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Hillsborough Must Confront Tragic Realities of Infant Mortality

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The Tampa Tribune

Published: June 22, 2008

A year ago local health professionals began probing Hillsborough County's disturbingly high infant mortality rate. They now have some answers to why so many babies are dying.

The bigger question remains. Will this community mobilize to do something about these deaths?

Babies in Hillsborough County die before their first birthdays at a higher rate than the state or national average. That alone would be alarming, but it's compounded by striking racial disparities.

A black infant born in this county is three times more likely than a white infant to die, and the rate in which black babies have been dying is higher now than it was 10 years ago.

The matter is of such a concern that last year lawmakers appropriated $1 million for local health groups in Hillsborough and eight other counties to begin investigating why these disparities persist even as Florida has made concerted efforts to reach pregnant women at risk of losing their babies.

This project, called the Black Infant Health Practice Initiative and led by the Healthy Start Coalition of Hillsborough County, is now coming to fruition. Its findings should serve as a wake-up call.

Consider:

•In perhaps their starkest discovery, researchers say that from 2003-2005, 109 black infants died who might have lived if Hillsborough had made progress in recent decades in eliminating racial disparities. These babies represent the infants who could be saved if the community committed itself to addressing the conditions that lead to infant mortality.

•The beliefs that higher infant mortality rates are caused by teen pregnancy, alcohol and drug abuse and babies being dumped in trash cans are not true.

The data shows that women 20 to 34 years old represent most of the mothers losing babies. The most common reason: The babies are born small - often no more than one pound - and premature - less than 23 weeks of a normal 40-week gestation.

•Mothers who suffer from health conditions such as high blood pressure, diabetes and obesity account for more than two-thirds of those whose babies died. That casts the infant mortality discussion into the larger issue of women's access to the basic health care.

• Stress - brought on by a tough economy, detached communities and perhaps even embedded racial attitudes these women encounter in their daily lives - probably affects the health of pregnant women, and thus their babies.

Progress Lost

At one time, Florida was making great strides in saving infant lives.

In 1975, the state infant mortality rate for black infants was more than 25 per 1,000. Now, the statewide rate has averaged 13.2 per 1,000 over the past three years; in Hillsborough County it is 18.4 per 1,000. In actual numbers, that translates to the loss of about 59 babies per year - more than one a week.

By comparison, the mortality rate for Hillsborough's white infants is six per thousand.

Researchers, though, point to this disturbing fact: While the mortality rate is down significantly from a generation ago, the disparity between black and white infants is actually wider than it was 30 years ago.

Researchers consider babies who die before their first birthdays the canaries in the public health coal mine. When babies die in inordinate numbers, it means there is something systemically wrong in a community.

Can't Dismiss Racial Issues

It's not as simple as talking about health care or poverty - although that must be part of the discussion.

The problem runs much deeper, as illustrated by this startling finding: A baby born to a black mother with a graduate-level college education is still more likely to die before his or her first birthday than a white baby born to a high school dropout.

"There is something about growing up as a black female in the United States that's not good for your childbearing health. I don't know how else to summarize it," Chicago neonatologist Richard Davis recently said in the PBS documentary, "Unnatural Causes ... Is Inequality Making Us Sick."

A series of focus groups sessions conducted by the Hillsborough initiative gave women a chance to tell their stories. Common threads of frustrating encounters with the health care system, gaps in their own family support networks and problems in employment and housing emerged.

For the very poor, the barriers to care are compounded by a Medicaid program that only enrolls women once they become pregnant, and then drops them six weeks after they give birth.

One black woman recounted the indifference she encountered when she visited a doctor's office, fearing she was going to have a miscarriage. She did while using the office's bathroom. A nurse coolly told her she had just flushed the baby down the toilet, adding "that's nature's way of dealing with a bad pregnancy."

They never said, "I'm sorry," or acknowledged her emotional loss.

Drawing On Resources

The initiative found some untapped resources, such as local churches and compassionate older women who are willing to provide aid for women before and after their pregnancies. Such community resources must be enlisted in the effort to save more infants.

Still hard truths need to be confronted. We know, unequivocably, that unplanned pregnancies spaced too close together, poor diet, a lack of exercise and substandard housing all contribute to babies dying. Nearly one-third of the women who lost their babies smoked during their pregnancy.

There are plenty of government and nonprofit agencies that deal with such issues, but this problem goes beyond a government solution. It needs the work of churches, social organizations and families to create a network of care and support more comprehensive than any single government program.

It is Hillsborough's challenge now to confront the tragic numbers and start finding solutions. With scores of babies dying unnecessarily each year, it is a challenge we must not ignore.

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