Infant Mortality n Infant mortality is an internationally

Infant Mortality n Infant mortality is an internationally recognized measure of a society’s ability to provide food, housing, income, education, employment and health care to its citizens

Infant Mortality n n n Multiple causes of infant mortality Preterm birth is the most frequent cause of infant death in the US, accounting for approximately 1/3 of all infant deaths Declines in infant mortality in the U. S. have been due to improved survival of small or premature infants, rather than due to decreases in the rates of low birthweight and prematurity

Infant Mortality n n Because of the increasing ability to keep very small infants alive in the US, low birthweight and prematurity have replaced infant mortality as measures of our society’s ability to take care of its most vulnerable populations This is why so much of our focus on infant mortality solutions is on solutions for the problems of low birthweight and prematurity

Infant Mortality n In general, higher Black infant mortality rates are not only due to the larger number of black infants born at low birthweight, but to the higher rates of death among Black term normal birthweight infants

Infant Mortality Rates, 2004 -2008 State/County City Dane Madison Kenosha City Milwaukee City Racine City Rock Beloit Wisconsin White Black Hispanic 4. 1 4. 8 4. 3 5. 7 6. 6 6. 5 6. 0 7. 5 8. 9 15. 1 14. 7 16. 0 22. 9 22. 3 5. 5 5. 2 4. 6 5. 0 7. 1 6. 8 10. 1 8. 6 5. 1 7. 5 5. 2 17. 7 16. 8 15. 9 4. 5 4. 6 6. 3 WISH (Wisconsin Interactive Statistics on Health)

Fetal Mortality: Another Important Indicator n n n Because the death of a fetus prior to birth is a more “invisible” event, fetal mortality gets little attention from policy-makers in comparison to infant mortality Many of the risk factors for fetal death are the same as those for infant death Measuring feto-infant mortality provides a much measure better of perinatal health than IM alone

Maternal Mortality Given current medical knowledge and technology, all maternal deaths in the U. S. are markers for a system gone awry n However, a maternal death does not carry the same political weight as an infant death n

Maternal Mortality n n Maternal deaths are just the “tip of the iceberg” ¨ Many more women are unhealthy during pregnancy, only a few die Most factors contributing to maternal morbidity and mortality also affect the well-being and survival of fetuses/infants

Risk Factors for Fetal/Infant/Maternal Mortality Risk Factor Fetal Mortality Infant Mortality Maternal Mortality Low-Income X X X Low Education X X X Very Low and High Maternal Age X X X Low and High Parity X X X Short interpregnancy Interval X X X Inadequate Prenatal Care X X X

Risk Factors for Fetal/Infant/Maternal Mortality Risk Factor Fetal Mortality Infant Mortality Maternal Diseases During Pregnancy X X X Smoking X X Indirect Substance Use X X X Depression X X X Prior Adverse Pregnancy Outcome X X X Trauma X X X

9 Ways to Reduce Infant Mortality ¨ ¨ ¨ 1. Ensure pregnant women have access to and receive adequate prenatal care. (15% in 2008) 2. Reduce the number of teen pregnancies. 3. Reduce the number of pre-term babies(<37 weeks gestation) by n a. Reducing the number of women using drugs and alcohol during pregnancy n b. Reducing the number of women who smoke during pregnancy n c. Increase the amount of folic acid a woman gets before and during pregnancy n d. Increase the number of women that maintain a healthy weight during pregnancy n e. Increase the number of women that choose natural child birth, by reducing planned c-sections or medically induced labors.

9 Ways to Reduce Infant Mortality ¨ 4. Increase the number of mothers that breastfeed their infants. ¨ 5. Decrease infant exposure to secondhand smoke and other risk factors for Sudden Infant Death Syndrome ¨ 6. Encourage “back to sleep” programs that highlight the importance of putting babies to sleep on their backs. ¨ 7. Teach parents the dangers of “shaken baby syndrome” and offer skills to cope with stressful situations. ¨ 8. Teach parents how to correctly install and use infant car seats and reduce other safety hazards. ¨ 9. Increase the number of women that graduate high school. Higher levels of education are linked to better infant care.

Strategies for Preventing Infant/Fetal/Maternal Mortality n Public Health/Clinical Strategies to prevent high-risk pregnancies: ¨ Comprehensive Sexual Health Education ¨ Preconceptional care/interconceptional care/well-women care ¨ Family Planning ¨ Genetic Counseling ¨ Prepregnancy nutrition ¨ Adolescent Pregnancy Prevention Programs

Strategies for Preventing Infant/Fetal/Maternal Mortality n Public Health/Clinical Strategies to prevent morbid events during pregnancy, maternal death, fetal death and LBW and preterm birth: ¨ Prenatal care/risk assessment n Physical health and psychosocial assessments to determine risk factors

Strategies for Preventing Infant/Fetal/Maternal Mortality ¨ Prenatal n n n Care (cont’d) Psychosocial interventions including smoking cessation, substance abuse reduction, depression screening and treatment Health education and promotion Screening for variety of medical risks (e. g. , hypertension, diabetes, STDS, HIV) and management of high-risk pregnancies

Strategies for Preventing Infant/Fetal/Maternal Mortality ¨ Family case-management of high risk women n Provision of social support n Prenatal home visiting (public health nurses, lay health workers, social workers) ¨ Mass media/health education campaigns

Strategies for Preventing Infant/Fetal/Maternal Mortality Public Health/Clinical Strategies to reduce post neonatal mortality: ¨ SIDS Initiatives (Back to sleep campaign) ¨ Access to well-child care and immunizations ¨ Postnatal home visiting/Social support ¨ Breastfeeding support and education ¨ 0 -3 Programs/Developmental Follow-up Programs ¨ Nutritional supplementation: WIC program ¨ Safe and adequate housing (public health has some role but not much control)

Strategies for Preventing Infant/Fetal/Maternal Mortality n Health of women independent of pregnancy: ¨ Intersection of chronic illness and maternal health (e. g. , diabetes, hypertension, bacterial vaginosis) ¨ Financial support for health care independent of pregnancy n Women’s ability to control their reproduction (access to family planning)

What else needs attention? n n n Community infrastructure - available to provide the basic supports necessary for healthy lives (e. g. , housing, safety, food security, employment) Environmental conditions: residential segregation, inadequate housing, community violence, environmental contaminants, options for healthy food purchases The extent to which poverty and racism are pervasive and are the overriding issues affecting health and well -being in many communities

Involvement of Fathers n n Studies have shown fathers who are active in their children's upbringing can significantly benefit their children's early development, academic achievement and well being. New study by University of South Florida researchers suggests that a father's involvement before his child is born may play an important role in preventing death during the first year of life -- particularly if the infant is black.

Involvement of Fathers n Among the study's findings: ¨ Infants with absent fathers: n n n ¨ Mothers with absent fathers: n n n were more likely to be born with lower birth weights, to be preterm and small for gestational age. Regardless of race or ethnicity, the neonatal death rate was nearly four times that of their counterparts with involved fathers. The risk of poor birth outcomes was highest for infants born to black women whose babies' fathers were absent. (7 times more likely to die) Obstetric complications contributing to premature births, such as anemia, chronic high blood pressure, eclampsia and placental abruption, were more prevalent Tended to be younger, less educated, more likely to never have given birth, more likely to be black, and had a higher percentage of risk factors like smoking and inadequate prenatal care than mothers in the father-involved group. “When fathers are involved, children thrive in school and in their development. So, it should be no surprise that when fathers are present in the lives of pregnant mothers, babies fare much better. “ Dr. Alio

Rock County Resources n n n n Prenatal Care Coordination AAIMC/Pathways Initiative WIC FCWHC Child Death Review Team (CDRT) Hospital Programs Rock County Health Department Healthy Families First

David Olds Study http: //www. rwjf. org/files/publications/other/David. Olds. Special. Report 0 606. pdf ¨ Elmira New York study ¨ n White, rural, and impoverished ¨ ¨ ¨ Unvisited moms-abuse/neglect 19% Visited mom -4% Nurse visited moms smoked 25% fewer cigarettes Nurse visited moms who smoked had 75% fewer preterm births 56 percent fewer doctor and hospital visits due to childhood injuries through child age 2. 69 percent fewer convictions of nurse-visited children at age 15

David Olds Study (continued) ¨ Memphis, TN n African-American, inner city, low income ¨ ¨ ¨ Nurse visited as 23 % fewer hypertensive disorders in pregnancy 80 % fewer hospitalization days for injuries 23 % fewer pregnancies by 2 nd birthday of infant ¨ Denver, CO n White, African American and Hispanic n Nurse visited vs. paraprofessional ¨ ¨ Nurse visited mothers more likely to enter workforce Fewer pregnancies by 2 nd birthday Children born to more psychologically vulnerable mothers had been language development and ability to control their behavior No difference in paraprofessional visited mothers than the control

Rock County Resources n Prenatal visits ¨ ¨ ¨ ¨ Nurses attempt to visit every 3 weeks prenatally Access to care Access to available community resources Nutrition education Quit Line Alcohol education Support breastfeeding Resource for questions n Postnatal/infant health visits ¨ ¨ ¨ ¨ Every 2 weeks for 2 months then monthly Baby metrics Infant health information Safe sleep practices Immunizations Medical care Growth and Development

Wrap up n Awareness of available services n Medicaid - Increase service coordination, systems integration, i. e. policies, waivers, discretion ¨ Increase eligibility for higher income but still relatively low income women

Wrap Up n n n Commit to stabilizing funding for valuable health programs; ensure access to comprehensive health care services for women, children, fathers and families across the life course, i. e. visiting nurses, PNCC, reproductive health Funding ¨ MCH funding from the Block Grant Dollars n $69, 000. 00 ¨Does not pay for 1 FTE PHN Incentives for African American nurses to practice in areas of high infant mortality

Thank you! Karen Cain R. N. , M. S. Health Officer/Director Rock County Health Department