State makes strides on infant mortality

But data shows racial differences persist

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WILMINGTON — While Delaware’s infant mortality rates have dropped steadily in the past 20 years, differences in decreases remain.

The Black infant mortality rate (children per 1,000 who die before their first birthdays, according to the Delaware Health Statistics Center) remains two to three times higher than non-Hispanic White babies in what Dr. Meena Ramakrishnan called a “disparity gap.”

Dr. Ramakrishnan, an epidemiologist and member of the Child Death Review Commission, shared data last week during a Kids Count in Delaware Timeline Tuesdays webinar. The event was hosted by the University of Delaware’s Biden School of Public Policy & Administration, which partnered with Highmark Blue Cross Blue Shield Delaware.

Gigantic strides were made in Delaware last year, considering the First State led the nation in infant mortality in 2001, according to Dr. Ramakrishnan. A series of measures began to mitigate the troubling trend, and the rates were dropping significantly by 2009. In 2018, Delaware’s rate of 5.8 fell to right around the national average of 5.67.

From 2014-18, the city of Wilmington had a rate of 14.5 infant deaths, while New Castle County was 7.8. Sussex and Kent counties registered rates of 6.5 and 6.4, respectively.

The disparity between race/ethnicity was pronounced during the same period — 12.2 for non-Hispanic Black infants, 8.4 for Hispanic and 4.5 for non-Hispanic White babies.

In addition, according to statistics cited by Dr. Ramakrishnan, the preterm birth rate among Black women is 51% higher than all other women in Delaware from 2016-18.

The Centers for Disease Control and Prevention notes that factors pushing preterm birth rates upward include, among others, teens and women over age 35, Black race, women with low income, tobacco and substance use, stress and prior preterm birth(s). Higher preterm birth rates correlated with pushing infant mortality upward, according to Dr. Ramakrishnan.

Prevention strategies include, among others, identifying women at risk for preterm birth, ensuring access to health care before and between pregnancies, providing access to family planning and education on birth spacing.

A disparity in neonatal deaths (0 to 28 days upon birth) persists among Black and White infants from 2014-18, sitting at just under 4% for White infants compared to just over 8% for Black infants, according to DHSC data. The post-neonatal mortality rate gap has grown even more, according to data.

Dr. David Paul, chairman of the Delaware Healthy Mother and Infant Consortium, described infant mortality as a “biosensor for what’s going on in the community, so that if one community, one state, one country has a high infant mortality rate, it’s reflective of the total health of that community.

“When I look at the data ... a few things jump out at me, (including) the high or increasing post-neonatal mortality rate in the Black population. ... That’s something that we really need to take a deeper dive into.”

As a Black woman and mother, Wilmington native Shane’ Darby said after analyzing the numbers, “I cannot master’s degree my way out of it. I cannot celebrity my way out of it.

“It’s kind of like these statistics stick, ... as a Black woman no matter what kind of educational level you’re on, what socioeconomic status you are, so it’s really kind of disheartening, these statistics. You just can’t escape them ... where we are now.”

During the webinar, Ms. Darby said, “It’s unfortunate because we have a lot of people in the Black community who don’t even know this information. So that’s one key for me — how can I help build awareness throughout the Black community, the Black woman, the Black man, other Black people who support families? How do we build this? How do we make people aware of this in Delaware?”

There’s a multitude of potential causes and solutions that must be considered, Ms. Darby said.

“My second (thought on the data) is, how do we develop programming to reduce some of these disparities? Are we looking at ... programs or implicit racism by health care providers? Are we looking at workshops and educational programs for women about the whole reproductive process and journey?”

Mini-grants awarded

Help is on the way to reduce the disparity gap in birth outcomes, thanks to $141,500 in mini-grants announced by the state of Delaware. The Delaware Division of Public Health and the DHMIC awarded the money.

The grantees — who will be honored during the consortium’s quarterly meeting March 3 — are the Parent Information Center of Delaware, the Rose Hill Community Center, the Metropolitan Wilmington Urban League and the Breastfeeding Coalition of Delaware.

All four grantees are dedicated to supporting the shared initiatives of DPH and DHMIC to:

  • Narrow the wide variance in poor birth outcomes between Black women and White women.
  • Build state and local capacity and test small-scale innovative strategies.
  • Improve public and professional awareness of the issues related to improving maternal health outcomes before, during and after pregnancies, especially for women of color.

“Every Delawarean has a role to play in decreasing the Black infant and maternal mortality rate, and our community knows best how to connect with and empower women to be healthy to improve outcomes for moms and babies,” said Dr. Paul.

“The consortium has undertaken an aggressive initiative to examine the social determinants of health by taking a life-course approach to both understanding and addressing the disparities that have led to the rise in Black maternal and infant mortality in Delaware,” he added.

DPH and DHMIC assessed each candidate’s program based on a number of criteria, all of which needed to support results-driven strategies and implementation in at least one of five priority areas. High-risk infant and maternal mortality zones established by DPH’s Healthy Women, Healthy Babies program also were considered. HWHB’s five priority areas are social networking for empowerment; father/partner involvement and engagement; toxic stress/adverse childhood experiences; financial empowerment/self-sufficiency; and housing.

“It’s time to give Black and Brown women and expectant mothers of Delaware a voice in deciding what is best for them by working alongside the health care community. This is a movement whose time has come,” Tiffany Chalk, DHMIC’s Well Woman/Black Maternal Health Group leader said.

“Our mission is to share Black and Brown women’s health care experiences as a mechanism to inspire change and close the disparities gap. With DHMIC’s support, we will collaborate with community partners and leverage the needed resources to sustain our efforts. Silence is no longer an option. As the collective voices of Black and Brown women grow stronger, so does our opportunity to bring about permanent change.”