The state's reported progress in reducing infant mortality is to be cheered, but the fact that infant mortality increased slightly for African-Americans in 2009, and that a smaller percentage of black women received prenatal care that year, should be deeply troubling to public health officials.
Persistent racial and class disparities in access to health care are the principal reasons Maryland's infant mortality rate — the number of infant deaths per thousand live births — has remained disturbingly high over the years. And the tragedy is that most of these deaths are preventable.
While the state's overall infant mortality rate declined from 8 deaths per thousand in 2008 to 7.2 per thousand in 2009, the rate among black families actually increased from 13.4 to 13.6 over the same period. Most of the state's progress can be attributed to the drop in infant mortality among whites, which fell from 5.1 per thousand in 2008 to 4.1 last year.
These figures are in line with results published earlier this year showing similar racial and class disparities in child mortality rates — the number of deaths among children under 5 per thousand births — as well as in adult and maternal mortality rates.
A study by the Baltimore City Health Department in May, for example, found that adults with little education and low incomes were much more likely to become sick and die than their better-educated, more affluent peers, and that mortality rates for African-American adults were nearly three times higher than those for whites.
Though Maryland is home to some of the world's finest medical institutions, the state's health dollars are spent overwhelmingly on treating disease rather than on keeping people healthy. Reducing infant mortality requires not only making access to affordable care available to more people, but offering all health care providers new incentives to improve the quality of services for the most disadvantaged groups and making it easier for them to get preventive care.
Last year, Baltimore City health officials targeted the 12 city neighborhoods with the highest rates of infant deaths, which are overwhelmingly African-American and poor, with an array of services aimed at reducing infant mortality.
The first phase of the campaign, called B'more for Healthy Babies, kicked off in June of this year and centers on teaching pregnant women and young mothers safe sleep habits as a way of avoiding infant deaths. Last year, 20 percent of infant deaths in Baltimore were caused by unsafe sleeping practices.
Other programs planned over the next three years include providing expectant and young mothers with a range of services ranging from primary health care, obstetrics and home visits to mental health counseling, domestic violence prevention and substance abuse treatment.
The idea behind such targeted efforts is that if officials can reduce infant deaths in just the dozen most distressed city neighborhoods to the statewide average, Baltimore's overall infant mortality rate will drop significantly.
Inequalities of race, class, income and education have been steadily increasing in American society over recent decades, and the gap is reflected by the depressingly high rates of infant mortality in Maryland and around the country. Bringing the numbers down will require efforts over many years that target the state's neediest communities if poverty and lack of education are not to become the equivalent of death sentences for far too many Maryland children.