A Public Health Perspective: Prevention and treatment key elements to reduce infant mortality rates

									Sarah Howard |
																			December 21, 2015

A report by the Centers for Disease Control and Prevention (CDC) found infant mortality rates in the U.S. declined 2.3 percent between 2013 and 2014, reaching a new low of 582.1 infant deaths per 100,000 live births (about 22,000 deaths a year).

In a recent New York Times article, CDC demographer T.J. Mathews said, “This is potentially the best news we’ve had yet.”

Despite the drop in rate, the U.S. has a higher infant mortality rate than many Western or developed countries.

The University of Minnesota Academic Health Center’s Health Talk spoke with Wendy Hellerstedt, Ph.D., M.P.H., associate professor of epidemiology and community health in the School of Public Health to better understand infant mortality and what can be done to help decrease infant mortality in the U.S.

Health Talk (HT): What does “infant mortality rate” mean?

Wendy Hellerstedt
Associate professor Wendy Hellerstedt

Wendy Hellerstedt (WH): The infant mortality rate is the number of deaths to liveborns within the first 365 days of life. It is a “tip of the iceberg” measure: if we see reductions in mortality, we may also be seeing reductions in morbidity (i.e., there are fewer severely ill infants).

HT: What are some of the reasons infants die?

WH: Around the world, infant death disproportionately affects marginalized and economically vulnerable populations. Infants die because many health conditions that are related to genetic predispositions, maternal characteristics or behaviors and/or the postpartum home or medical environments. Preventing high-risk births, treating high-risk infants, and keeping infants healthy are all important to infant survival. For example, the leading cause of infant death in the U.S. is congenital anomalies (birth defects). There are hundreds of birth defects, many of which have multiple or unclear etiologies, making it difficult to prevent many of them. As interventions improve, including everything from screening to neonate surgeries, we are better able to treat some of them.

The second leading cause of infant death is low birthweight, also a complex outcome with many etiologies. We have had some success in preventing low birthweight (through prenatal smoking cessation, for example) and some success in treating too-small infants. In 2014, we saw a decrease in deaths due to respiratory distress, a condition that is strongly associated with being born too early and a condition that can be treated, so we may have seen success in both prevention and treatment for that single cause of death.

HT: Why have we seen a decrease in infant deaths?

WH: This may be both a public health (prevention) and a medical (treatment) success. It may also be a public policy success, related to many publicly funded initiatives and the Affordable Care Act (ACA). There are several situations that threaten infant health: unintended pregnancy; poor prenatal health or health services; and, for infants, poor health, inadequate health care, and/or unstable environment. Prevention and treatment, through programs and policies can address these situations by providing contraceptive, prenatal, postpartum, parenting, and home services and programs.

HT: What are some public health approaches to improve infant survival?

WH: We think about optimizing infant health prior to conception through reproductive life planning and contraceptive services: we know how to prevent unwanted or unintended pregnancies and we know that women with such pregnancies are at highest risk for poor outcomes. We need to make sure that pregnant women have early access to prenatal care to assess and treat medical conditions that could compromise maternal or fetal health. We need to think about birthing care: we have seen a small reduction in cesarean sections and early induced deliveries, both of which are related to the birth of too-small and/or too-early babies. Finally, infants need good health care and supportive environments to thrive (and survive), so we need to reach out to parents with programs and education. The ACA mandates that maternal and infant preventive health services—and contraceptive services— be considered essential health benefits and thus be available to insured individuals without out-of-pocket costs. So we also need to enable families to get insurance coverage.

HT: Compared to other Western and developed countries, why does the U.S. have a higher infant mortality rate?

WH: Some data suggests that our higher rate may be explained — in part — by how we count deaths. Infant mortality is specifically counted among liveborns. Liveborns are defined as “viable” (i.e., have the potential for life). There may be variability in the definition of “viability.” It is possible, in some countries, that very early deaths are counted as fetal (i.e., never viable) deaths where the U.S. with a liberal definition of viability, would count them as infant deaths. In addition to differences in definitions, there are also social and cultural differences among countries. An important contributor to infant death universally is economic disadvantage—some Western countries have fewer disadvantaged people than we do. Also infant survival is associated with the availability publicly supported reproductive life planning, prenatal, and postnatal services to economically vulnerable people. Again, some Western countries do a better job of that.

HT: What can we do to further decrease infant mortality rates?

WH: Public commitment and funding have made a difference in the U.S: we have seen infant mortality drop by 90 percent since 1935, primarily because of public policies and programs, like Medicaid, Title X Family Planning and Healthy Start. Most recently, the ACA may have had an impact. We need to keep advocating for these initiatives because our funding levels have never matched our need. We also need to keep promoting low-tech preventive solutions like breastfeeding, family planning, immunization, smoking cessation and safe sleep education (i.e., put babies on their backs). Because some solutions, like family planning, are under constant political attack, we need to present evidence-based arguments to counter political agendas. One way to do that is to help people understand long-term consequences of services like family planning: planned pregnancies are the healthiest pregnancies. –This post originally appeared on the Academic Health Center’s HealthTalk blog

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