Study Shows How the Flint Water Crisis Impacted Fertility and Fetal Death Rates
By Keith Matheny
The city of Flint saw fewer pregnancies, and a higher number of fetal deaths, during the period women and their fetuses were exposed to high levels of lead in their drinking water, according to a new research study that reviewed health records from Flint and the state.
Fertility rates decreased by 12% among Flint women, and fetal death rates increased by 58%, after April 2014, according to research by assistant professors and health economists David Slusky at Kansas University and Daniel Grossman at West Virginia University. The pair examined vital statistics data for Flint and the rest of the state of Michigan from 2008 to 2015, zoomed down to the census-tract level.
That post-April 2014 time period is significant, because that's when -- in an effort to save money -- the city of Flint switched from water supplied by the city of Detroit to using the Flint River as a drinking water source, without adding needed anti-corrosives to the water. Lead levels in drinking water supplies spiked as a result.
The problem, however, wasn't acknowledged by Gov. Rick Snyder and state health and environmental officials until late September 2015 -- months after Virginia Tech researcher Marc Edwards and U.S. Environmental Protection Agency manager Miguel Del Toral alerted state and federal officials of their concerns, and weeks after Flint pediatrician Mona Hanna-Attisha's own research showed children's lead blood levels were rising in Flint.
According to the federal Centers for Disease Control and Prevention, lead can damage a developing baby's nervous system, causing miscarriages and stillbirths, as well as infertility in men and women. In the late 1800s and early 1900s, some women used lead pills to terminate pregnancies.
Additionally, state health officials confirmed 91 cases, including 12 deaths, from Legionnaire's Disease, a respiratory infection, in Genesee County in a 17-month period in 2014-15. Though not conclusively tied to the Flint water crisis, cases spiked after the city switched its water source.
Flint has since switched back to Great Lakes Water Authority-supplied water.
There is no safe level of lead in the body, but the impacts of lead are considered most severe on the developing brains and nervous systems of children and fetuses. It can lead to lower intelligence, behavioral problems and diminished life achievement, according to researchers. And the damage is irreversible; it cannot be undone.
Fifteen state and local officials have been criminally indicted as a result of their alleged actions and inactions in the Flint water crisis, including Michigan Department of Health and Human Services Director Nick Lyon, state Chief Medical Executive Eden Wells, and Liane Shekter-Smith, the fired head of the Michigan Department of Environmental Quality's drinking water unit.
Lyon's preliminary examination, which will determine if his case proceeds to trial, is scheduled to begin Thursday morning in a Flint courtroom.
In the Kansas study, Flint's birth and fetal death data was compared to similar data from 15 other large Michigan cities, including Detroit.
On fertility rates, "Flint's numbers fell off a cliff, and the rest of the cities stayed pretty much constant" after April 2014, Slusky said.
"We weren't particularly surprised by this, but we didn't expect it be as clean and clear as it was."
The researchers looked at the number of women of child-bearing age in Flint and other large Michigan cities, and the number of live births, to calculate a birth rate for each city. Comparing Flint to other large Michigan cities helped mitigate for other factors that might affect birth rates, such as couples holding off on having children after the economic recession beginning in fall 2008, Slusky said.
Researchers also attempted to account for concerns by Flint residents about their city's water quality, and whether that led to any decision to wait on children. The researchers examined Google data for searches from Flint on "lead" and "lead poisoning," but found no increases in such searches until September 2015.
"During most of our time period, when the city and state officials were saying there was no problem, we didn't see any evidence of knowledge about lead in the water," Slusky said.
American Time Use Survey results showed Flint residents did not report any less sexual activity during the time period, he said.
"Either Flint residents were unable to conceive children, or women were having more miscarriages during this time," Slusky said.
The fetal deaths data is more limited, as state statistics are only kept for fetuses that die after 20 weeks and in a hospital, Slusky said. As a result, such deaths are recorded in very low numbers, "maybe one child per 5,000 women," he said.
While less statistically certain than the observed drop in fertility rates, the similarity of findings on fetal death increases in Flint to those from research done by Edwards in Washington, D.C., after residents were exposed to elevated lead levels in drinking water from 2000 to 2004, "suggests that what we are finding is not implausible," Slusky said.
Additional findings from Slusky's and Grossman's research included that the sex ratio of babies born in Flint skewed slightly more female following the water change. Other scientific research has shown male fetuses are more fragile.
Babies born in Flint were also nearly 150 grams lighter than in other areas, were born a half-week earlier and gained 5 grams per week less than babies in other areas examined over the time period.
Slusky's and Grossman's research appears in a working paper distributed as part of the Kansas University Economics Department's Working Papers Series in Theoretical and Applied Economics. It has not yet been peer reviewed by other scientists, Slusky said.
Edwards, who has continued to work on assuring the safety of Flint's water from lead in the nearly two years since the crisis came to light, said in an e-mail he has not seen the data behind the researchers' findings.
"The magnitude of the adverse pregnancy outcome effect appears to be somewhat larger than I would have predicted, based on the water lead exposures that we think occurred -- but then again, what we think occurred is very often wrong," he said.
"This will certainly prompt a flurry of research by others, to try and replicate the results."
Slusky said he hopes his findings inform policy-makers.
"Flint was a government failure -- enough people have been indicted that there's a reasonable consensus around that," he said.
"We know monitoring the water, and putting the right types of anti-corrosives in it, is not free, is not cheap. Now I've told you what the cost of not doing something is, and what the benefit is. That's the hope of this kind of research; quantify the benefit."
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