CHARLESTON, W.Va. (WV News) — In the United States, two babies die every hour before reaching their first birthday in what one advocacy specialist calls a crisis that has gone unnoticed by many.
The United States’ infant mortality rate is higher than many other developed nations, according to the United Health Foundation, and West Virginia’s infant death rate exceeds the national average.
Although overall rates have improved in recent decades, “we are still facing a large crisis when it comes to infant health,” said Dr. Jordana Frost, director of strategic programs for March of Dimes.
Alarming racial disparities in infant mortality are also apparent in data. In the period from 2015 through 2017, Black babies were nearly two times more likely than White babies to die within their first year of life in West Virginia, according to Dr. Lauri Andress, West Virginia University assistant professor in the Department of Health Policy, Management, and Leadership.
The causes of infant mortality and disparities in rates are complex.
Preterm births and low birthweight are the leading risk factors and causes of infant death, according to Jessica Holstein, assistant director of communications for the West Virginia Department of Health and Human Resources.
Smoking is a leading cause of preterm births, and West Virginia has the highest smoking rate in the nation. Therefore, smoking cessation programs have been a major focus for efforts aimed at preventing infant mortality, according to Amy Tolliver, director of the West Virginia Perinatal Partnership.
Efforts have also focused on education on co-sleeping.
“Sudden Unexplained Infant Death (SUID) is the leading preventable cause of death among infants. Co-sleeping and/or hazardous sleep environments are known risk factors for White and Black SUID,” Holstein said.
Health care providers have also been improving access to maternal care. Of the 20 counties with the highest infant mortality rates in the state, many are in counties deemed to be maternity care deserts, according to Frost.
“Progress has been made in lowering the mortality rates of these at-risk infants,” Holstein said.
According to federal Centers for Disease Control and Prevention data, West Virginia’s infant mortality rate has gone from 8.16 per 1,000 births and the ninth worst among U.S. states, to 6.31 per 1,000 births and 16th worst in the nation in 2019.
Despite improvements in the state and across the nation, however, Andress argues efforts to date have been inadequate to address infant mortality and socioeconomic and racial disparities in those rates.
“When you dig a little bit deeper, you see the same kinds of disturbing trends that we’ve seen in the United States for the last 30-some odd years with subpopulations,” said Andress, who is currently researching how poverty and racism affect infant mortality in the state.
According to Andress, the greater the access a population has to resources and opportunities, the less likely that population is to have high infant mortality rates.
“We’ve increased access to prenatal care, we’ve come up with these clinical solutions, but we still have these same death rates for infants, the difference between Black women and women. Prenatal care is clearly not the solution to the gap in the infant death rates between U.S.-born Black women and White women,” she said.
While data shows more education and higher income typically protect an individual from poor health outcomes, this is not true for Black women in terms of infant mortality.
“In fact, you can have a higher level of education, you can have a fairly high degree of income, and we still have this high infant death rate for Black women. We’ve been working very diligently for I’d say about 10 or 12 years to try to figure out why that would be so,” she said.
Andress argues that an answer can be found in trauma experienced by moms related to poverty and racism.
“This is also being looked at in other places, in other medical centers and schools of public health, and essentially the theory is that the level of trauma experienced by women over time, over generations, 24 hours a day 7 days a week has shaped their reproductive system, making it weaker and less likely to produce healthy infants. So trauma, as defined in West Virginia, is both poverty and racism,” she said.
In West Virginia, entrenched poverty has caused White women to experience higher infant mortality rates than in other states.
“I think that until West Virginia radically addresses issues of poverty in that state, White women will continue to have higher infant death rates than White women in other parts of the United States. Black women in West Virginia who experience both poverty and racism, they would benefit from efforts to eradicate poverty in West Virginia, but until we address racism in the United States, that will continue to be a problem for Black women and infants in maternal health in the United States,” she said.
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