Just a few years ago, Maryland's infant mortality rates were comparable to those in some developing countries, a tragic failure of public health that brought heartache and unimaginable loss to hundreds of families each year. Yet despite the fact there are no quick or easy fixes that will end the suffering of grieving parents and relatives, Maryland recently has made important strides in solving what once seemed an intractable problem. The lessons of those successes offer hope of even greater progress in the future if the effort can be sustained.
The state health department recently reported that infant mortality rates in Maryland had fallen to record lows for the third straight year. In 2012, the last year for which statistics are available, the rate dropped to 6.3 deaths per 1,000 live births, down 6 percent from the previous year and 24 percent from just three years earlier. While officials caution against reading too much into data from any single year, the steady downward trend suggests that the multi-pronged approach to preventing infant deaths adopted by city and state health workers in 2009 is saving hundreds of young lives that otherwise would have been lost.
As with any problem as complex as infant deaths, progress has depended on coordinating an array of health initiatives and interventions through public-private partnerships that together aim to reduce the risk factors and address the most preventable causes of infant deaths. The main risk factors have been known for decades: births to teenage mothers; premature and low-birth weight babies; and sleep-related deaths caused when infants are improperly positioned in beds or cribs. Any successful prevention strategy has to take into account all those factors and then seek to change the specific behaviors of parents and caregivers that put infants at risk.
Baltimore City, for example, inaugurated a novel public information campaign in 2009 called B'more for Healthy Babies. The effort, which employs teams of outreach workers in the city neighborhoods with the highest rates of infant deaths, targets expectant mothers and encourages them to get early pre-natal care, watch their weight, avoid tobacco and alcohol, and adopt safe sleep habits after their babies are born. The outreach teams, who often live in the communities where they work, connect the women with health and social service agencies, set up doctor's appointments and conduct regular follow-up visits throughout the pregnancy and after the baby is born.
Last year, realizing that many deaths occurred when fathers or male relatives were enlisted as caregivers, city Health Commissioner Dr. Oxiris Barbot expanded the campaign by producing a video designed to be shown in local barbershops that also teaches men the "ABCs" of safe sleep for infants — "Alone, on their Backs, in a Crib." She's also planning a Spanish-language version of the B'more for Healthy Babies campaign to reach out to the city's fast-growing Hispanic community.
State health secretary Dr. Joshua M. Sharfstein says Maryland's decision a few years ago to expand access to Medicaid enabled more low-income and minority women to receive pre-natal examinations and other health services, and that also contributed to the drop in infant deaths. In addition, he and Dr. Barbot hope that many women will be eligible to get subsidized coverage for home visits by nurses and other social and health services under the Obama administration's Affordable Care Act when the law kicks in later this year. It's a multidisciplinary approach involving many different organizations and agencies, but the goal they all share is to change the behaviors that put infants at risk, which is often the most difficult thing to do when you're trying to improve health outcomes.
Moreover, not all the news this year was as rosy as the statewide statistics might suggest. The infant mortality in some jurisdictions on the Eastern Shore, such as Dorchester County, actually rose slightly last year despite the overall decline across the state, and the rate among African-Americans is still two to three times the rate of whites in parts of Baltimore City and Prince George's County — a reflection of the state's persistent and well-documented disparities in health outcomes along racial and class lines. Reducing infant mortality requires a long-term effort that officials must find the funding to sustain if progress is to continue. Maryland officials can take some pride in what they've managed to accomplish in just a few short years, but much remains to be done.