Saturday, December 26, 2009

Too many Lane County babies dying

Before Thanksgiving, the Register-Guard published Tracking infant mortality | Why is the rate so high in the United States? This editorial explores the connection between inadequate health care and the nation's high infant mortality rate. According to the CDC and as reported in the New York Times, the United States trails 29 nations, tying with Poland and Slovakia, in infant mortality.

Some of the reasons for high infant mortality in the United States include:
  • High rates of premature birth
  • Excessive use of cesarean section and labor-induction drug
  • Lack of health care and social support, particularly among poor and minority women
  • Infertility treatment practices

While the Register-Guard has covered Lane County’s unbelievably high rate of fetal-infant mortality in the past, no mention was made in this editorial. The following opinion piece was submitted by Katharine Gallagher, member of Lane County Friends of the Birth Center, and published on December 6th. The quoted rate of 9.5 deaths per 1,000 births should have been identified by Katharine as the fetal-infant mortality rate, which includes both fetal (24 weeks gestation and 500 grams) and infant deaths (through the first year of life). This rate was incorrectly identified as the infant mortality rate, which includes only infant deaths.

Too many Lane County babies dying | The infant mortality rate here is higher than it is statewide, nationwide and in Poland and Slovakia
By Katharine Gallagher
For The Register-Guard
Appeared in print: Sunday, Dec 6, 2009

Readers of The Register-Guard’s Nov. 25 editorial “Tracking infant mortality: Why is the rate so high in the United States?” may have been surprised to learn that the United States ranks 29th among nations for infant mortality — tying with Poland and Slovakia, and trailing countries of considerably lesser means. These readers will be shocked to learn that Lane County’s most recent 2007 infant mortality rate (9.5 per 1,000 live births) is higher than the mediocre rates in Multnomah (7.4 per 1,000), Clackamas (6.7) and Washington (6.4) counties; higher than that of Oregon statewide (7.9), and higher even than U.S. rates (9.3).

Put another way, babies born in Lane County start life at greater risk than they would in Poland or Slovakia. Why is the infant mortality rate so high here? More importantly, what are we doing about it?

While national infant mortality rates are a compelling indicator of the health care system’s failures, limiting our consideration to the national context suggests we can wait for federal policymakers to make things better. This is shortsighted.

Infant mortality rates have long been accepted as the most sensitive indicator of a community’s overall health, as well as a barometer of social and economic well-being. The death of an infant is a seminal event demanding a ground-level examination of the resources available to local health and human service departments and their capacity to effectively deploy them. Equally important, it is a call for civic engagement.

After more than a decade of too-high avoidable fetal and infant mortality rates, we need a new approach. The Lane County Public Health Department recently established the Healthy Babies, Healthy Community Initiative to encourage a community-led response among public, private and nonprofit organizations, researchers and community members. Initiative participants support adopting a local Fetal Infant Mortality Review Program. FIMR is a national network of community-based, action-oriented programs with a record of success.

The goals of the FIMR program are to support grieving mothers and to prevent avoidable future mortalities. When a fetal or infant death occurs, FIMR is notified. If the mother is willing, she participates in an interview with qualified professionals. Mothers’ stories help renew local commitment to finding and solving community-specific problems contributing to infant mortality. Most importantly, FIMR puts mothers and families in touch with professionals able to provide bereavement support.

Once family needs are being met, prevention moves to the forefront. Information is collected and analyzed. Sources of data — stripped of information that identifies the family, health care providers and institutions — include the mother’s interview, medical records, birth and death certificates, coroner’s reports, and records from health and social service agencies. A qualified case review team identifies the most prevalent factors and makes recommendations for improvements. Participants in the Healthy Babies, Healthy Communities Initiative would then translate these recommendations into a transparent, systematic community action plan and implement it.

The initiative anticipates receiving results of the first data analysis of fetal and infant mortalities from the Lane County Public Health Department after the New Year.

Analyzed data is essential to understanding our current local context. Are the infants we lose born at term? Do they survive past the critical first month? What is the mother’s age? What kind of support did she receive before, during and after giving birth?

With this information, we can act to reduce fetal and infant mortality. Without it, we are operating in the dark, facing another decade of avoidable tragedy.

Lane County’s fetal and infant mortality rates are not set in stone. We can, we must, insist that avoidable mortalities occurring in our midst cease. The Healthy Babies, Healthy Community Initiative is a positive development. To meet its potential, it must have a funded, functioning FIMR program. Since 2007, the $150,000 FIMR funding request to facilitate data analysis and case review has gone unanswered.

Elected officials, civic leaders, and community members have demonstrated the collaborative action necessary to build state-of-the-art courthouses, hospitals, stadiums and athlete learning centers. When we see this same level of commitment directed toward solving the problem of fetal and infant mortality, we will begin charting a better course for our most vulnerable babies and families. Financially, the funding requirements are a pittance compared to the costs of these new facilities. The return on investment, however, is beyond compare.

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