Healthy Babies: Tracking Progress Across the Nation

Sep 19, 2013, 1:24 PM

A woman holds her baby.

Every baby should have a chance to celebrate a healthy, happy first birthday. Unfortunately, that is not always the case. And that risk disproportionately affects people with lower income and people of color. This Infant Mortality Awareness Month, we can celebrate some progress in helping more babies reach that first milestone, according to health officials who shared successes at the Association of State and Territorial Health Officials (ASTHO) Annual Meeting in Orlando, Fla., this week.

>>Follow our ASTHO Annual Meeting coverage throughout the week.

file David Lakey, MD, Commissioner of the Texas Department of State Health Services

“We are collectively moving forward in improving birth outcomes across the nation,” said David Lakey, MD, Commissioner of the Texas Department of State Health Services and former ASTHO president, who took on healthier babies as his President’s Challenge during his tenure. Lakey set out a goal of an 8 percent reduction in premature births by 2014.

“There is a high human cost of prematurity,” said Lakey, and that cost includes low birth weight, increased morbidity and mortality, and an impact on standardized test scores and other outcomes later in life for those who do survive. “Those who are born early have a much lower chance of having a healthy, happy first birthday.”

There is also an economic and societal cost of premature birth, the cost of which is largely paid for by Medicaid. Lakey said that 57 percent of all Texas births are paid for by Medicaid. Extreme preterm birth costs an average of $71,000—while a full-term birth costs an average of $420.

The good news is “there are very concrete things we can implement to make a difference,” said Lakey, including improving the health of the mom before she gets pregnant and reducing early elective deliveries. All 50 states, Washington D.C. and Puerto Rico have taken the pledge to meet the goal of reducing premature births by 8 percent by 2014, with support from a wide array of critical partners, including the March of Dimes.

As a result of that commitment, the nation as a whole has seen a reduction in premature births from 12.2 per 1,000 births to 11.5. Infant mortality has gone from 6.69 per 1,000 births in 2006 down to 6.05 per 1,000 births in 2012.

>>Learn more about the Healthy Babies initiative from ASTHO.

At the ASTHO meeting, several state health officers shared how they have made significant progress to improve the chances for healthy babies in their states.

file David Lakey, MD, Brenda Fitzgerald, MD, and Edward Ehlinger, MD, MSPH

“We had a real problem,” said Brenda Fitzgerald, MD, Commissioner of the Georgia Department of Public Health. The infant mortality rate in Georgia was 8.4 per 1,000 live births, 20 percent above the national average. “We were losing three babies each day.”

Fitzgerald and her colleagues started by looking at the data, mile by mile across the state, to reveal where the most critical issues resided.

Data was a common theme.

“We don’t gather data so we can be health historians—we gather data so we can drive quality improvement,” said Lakey.

In Georgia, the local data showed that one particular city, Valdosta, had an infant mortality rate of 17.4, as opposed to the state average of 8.4. This was an extreme example, but this was just one of many at-risk areas. Critically, the at-risk areas often overlapped with the one-third of Georgia counties that had no obstetric services available at all, as well as the 19 more that had fewer practices than were needed.

Using the data to inform targeted action, Fitzgerald led an effort to decrease prematurity rates once it was revealed that it was “THE indicator we can do something about in Georgia” to decrease infant mortality rates.

The plan to tackle prematurity included a strengthened perinatal system, a network of telemedicine OB/GYN services to support underserved areas, an education campaign around elective early deliveries, and strong partners across sector to help implement and publicize a variety of programs. Breastfeeding, appropriate vaccinations, smoking cessation and safe sleep education were also wrapped into these plans.

One of the most innovative components of the plan included targeted community interventions in high-risk areas with grant-funded Centering Pregnancy programs that include hour-long group prenatal visits that actual occur in the health department itself.

The result? Overall infant mortality in Georgia declined from 8.4 per 1,000 in 2006 to 6.8 percent in 2011—“that’s 1,000 Georgia babies [saved] per year,” said Fitzgerald. In Valdosta, they went from 20 percent of deliveries being premature to just 5 percent premature.

“What we do is important,” said Fitzgerald to the crowd of health officials. “Start with data, share the data, bring the coalitions together and change is made.”

Edward Ehlinger, MD, MSPH Edward Ehlinger, MD, MSPH

Edward Ehlinger, MD, MSPH, Commissioner of the Minnesota Department of Health, underscored that ensuring healthy babies is about more than just health care.

“If we reduce disparities in infant mortality it will not be because of better medical care. It will be because we reduce inequities in social determinants of health,” said Ehlinger.

The data in Minnesota uncovered startling excess infant mortality for babies born to black women in the state, mostly concentrated in urban areas.

Ehlinger’s analysis showed that the highest impact and most feasible changes included improving preconception care, preventing SIDS and—critically—improving the social determinants such as education, income and housing. He said the last point often surprises people who see social determinants as intractable, but he emphasized that there are changes we can effect and that they will have enormous impacts.

“When we’re working on social determinants, we’re working on the preconception period of all women of childbearing years,” said Maxine Hayes, State Health Officer for the Washington State Department of Health, who received a standing ovation from the room for her long-term efforts to improve birth outcomes for African-American women.

Hayes referenced the Healthy Start collaboratives, funded for the last 20 years, that aim to ensure every child receives the physical, emotional and intellectual support that he or she needs—in school, at home and in the community—to learn well.

“If we don’t get it right in the beginning of a child’s life, we’re not going to get it right,” said Hayes.

This commentary originally appeared on the RWJF New Public Health blog.