New Jersey has made big strides in reducing infant mortality, but black babies still die at three times the rate of white newborns and women of all races are more likely to lose their lives during childbirth here than in many other states.
A growing awareness of these poor outcomes — and the significant racial disparity in the statistics — has triggered a new interest among state leaders eager to find ways to improve infant and maternal health in the Garden State. The answer, experts insist, involves addressing poverty and other underlying social factors that have wide and diverse impacts on health and wellness.
On Monday U.S. Rep. Bonnie Watson Coleman hosted an “emergency meeting” with a handful of healthcare experts, including acting Human Services commissioner Carole Johnson, to explore how the Garden State can better address these issues — including a racial gap in infant mortality that she said is among the largest in the nation. New Jersey’s First Lady Tammy Murphy also joined the Trenton event.
And state Sen. Joseph Vitale (D-Middlesex) is working on legislation to expand the state’s data collection around maternal and infant deaths and encourage clinical best practices. He and Sen. M. Teresa Ruiz (D-Essex) have also reintroduced a proposal to create a more robust panel, armed with subpoena power, to investigate pregnancy-related deaths.
Racial gap greater in maternal mortality
Infant mortality has declined for more than a decade in New Jersey and was down to 4.8 deaths per 1,000 live births in 2015, below the national average of 5.9, according to state data. But the state’s mortality rate for black babies was 9.7, versus 3.0 for white newborns.
The racial gap is even greater in maternal mortality statistics, for which New Jersey lags the outcomes in many other states. (The assessment includes pregnancy or birth-related deaths that occur up to a year after delivery.)
At least 36 out of 100,000 pregnancies or births result in the mother’ s death in New Jersey, compared to 20 out of 100,000 nationwide, according to the 2016 America’s Health Ranking report. Data collected by the state’s Maternal Mortality Review Program shows that, in 2013, the maternal death rate for white mothers was 12.8, compared to 46.5 among black women.
“There is no more vulnerable time in woman’s life than when she is pregnant and no more vulnerable time in a child’s life than their infancy,” Watson Coleman (D-12th), said. “Protecting mothers and babies is a paramount function of government, but these disparities demonstrate that we have so much more work to do.”
While the immediate outcome of Monday’s event was not clear, Johnson, whose department oversees Medicaid and a number of family health programs, said she shared Watson Coleman’s concerns. “I am pleased to join the Congresswoman in this convening to examine this urgent issue and to highlight the important role of health insurance coverage, including Medicaid coverage, in timely care for women and infants and to explore additional steps to address these unacceptable disparities,” she said.
Infant and maternal health disparities were also flagged as a legislative priority for Vitale and some of his colleagues, resulting in a legislative hearing held early last week. Each year, nearly 500 Garden State infants die before their first birthday, most of preventable causes.
“As a committee and as a state we have our work cut out for us to reduce these numbers,” Vitale said.
During the hearing, speakers agreed it is important for healthcare providers to learn and practice proven techniques to ensure quality care, and for mothers and their partners to understand the importance of overall health and prenatal care. But truly addressing racial disparities will require more comprehensive and costly initiatives aimed at reducing poverty and combating associated ills, including lack of access to care, unsafe housing, and food insecurity, they added.
“We need to consider being very careful not to be too simplistic,” Barbara Ostfeld, a professor at Rutgers Robert Wood Johnson Medical School and director of the SIDS Center of New Jersey, which studies sudden infant death syndrome, told the health committee. “It’s very easy to say, ‘let’s launch a campaign to (encourage women to) take folic acid to reduce neural tube defects (in the brain).’ It’s much harder to say, fix poverty. But the bold action may be the one that has the most impact.”
Experts note that the Garden State has led the nation with its efforts to investigate maternal mortality, thanks to an expert panel that has reviewed more than 700 deaths since 1999. Hospitals here participate in a federally funded collaborative — one of just 13 nationwide — that has succeeded in reducing early elective deliveries, or unnecessary cesarean-section births, and state laws require infants to be tested for a wide range of potentially fatal conditions.
Elevate women’s voices
And last month, New Jersey was the first state to mark Maternal Health Awareness Day, an effort to encourage a three-step protocol — ‘Stop, Look, and Listen’ — designed to elevate women’s voices and ensure they are heard by healthcare providers when they raise concerns about their pregnancy or delivery.
“We have done a lot in New Jersey to address this issue of maternal mortality and morbidity,” said Dr. Gloria A. Bachmann, director of the Women’s Health Institute at Rutgers Robert Wood Johnson Medical School, who led the charge to create the annual event, celebrated on January 23. “We can build on what we have created,” she told the Senate panel.
Addressing underlying social concerns requires a comprehensive approach, beyond healthcare alone, and can’t be limited to the nine-month period during which a woman is pregnant, Ostfeld, with Rutgers, noted. “You can’t address this in a prenatal visit,” she said. “These are things young adults and children and families need to have across their lifespan.”
Racism, a significant factor
Racism is also a critical factor, Ostfeld and others explained. Nadia Hussain, who leads the maternal justice campaign for a national organization, MomsRising, noted that black women are not more likely to develop preeclampsia or to start hemorrhaging during birth – two potentially fatal conditions associated with delivery – but they are more likely to die as a result, in part as a result of delayed or less effective care.
Hussain said it is important for providers to address their own potential biases in treatment, noting that educational tools exist to help doctors and nurses treat all patients equally. She also urged state officials to invest more in expanding access to care, particularly in community clinics or other facilities that are familiar to black families.
“The risk of dying should not be defined by any zip code or race,” Hussain said.
Ilise Zimmerman, executive director of the Partnership for Maternal and Child Health of Northern New Jersey, called for funding an office focused on black infant mortality and a home-visitation program, in which trained staff are dispatched to meet with new mothers, an effort that has proven successful elsewhere. She also called for greater diversity on the state’s maternal mortality panel and urged the group to present clear recommendations, in addition to its findings.
“The action steps are what changes the needle on whether or not mothers and children live or die,” Zimmerman said.