-Allen County Department of Health, says medical professionals can best prevent the causes of infant mortality by partnering with the community organizations where mom lives to make services and resources more accessible.

“We have a tremendous amount of resources, but not everyone is familiar with those resources,” McMahan lamented. “What we’re trying to do with [community] organizations is develop that collaborative piece, that system of care to help parents have their issues addressed when they need them, like tobacco cessation.”

The Indiana State Department of Health has launched an initiative to develop more community partnerships, first by analyzing local data, and then by providing that data to local community leaders who then can design targeted solutions.

“Like politics, most health care is local, so we’re trying to energize local areas to help fix the problem in their area,” VanNess said. “We’ve got local health departments, local minority health coalitions, community health centers, hospitals, physician groups, all coming together.

“We’re helping them get into the same room so they can discuss who does what and not duplicate so that we can use our resources more effectively.”

For example, VanNess described how data analysis discovered a possible solution.

“There’s a higher rate of suffocation among black infants,” VanNess noted, “whether that’s from sleeping with parents or not putting babies to sleep on their back. So we’re trying to provide information about sleep habits. That’s a statistic that through education we can certainly improve and is pretty straightforward to improve.”

Families, health care providers and community organizations working together can ensure that more Indiana babies are blowing out a candle on their first birthday.

— Bill Stanczykiewicz is President & CEO of the Indiana Youth Institute. He can be reached at iyi@iyi.org and on Twitter @_billstan

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