If there’s one issue that draws sympathy and action from both political parties, it’s the nation’s infant mortality rate, which is one of the worst in the developed world.
In fact, the United States even trails behind developing countries like Cuba. According to the CIA, for every 1,000 births in America, nearly six babies die before their first birthday.
The infant mortality rate is a good, albeit tragic, indicator of the overall health of a community. If many women aren’t giving birth to healthy babies, it may, for example, signify a widespread drug problem among expecting mothers. The most common causes of infant mortality in America are complications stemming from low birth weight, premature birth, unsafe sleep environments and exposure to secondhand smoke.
In the past decade, several cities with high infant mortality rates have spent money and resources trying to get them down. But despite their efforts, babies are still dying in these communities more often than one would expect for a developed nation.
Columbus, Ohio, provides a stark example of how difficult it can be to address this issue. Since the city made it a priority, the infant mortality rate has actually gone up.
In 2015, the city launched CelebrateOne -- a campaign to target eight neighborhoods with high rates of infant mortality. Since then, the infant mortality rate rose from 7.7 deaths per 1,000 births to 9 deaths per 1,000 births. Most disappointingly, most of the uptick was for sleep-related deaths -- something CelebrateOne focused on preventing.
Erika Clark Jones, the new executive director of CelebrateOne, says the city only had money for the campaign through the end of 2015. Additionally, the city didn't deploy a key part of its strategy, community health workers, until June 2016.
“We have to be driving that safe sleep message all of the time," says Jones. "We need to be constantly reminding them and holding events to keep it in mom’s minds."
Despite their lack of progress so far, Jones is cautiously optimistic about the future. Her team has an ambitious set of goals that includes reducing the rate of unsafe sleep deaths by 31 percent by the end of the year and an overall 40 percent reduction of infant mortality by 2020.
“We know our goal is aggressive. We’re trying to build in the supports to improve the upstream stuff,” she says.
But it's not enough to simply throw money at the problem. Practitioners say it has to be targeted to the right people, places and programs. The main drivers of infant mortality are well-known to experts, but they can differ depending on the region.
Shelby County, Tenn.
When Shelby County, Tenn., Mayor Mark Luttrell was elected in 2010 and dug into health data, he found that teen pregnancies and smoking were among the biggest contributors to infant mortality.
Studies have shown that pregnant teens are more likely to smoke and carry sexually transmitted diseases; their young age also puts them at higher risk of complicated pregnancy and premature birth.
In 2003, Memphis’ infant mortality rate was higher than that of Saudi Arabia and Venezuela -- nearly 15 deaths per 1,000 births. But by focusing on teen pregnancy and smoking, the city has been able to cut its infant mortality rate in almost half. At 8.2 deaths per 1,000 births in 2016, it dipped to its lowest level ever, though it's still above the national average.
“We regularly look at data and adjust our approach,” says Alisa Haushalter, director of Shelby County’s health department. Now, the city is focused on promoting breastfeeding, which the World Health Organization says reduces infant mortality, and getting fathers more involved in raising their babies.
When Kimberlydawn Wisdom was appointed surgeon general of Michigan in 2003, she knew she wanted to address the city's high infant mortality rate. But she didn’t just want to start another educational campaign that would be forgotten or write another grant for a program that might go underutilized.
“Every time an administration changes and people leave their posts, the rate climbs back up. Let's tackle this in a sustainable way,” she recalls thinking.
Wisdom, now the senior vice president of community health at the Henry Ford Health System, which oversees Detroit's infant mortality program, discovered that the city had 100 programs dedicated to infant and maternal health. "But they were undersubscribed," she says. That's the bad news. The good news is that "it wasn’t like we didn’t have the resources."
So she rerouted some of those resources to create a community health program. PSAs and billboards, she says, are useless unless someone links mothers and fathers to the right program -- in person. That’s where community health workers come in.
“Community health workers are ultimately the secret sauce to make that connection to different programs; it isn’t going to happen organically,” says Wisdom.
A community health worker is an advocate, often from the place they’re serving, who understands the health disparities and barriers to care that are specific to the community. Their ultimate goal is to help improve new and expecting mothers' overall well-being in ways that a traditional doctor doesn't -- like securing transportation to the clinic and improving eating habits.
Wisdom did ultimately use grant money to kick off the community health worker program, initially called “Sew Up the Safety Net.” It has since been rebranded to the Women-Inspired Neighborhood Network.
Detroit still has a long way to go. The city's 2015 infant mortality rate (at 13.3 deaths per 1,000 births) was one of the highest in the country. But Wisdom is encouraged.
In 2012, 323 women were matched up with a community health worker throughout their pregnancy and the baby’s first year. There were no deaths. In the most recent group to be matched, starting in April 2016, there so far have been no deaths. And, 100 percent of the mothers are breastfeeding.
“These women have been having outstanding health outcomes,” says Wisdom.