Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Infant Deaths

Summer 2004

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Size of the Problem

Over 68,000 births annually are recorded in Minnesota with an estimated 1,096,832 women of childbearing age (15 to 44 years old) in the state [1]. In 2002, 362 infants died in their first year of life. Minnesota’s rate of infant mortality (deaths per 1,000 live births) declined over the last decade.

Seriousness

People affected by infant deaths.
The Healthy Minnesotans 2004 goal is that fewer than 5 infant deaths per 1,000 live births will occur each year. Infant mortality rates are an important public health indicator of the conditions in our communities that are favorable or unfavorable for childbearing families. Strategies to reduce infant deaths in Minnesota support the principle that early and adequate prenatal care has a positive influence on birth outcomes in all racial groups [2].

The leading cause of infant death in Minnesota as well as the U.S. is congenital anomalies or birth defects. About 150,000 babies nationwide are born each year with birth defects caused by both genetic and environmental factors. Birth defects account for about 30% of Minnesota’s infant deaths each year. However, the causes of about 60% of birth defects are unknown. In 2004 Minnesota passed legislation to provide a state birth defects information system. With funding from the Centers for Disease Control and Prevention (CDC) and leadership from MDH’s Environmental Health Division and Minnesota’s Chapter of the March of Dimes, it is hoped that Minnesota will be better able to identify contributing factors and patterns of birth defects and, most importantly, identify effective interventions to reduce birth defects.

Minnesota and US Infant Mortality Rate, 1995-2002
  Deaths/1,000 Births
Year US Infant Death Rate Infant Death Rate
1995
7.6
6.8
1996
7.3
5.9
1997
7.2
5.9
1998
7.2
5.9
1999
7.1
6.2
2000
6.9
5.6
2001
6.8
5.4
2002
6.9
5.3

Much research has focused on two of the leading causes of infant mortality: preterm/low birth weight births and Sudden Infant Death Syndrome (SIDS). Medical, demographic and behavioral risk factors contribute to preterm/ low birth weight and SIDS.

Disparities
According to Minnesota birth certificate data, rates of infant mortality are 2 to 2 ½ times higher among populations of color compared to white infant deaths [3].

Geographic disparities also exist for infant deaths. Infant mortality rates are higher in select regions of Minnesota:

  • Northwest region (7.2)
  • Northeast region (6.6)
  • Metropolitan region (6.6) [4].

National data indicate that cities with higher rates of infant mortality were in the Midwest, Southeast and Northeast [5].

Minnesota Infant Mortality by Race,
1989-1993 and 1996-2000
  Infant Deaths/1,000 Births
Race 1989-1993 1996-2000
White
6.5
5.2
Hispanic
7.3
6.8
Asian
6.2
7
American Indian
16.5
12
African American
16.5
12.7

Economic
The cost-effectiveness of early and adequate prenatal care to prevent preterm/low birth weight births has been well documented. The CDC has estimated a savings of $14,755 per low birth weight birth prevented if all U.S. women received adequate prenatal care [6].

Interventions

Nationally, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have collaborated in publishing Guidelines for Perinatal Care which specifically address the need for early and adequate prenatal care.7 The Minnesota-based Institute for Clinical Systems Improvement standards for prenatal care has a strong emphasis on early and adequate prenatal care [8]. The Association of State and Territorial Health Officials issued a policy statement in 2003 that recommends, “expand access to prenatal care services through targeted outreach and intervention” [9].

Public health strategies to decrease fetal and infant deaths were identified by the Minnesota Fetal and Infant Mortality Review (FIMR) projects. Recommendations included:

  • Improve standards/quality of perinatal care.
  • Reduce barriers to accessing perinatal and pediatric care due to race/ethnicity, age, income, and/or language.
  • Improve phone communication in providers’ offices, labor and delivery areas, and other areas that impact care.
  • Empower women by providing them with information about their own health.
  • Provide culturally sensitive prenatal care and education.
  • Encourage providers to develop a system to follow-up on patients who missed appointments or failed to schedule appointments for prenatal and well child care.
  • Establish a sustainable and coordinated system of home visiting from pregnancy through early childhood.
  • Encourage professional organizations, providers, health plans, health care purchasers, and public health agencies to develop and utilize guidelines for prenatal care coordination and case management.
  • Provide culturally sensitive education to promote infant sleep safety.
  • Provide education on the impact of tobacco use on pregnancy and infant health.
  • Provide education on the role that alcohol and drug abuse play in infant death.
  • Increase community awareness that domestic violence may begin/escalate during pregnancy.
  • Increase public awareness to begin prenatal care in the first trimester for all pregnancies.
  • Promote public awareness of individual responsibility for reproductive health.

Effectiveness of Interventions
Studies have documented the effectiveness of early and adequate prenatal care as a method to reduce infant mortality.

Status

Minnesota Resources
Programs and strategies that promote early and adequate prenatal care include:

  • Local public health improved pregnancy outcome (IPO) projects;
  • Public health nurse home visiting programs.
  • The WIC program
  • Twin Cities Healthy Start
  • Health Plan Perinatal Incentive Programs
  • Metro Maternity Case Management Project
  • Culturally specific programs to reduce infant mortality funded by MDH’s Eliminate Disparities in Health Initiative (EHDI)
  • Southwest MN Integrated Prenatal Project
  • Doula Programs
  • The Nest Incentive Programs
  • Tribal Health Initiatives
  • Save 10 Community Task Force

Community Awareness
The Save 10 Community Task Force, the Center for Health Statistics, the Office of Minority and Multicultural Health, the Maternal and Child Health Section, the Minnesota Sudden Infant Death Center, the March of Dimes, Twin Cities Healthy Start, the Division of Indian Work, the American Indian Family Center, the Stairstep Foundation and local FIMR projects have been attempting to raise community awareness about the disparity in infant mortality experienced particularly by African Americans and American Indians in Minnesota.

These efforts to improve community awareness began with local metro public health agencies over 10 years ago, especially St. Paul - Ramsey County Public Health and the Minneapolis Department of Health and Family Support. However, no current data exist to measure community awareness.

References

1. Minnesota Center for Health Statistics. 2003
2. MDH. Healthy Minnesotans: Public Health Improvement Goals 2004. September 1998.
3. MDH. Populations of Color in Minnesota Health Status Report- Update Summary. Fall 2003.
4. MDH. Infant Mortality. Population Health Assessment Quarterly 1(3). Winter 2000.
5. Haynatzka V, Peck M, Sappenfield W, et al.Racial and ethnic disparities in infant mortality rates-60 largest US Cities, 1995-1998. MMWR 51(15):329-343. April 2002.
6. CDC. An ounce of prevention: what are the returns? October 1999.
7. American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG). 2002. Guidelines for Perinatal Care. Washington, DC.
8. Institute for Clinical System Improvement. Routine Prenatal Care. 2003. www.ICSI.org [Attn: Non-MDH Link]
9. Association of State and territorial Health Officials. State Policy Options to improve Birth outcomes. October 2003.