Forum tackles local, national infant mortality issue

“This isn’t an easy topic,” admitted Marcy Paul, chair of the Fort Worth Commission for Women.

Paul was speaking to an audience of about 200 people, mostly women, at the Synergy 2009 Infant Mortality Forum. While it’s long been known by health professionals and other women’s issues leaders in Fort Worth that Tarrant County has high rates of infant mortality, the recent forum was focused not just on the health of mothers but on women in general.

The Sept. 24 forum featured a panel of speakers who have studied Tarrant County and the city as well as those who have been involved in initiatives to try to promote healthy birth outcomes. Kathryn Cardarelli, director of the Center for Community Health at the UNT Health Science Center, has studied infant mortality for several years and showed data about local rates as well as national rates.

Internationally, the United States has a higher infant mortality rate (the number of infant deaths within the first year after birth per 1,000 live births) than Cuba, Hungary and Israel, Cardarelli said, and the rate is commonly used as an indicator of the health of a nation.

What is troubling, though, she said, is that the number of babies with low birthweight also is rising, and low birthweight puts a baby at a higher risk for infant mortality.

According to 2005 data, American whites have an infant mortality of 5.7 and blacks have a rate of 13.7. In Tarrant County, for the same year, the white rate is 6 and the black rate is 19.5. Unfortunately, there is no definite reason why the disparities are so pronounced, Cardarelli said; even the most well-educated black women have higher rates of infant mortality than the most uneducated white women. Researchers are still trying to untangle the factors that contribute to the disparities.

“There’s a lot that we know we don’t know, but what we can do as scientists is rule out other explanations,” Cardarelli said.

What is definite, though, is that preconception care — making sure a woman has a healthy weight and diet, can plan her pregnancies, and has diseases like diabetes well-managed — needs to be part of routine health care for women, she said. Thinking about the health of infants has to start before a woman even becomes pregnant.

“What I’m talking about really is a paradigm shift,” she said.

Dr. Josephine Fowler, vice president of academic affairs with the JPS Health Network, also pointed to other minorities and subpopulations within minorities. Puerto Rican infants, for example, have 1.4 times the infant mortality of non-Hispanic white babies and are twice as likely to die from issues related to low birth weight.

Mexican immigrant women, though, have about a 10 percent lower infant mortality rate than non-Hispanic whites, Fowler said. These good birth outcomes seem to even out a bit after women become more acculturated to the U.S. though, because U.S.-born Mexican-American women’s infant mortality rates are about equal to non-Hispanic whites. Health professionals should be trying to learn from populations with good outcomes, Fowler said, and perhaps encouraging women to hold on to characteristics that give them an advantage.

“Shouldn’t we all be learning from each other instead of swaying each other in different ways?” Fowler asked.

Kim Parish Perkins, executive director of the Fort Worth/Dallas Birthing Project, oversees two programs focused on supporting women through pregnancies in order to have better birth outcomes. The Aintie-Tia program matches a certified doula, or non-medical birth assistant, with women 18 and older who are at risk for higher rates of infant mortality. The SisterFriend program pairs volunteers with pregnant women and teenagers to provide social support.

“You want to start curing infant mortality, you start curing your community,” Parish Perkins said.

Women, and particularly minority women and black women, are often dealing with stresses that aren’t directly related to their pregnancy but can still impact the outcome, she said. Rosalyn MacKey, a SisterFriend volunteer, lost her first baby to sudden infant death syndrome when she was younger, and said it wasn’t until much later that she recognized what may have contributed to her personal tragedy. Her mother had cancer when she was pregnant, and her father was dealing with a dying wife, and MacKey was also supporting the children of relatives. The stresses of her situation had an impact, she said.

“Here we are 27 years later, still trying to figure it out,” she said.

Cardarelli said the most important thing to help infant mortality rates is to get women healthy before they get pregnant. She pointed out the Texas Women’s Health Program, through the Texas Health and Human Services Commission, which provides free women’s health services –

including routine gynecological care and health screenings as well as birth control – for women who do not have private insurance or Medicaid that pays for family planning. While some area health professionals do not accept the program – the JPS Health Network doesn’t accept it – more physicians and administrators need to be aware of the program and similar women’s health programs and support them in order to support women and health infants, she said.