Monday, August 17, 2009

Tarrant County’s tragic record of infant mortality


Infant mortality is often used to compare the health and well-being of nations, as well as population groups within nations. On this measure — defined as babies who die before their first birthday — our nation, state and county tragically perform poorly.

In 2004, the United States ranked 29th in the world, trailing developing nations such as Cuba and Hungary, at 6.3 deaths per 1,000 live births.
In 2005, the U.S. rate rose to 6.9 per 1,000, compared with 6.5 for Texas. Tarrant County’s performance comparatively is atrocious at 8.2 per 1,000 live births. Fort Worth has the highest rate for Texas cities with 10,000 or more births at 8.1, and Arlington is highest in cities with 5,000 or more births at 9.4.

Infant mortality is the ultimate racial health disparity. In Tarrant County in 2005, the rate for blacks was 19.5 per 1,000 births, compared with 6.0 for whites and 6.9 for Hispanics. More than 200 people carrying red-and-white umbrellas participated in a "Stop the Reign of Infant Mortality" silent march Wednesday in downtown Fort Worth to raise awareness.

Medically, the primary causes of infant mortality are low-birth-weight babies, especially those born prematurely; genetic deformities; and sudden infant death syndrome. Less than 2 percent of U.S. births — those babies born before 32 weeks of pregnancy — account for half of the deaths.

But those causes are closely linked to unhealthy mothers who struggle with economic and environmental disadvantages and cope by practicing unhealthy behaviors. Women who drink, smoke, eat poorly during pregnancy or suffer physical and mental abuse are much more likely to have low-birth-weight babies.

Location can be an enormous factor. Women often lack transportation to seek prenatal care and poor neighborhoods typically suffer healthcare provider shortages. These areas are also considered "food deserts," meaning the lack of available supermarkets with ample supplies of nutritious food.

In 2007, Fort Worth Women’s Health Initiative assessed the health of women 18-44 years old in four ZIP codes — 76104, 76105, 76112 and 76119 — using in-person interviews. Those codes are among the nation’s worst 25 in infant deaths. About 58 percent of the women were black and 33 percent were Hispanic. What they found:

Nearly 36 percent had less than a high school education; about 71 percent were not married. More than 69 percent were overweight or obese, about 25 percent reported feeling depressed or hopeless nearly every day and more than 8 percent had been physically abused in the past year.

An astounding 82 percent were uninsured, compared with about 37 percent of women 18-44 in Texas and about 21 percent nationally.

Few took advantage of safety-net programs. Although most native-born women were eligible for the JPS Health Network, only about 9 percent were enrolled. About 22 percent said they had no pregnancy-health coverage despite the fact that county and state programs cover all pregnant women in Fort Worth.

Prenatal care is an important component of ensuring a healthy pregnancy. But as the study’s authors point out, such care is often too late because it cannot undo years of damage to health. They emphasize the need for preconception health interventions and family planning, given that about 50 percent of pregnancies are unplanned.

Programs such as the Fort Worth/Dallas Birthing Project that match volunteers and pregnant girls to provide mentoring and emotional support are crucial. Such efforts can go a long way to help mitigate the disparities that foster heartbreaking loss of innocent lives.

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