Racial Disparity in Infant Mortality Remains Persistent Public-Health Challenge

Reducing black infant mortality means addressing a range of issues, such as poverty, smoking, stress, food insecurity — even gum disease

black mother and baby
Babies of all races born in New Jersey die less frequently than in the past, and at a lower rate than in the nation at large.

But despite these gains, black infants remain three times more likely to lose their lives in the Garden State than white newborns, a disparity maternal health advocates said is one of the largest racial gaps nationwide.

Recent reports confirm that infant mortality rates continue to decline nationwide, but the persistent gulf between racial death rates prompted healthcare experts to join Rutgers Biomedical and Health Sciences program and host a conference dedicated the issue. The event, held Friday, included discussions of the contributing factors — like poverty, smoking, and stress — and explored ways state officials, clinical providers, churches, and other community organizations are working to reduce this disparity.

“We really felt it was time to re-energize on this topic,” explained Barbara Ostfeld, a professor of pediatrics at Rutgers Robert Wood Johnson Medical School and director at the SIDS Center of New Jersey, who helped organize the event. Addressing this complex topic involves significant challenges, she said, but it is a problem that can’t be ignored.

‘No simple answers’

“There are no simple answers. But there are answers,” Ostfeld said. “And we don’t have the choice in saying, ‘this is overwhelming.”

Data released by the federal Centers for Disease Control and Prevention in March confirmed that infant mortality rates reached new lows in the United States in 2014, the latest year for which data was available. Overall, the figure — a basic measure of public health — declined 15 percent over a decade, to 5.8 deaths per 1,000 live births.

New Jersey’s numbers showed a similar decline since 2005, to reach an infant mortality rate of 4.4 by 2014. But a racial breakdown of the data puts the Garden State in a far less positive light: African-American babies die at a rate of 8.9 per 1,000 and white infants at 3.1 per 1,000, compared to 10.9 and 4.9, respectively, nationwide. (Hispanic and Asian babies also experience higher infant mortality rates than white children, but the disparity is less significant.)

The gap between the rates for black and white newborns raised alarms; Ostfeld said New Jersey’s disparity was among the largest nationwide. “We were very concerned,” she said.

Other racial disparities

Infant mortality is not the only health indicator that reveals racial disparities in New Jersey. The 2017 KidsCount data book, released in May, showed Garden State kids are gaining on a wide variety of health and social-welfare measures, but black youngsters were more likely to be born underweight, to live in a single-parent household, or to experience poverty.

At Friday’s conference — also sponsored by the SIDS center and the Partnership for Maternal & Child Health of Northern New Jersey — Denise Rodgers, the vice chancellor for inter-professional programs at Rutgers University, talked about the social factors that impact black infant mortality, including poverty.

Poor communities have higher numbers of single-parent families, greater food insecurity, and they also have higher death rates among babies, data has shown. (In Camden and Essex counties, the infant mortality rate in 2014 was 12.5 and 10.3 per 1,000 live births, respectively.)

“There’s no question, poverty correlates with infant mortality,” Ostfeld added, “and there is a consistent correlation between ethnicity and poverty.”

Poverty just part of picture

But poverty is only part of the picture, Ostfeld explained. Other factors include smoking – not just by the mother, but by any family member, since cigarette toxins can linger in the home. Black men have the highest smoking rates, she noted.

Maternal stress is another concern, Ostfeld noted, so racial discrimination and crime-ridden communities also put infants at greater risk. A mother’s obesity, depression, and gum disease are other health problems that can drive up infant mortality.

While these complex factors can seem insurmountable, Ostfeld said the conference — which attracted some 200 students, healthcare advocates, clinical providers and other stakeholders — was designed to prompt discussion around practical solutions.

The afternoon involved breakout sessions on access to care, engaging fathers and the faith-based community, addressing HIV, and pursuing legislative solutions. (Ostfeld said the group would like to develop an “Infant’s Bill of Rights” to help focus attention on the importance of early nutrition, safe housing, and other critical protections.)

Officials from several state agencies also provided updates on their work to address the issue. These programs include the Improving Pregnancy Outcome Initiative, launched in 2013 by the Department of Health, which involves trusted community health workers who target low-income women of childbearing age and work through a county network to connect them with appropriate care. The $4.8 million program now operates in all 21 counties, according to DOH spokeswoman Donna Leusner.

In December the department also launched its Doula program in Newark, which has trained five women in evidenced-based practices that they can use to help support and guide mothers-to-be in their community. These women visit the mother several times before they deliver, are with them during the birth, and can then provide information and referrals after the baby is born, Leusner said.

Ostfeld also credited the work of the Strong Start for Mothers and Newborns program, now underway at dozens of hospitals nationwide, including eight in New Jersey. St. Peter’s University Hospital, in New Brunswick, launched its program in 2013 with the Central Jersey Family Health Consortium, and it has since helped 1,200 women with practical tips on things like breastfeeding and dealing with family stress.

“No problem gets solved all at once, but every problem can be broken down into steps that can be taken,” Ostfeld noted. “This is step one; it’s not a one-day conference that ends, but a process that goes forward.”

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