The United States spends more on healthcare per capita than does any other country in the world. Despite this high spending, however, we fall far behind many developed and developing nations in birth outcomes. In 43 countries, infant mortality rates are lower than in the United States. For every 1,000 babies born in the U.S., an average of 5.82 will die before their first birthday—a rate similar to Serbia’s.
Across the U.S, significant disparities in infant mortality rates exist. The lowest rates, around 4.3, are seen in California and match those of Australia and the UK. In Alabama, where there are 8.7 infant deaths for every 1,000 live births, rates are slightly higher than in Sri Lanka and Botswana. Pennsylvania hovers around the national average with an infant mortality rate of 5.9. Pittsburgh specifically experiences an average of 6.65 infant deaths for 1,000 live births, with average infant mortality rates ranging from 4.75 to over 30 infant deaths for 1,000 live births in various Allegheny County neighborhoods.
The disparities are not only geographic: Nationwide, and in the Pittsburgh communities where Corps members serve, significant racial disparities exist in infant mortality and associated factors that affect birth outcomes. National CDC data shows racial disparities in infant mortality, preterm birth, and low birth weight. According to 2007 data, non-Hispanic black women, American Indian and Alaska Native women, and Puerto Rican women experience higher rates of infant mortality than do non-Hispanic white women in the United States. Specifically for Puerto Rican and non-Hispanic black women, higher infant mortality rates are mostly due to more preterm births and preterm-associated causes of death in these populations.
In Pittsburgh specifically, according to an infant mortality study from the Allegheny County Health Department, between 2008 and 2012 white infants in Allegheny County had an average infant mortality rate of 4.75, while the rate for black infants was 13.73. The same report determined that “disorders related to preterm birth and low birth weight,” also more prevalent in black infants than in white infants, were a main cause of infant mortality in that time period.
NHC plays a role in addressing the issue of preterm birth and low birth weight that connects to disparities in Pittsburgh. As the Maternal Child Health Coordinator at the UPMC Shadyside Family Health Center, I provide interconception care that aims to improve the health of women between pregnancies. When women have identified risk factors—including tobacco use, depression, lack of contraception, and lack of folic acid intake—that can affect their own health and future birth outcomes, I offer health education and case management to coordinate care and address these risk factors. By reaching “one woman at a time,” as my mentors like to say, I hope that I am empowering women with information that can help them both improve their own health and promote better outcomes for future pregnancies.
Sources: https://www.cdc.gov/nchs/nvss/deaths.htm https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality.htm http://www.post-gazette.com/news/health/2016/03/29/Infant-death-rates-going-down-in-Allegheny-County-some-problems-persist/stories/201603080001 https://www.cdc.gov/nchs/data/databriefs/db74.pdf http://www.achd.net/biostats/pubs/pdf/2015_Birth_Cohort_Report_FINAL.pdf https://www.prematurityprevention.org/getattachment/a30f81d7-7499-4f92-a8d2-afc0a8a9265c/IMPLICIT-toolkit.aspx