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Tue October 9, 2012
Infant mortality, part 3: A public health crisis needs solutions
In our final segment of State of Opportunity, Jennifer Guerra looks at what's being done today to help ensure that all children have an equal shot at celebrating their first birth - no matter where they live, what color their skin is, or how much money their parents have in the bank.
A Healthy Start approach, or how to get the black infant mortality rate down to zero
State of Opportunity reporter Jennifer Guerra tagged along with Jenny Hall on a home visit to see a client of hers who lives near Flint.
Hall is a social worker in Genesee County and she visits her client, Melissa, three or four times a month. Like a lot of Hall’s clients, Melissa is on Medicaid and receives federal and state aid. “She’s 18 and has three small children, and we’re gonna go meet with her and see how she’s doing as far as coping,” says Hall.
These home visits are part of Healthy Start, a program designed to reduce infant mortality disparities in places with some of the worst birth outcomes.
To help women like Melissa break out of the cycle of poverty and help their infants thrive, Healthy Start involves a nutritionist, a nurse, a social worker, and a community health worker. Together, they assess the needs of the Mom, and then decide who should do the home visits. Also, there's no cap on the number of home visits up until the baby turns two.
The funding for Healthy Start is a combination of state Medicaid dollars and a $750,000 federal grant. There are six Healthy Start programs in Michigan with more on the way. Most are focused on African American mothers and their children, but one program focuses on Michigan’s Native American population.
So how successful is Healthy Start? Well, when the Genesee County program began over ten years ago, the African American infant mortality rate there was nearly four times higher than the rate for white babies. Today, the black infant mortality rate for Healthy Start babies in Genesee County is zero; zero babies in the program died before their first birthday.
And they don’t cherry pick “ideal candidates” to be in the program. The higher the need, the better.
Sewing up the safety net for Detroit women
Sew up the Safety Net is a new infant mortality reduction effort in Detroit. It's funded by a 1.8 million dollar grant, and is a collaboration between four Detroit health systems: Henry Ford, Detroit Medical Center, Oakwood, and St John Providence.
Their goal is to sign up 1,500 at-risk women from three Detroit neighborhoods, the vast majority of whom will not be pregnant. The idea is to help the women long before they get pregnant, so that they can improve their chances of having a healthy baby.
Sew Up the Safety Net uses something called a “community health worker” model, meaning the community health workers live in the neighborhoods where they work.
Two community workers will be assigned to each of the program's three targeted neighborhoods. They'll visit the women at their homes and talk with them about nutrition, education, health, wellness and family planning.
Henry Ford Hospital's Dr. Kimberlydawn Wisdom is spearheading the new program. By addressing not just what happens inside the hospital, but in the neighborhoods as well, Wisdom thinks they can start to move the needle on infant mortality, and improve the health of the whole community while they’re at it.
“If you have a safe environment where they can move more, guess what, the whole community benefits, the children, the men, families," says Wisdom. The same, she says, goes for access to fresh fruits and vegetables. "All these different factors," Wisdom continues, "that will help decrease the infant mortality rate are the same factors that will actually lift a whole community in terms of its health status."
The 1,500 women who will participate in Sew Up in the Safety Net will be tracked over the next three years to see both if the “community health worker” approach works, and if it can be replicated.
The role of the Affordable Care Act
Infant mortality isn't just a problem in Michigan, it's a problem across the country. The Obama administration is developing a plan to reduce infant mortality nationwide. Kay Johnson is the woman heading up the advisory committee for the plan, and she says the Affordable Care Act will play a big role.
Right now, if you’re poor and you’re pregnant, you’re likely covered by Medicaid. But it you’re a low-income woman and not pregnant, chances are you don’t qualify for Medicaid, and you can’t afford health insurance on your own. Johnson says "four out of ten low-income women with incomes below 200 percent of poverty do not have health insurance."
Johnson says the Affordable Care Act now gives low-income women of childbearing age the opportunity to get well-women visits and screenings and preventive services that might stave off chronic conditions like hypertension and diabetes, conditions that are known to lead to preterm and low birth-weight babies.
Better access to contraception is also part of the health care reform law.
If Michigan goes through with Medicaid expansion as it’s written in the Affordable Care Act, some 400,000 - 500,000 people in Michigan who didn’t qualify before will now have health insurance.
Other strategies to reduce infant mortality
Educating parents on safe sleep environments is something nearly all public health officials brought up as something parents can actively do to reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related causes of infant death. There are many nurse home-visiting programs available to women in the state - whether you’re a new mom, or this is your fifth baby; whether you qualify for Medicaid or not.
Another thing you can do to improve your baby’s chance of survival? Not smoking during pregnancy is probably the number one preventable risk factor for poor birth outcomes. And yet, in Michigan about 18 percent of Moms smoke during pregnancy.
When it comes to breastfeeding, the Centers for Disease Control and Prevention recommend all babies in the U.S. be breastfed exclusively for six months or longer. (Though that’s pretty tall order considering the CDC says just over 10 percent of babies in the U.S. are exclusively breastfed at six months...and the rates are particularly low for African American babies.)
Breastfeeding is a personal choice, of course, and there are a host of reasons why some women don't breastfeed. But studies have shown lots of health benefits associated with breastfeeding - from helping to prevent infection in babies to reducing the risk of SIDS.
Dr. Paula Schreck is medical director of the Mother Nurture Project at St John Hospital and Medical Center, where she runs a breastfeeding support group. She sees breast milk as the ultimate preventative medicine:
“If you’re talking about poverty, if you’re talking about improving the health of a population, where best to start than hour one of life, providing optimal nutrition that’s free!” says Schreck.
Saving babies' lives costs money
Breastmilk is free, but the support group Schreck runs isn’t - it's grant funded. So are the other programs highlighted in this post and throughout the documentary.
Helping infants survive their first year isn’t free, and there’s clearly no silver bullet.
But many researchers and public health workers believe we can start to make a difference by focusing not just on what happens in the doctor’s office and at the hospital, but what happens in the communities where women and their children live.
Dr. Renee Canady from the Ingham County Health Department says she will continue to search for solutions to the infant mortality problem, not just for herself, but for the son she lost many years ago.
“It’s my hope," says Canady, "to be looking back long after retirement, sitting back at 94 saying, 'Wow, infant mortality just rarely happens. We finally figured it out.'"