Steps urged to save more black and American Indian babies from early death

Each year in Minnesota, about 380 babies die before their first birthday. The most common cause of infant deaths are congenital disorders, followed by premature births and sudden unexpected infant deaths, including Sudden Infant Death Syndrome.

Although Minnesota has one of the lowest infant mortality rates in the country — better than 42 other states — the state's good ranking masks a stark difference in mortality among racial groups.

American Indian and African-American babies die at twice the rate of white babies. If those infants shared the same low mortality rate as white infants, about 40 more babies in Minnesota would survive each year.

In a new report released today, the Minnesota Department of Health proposes seven recommendations to improve infant survival:

• Improving health equity and addressing the social determinants of health that most significantly impact disparities in birth outcomes

• Reducing the rate of sudden unexpected infant deaths which includes sudden infant death syndrome and sleep-related infant deaths in Minnesota

• Assuring a comprehensive statewide system that monitors infant mortality

• Providing comprehensive, culturally appropriate, coordinated health care to all women during preconception, pregnancy and the post-partum period

• Reducing the rate of pre-term births in Minnesota

• Improving the rate of pregnancies that are planned, including reducing the rate of teen pregnancies

• Establishing an ongoing task force of stakeholders to oversee implementation of recommendations and action steps

Many attempts have been made to close infant mortality gaps by encouraging women to quit smoking, take folic acid supplements during pregnancy, immunize their babies and put their infants to sleep on their backs.

Those strategies have improved the state's overall infant mortality rate. But they have not eliminated the persistent disparities among racial groups, state Health Commissioner Ed Ehlinger said.

"We can no longer be just focusing on programs and services and what happens with the individual," Ehlinger said. "We as a public health community have to look at what are the conditions that create health."

Researchers call the conditions in which people are born and live "social determinants of health." Housing quality, neighborhood safety, job and educational opportunities and stress all have profound effects on a person's health, Ehlinger said.

With that in mind, Ehlinger supported an increase in the state's minimum wage last year. This year, his department made the case for paid maternity leave in a white paper it presented to the Legislature.

"We know that the studies have shown that if you have 10 weeks of paid maternity leave, that can reduce infant mortality by about 10 percent," Ehlinger said.

But advocates for both American Indians and African-Americans hope the new focus won't distract from the work they've been doing with individuals.

Noya Woodrich, a longtime advocate of reducing the infant mortality rate in her American Indian community, agrees that society needs to think more broadly about the factors that influence health.

But she said it would be unfortunate if the health department's approach draws money and support away from important work being done now to save infants. Some policy ideas, such as paid leave, are likely irrelevant to most American Indians, she said.

"Changing a maternity leave policy for a population where a large percentage of the people don't even work, that's not going to have an impact on us," said Woodrich, who also is president and CEO of the Greater Minneapolis Council of Churches.

Woodrich said programs to reduce infant mortality in the American Indian community could be more successful if government and private donors maintained consistent funding support. She said much of the money has come in fits and starts over the years and that has made it hard to keep the momentum going.

Alfred Babington-Johnson, president and CEO of the Stairstep Foundation, has similar complaints about funding for infant mortality programs in the African-American community. He said a successful program that provides birthing assistants or coaches was launched a few years ago, but funding inconsistencies have limited its reach.

Babington-Johnson praises the Health Department's desire to tackle the social determinants of health. But he's frustrated that it is taking so long to eliminate disparities.

"There is yet to come forward strategies, tactics or even the opportunity to think about strategies or tactics," he said.

Ehlinger, the state health commissioner, said the department's seven recommendations on infant mortality are deliberately broad because community work groups are still trying to settle on specific ways to reduce pre-term births, accidental sleep deaths and other problems that contribute to infant mortality.