Researchers Try To Explain Steep Decline In Black Infant Mortality In Wisconsin County

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A steep decline in black infant mortality in Dane County, Wis., could provide insight for researchers studying racial disparities in infant deaths across the U.S., the New York Times reports. The latest federal data taken in 2007 found an infant mortality rate of six deaths per 1,000 infants for whites and 13 per 1,000 for blacks. The racial gap primarily is due to a higher rate of very premature births among blacks, according to the Times.

In Dane County, the infant mortality rate among blacks "plummeted" from the 1990s to the current decade, from an average of 19 deaths per 1,000 to fewer than five per 1,000, reaching a level similar to that of whites, the Times reports. Experts say the decline is puzzling because obstetrical services for low-income women in the county have not changed substantially. In other parts of Wisconsin, black infant mortality rates remain among the nation's highest, exceeding 20 deaths per 1,000 in some areas. Thomas Schlenker, director of public health for Dane County, said that the decrease accompanied larger declines in the numbers of very premature and underweight births for blacks.

Philip Farrell, a professor of pediatrics and former dean of the University of Wisconsin School of Medicine and Public Health, said, "This kind of dramatic elimination of the black-white gap in a short period has never been seen," adding that no significant changes have occurred in the capabilities of prenatal care or medical technology. Experts hope that figuring out what led to the declines in Dane County would allow other cities and counties to replicate the improvements.

Health officials say that without a simple medical explanation for the decrease, the most likely theory is one that links infant mortality to the well-being of mothers from the time they were in the womb themselves. This theory factors in women's physical and mental health, personal behaviors, exposure to stresses such as racism and social ties. Such factors could affect how well young women take care of themselves and manage their pregnancies. Karen Timberlake, Wisconsin secretary of health services, said that the likely explanation for the decline is in "the interaction among a variety of interrelated factors."

According to the Times, pinpointing how public and private services in the county might have changed over the decade is a substantial challenge. Schlenker said, "I think it's a community effect," adding, "Pregnant women need to feel safe, cared for and valued. I believe that when they don't, that contributes to premature birth and fetal loss in the sixth or seventh month." He said services such as ABC for Health, a law center, have connected low-income women with insurance and medical services. He added that local HMOs have became more assertive at promoting the health of prospective mothers.

Other programs could also play a role, the Times reports. A federally supported clinic serving the uninsured, Access Community Health Center, has cared for an increasing number of women using nurse-midwives in the county. Over the years, health programs in the country have sent more nurses to visit low-income women at high risk of having premature births and dispatched social workers to more homes. In addition, community leaders in the county started keeping a closer watch on young pregnant women after being shocked by high mortality rates (Eckholm, New York Times, 11/27).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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