Reducing Infant Mortality Rates through Evidence-Based Programs
Researchers have documented persistent racial disparities in infant mortality rates (IMR) in the United States. Infants born to African American mothers are twice as likely to die than Caucasian infants during their first year of life. In fact, the infant mortality gap between African Americans and Caucasians has widened since the 1960’s.
Fig.2. Racial gap in IMRs has increased between african americans and whites since the 1960s.
From Willis E, McManus P, Magallanes N, et al. Conquering Racial Disparities in Perinatal Outcomes. Clinics in Perinatology. 2012;41:847-875.
The main cause of death in Caucasian infants has been attributed to congenital malformations while in African American infants, the primary reasons for infant deaths are disorders related to preterm births and low birth weight. These profiles of infant deaths have remained unchanged from the years of 2000-2010. Regions with higher infant deaths have been burdened with the highest poverty rates, unemployment rates, and high school graduation dropout rates.
Table 1. Profiles for causes of infant death for african american and white infants has remained unchanged from the years of 2000-2010. From Willis E, McManus P, Magallanes N, et al. Conquering Racial Disparities in Perinatal Outcomes. Clinics in Perinatology. 2012;41:847-875.
Researchers have documented that racial disparities in IMRs cannot be attributed to genetic predispositions. Rather, they suggested environmental epigenetics as a likely biological mechanism responsible for adverse birth outcomes. Scientists believe that environmental factors such as poverty, nutritional deficiencies, chronic stress, and endurement of generational discrimination induces changes in gene expression. These biological changes brought about by environmental exposures can be inherited by future generations. This important finding brings attention to the importance of understanding epigenetic mechanisms to predict health outcomes in future generations.
Researchers recommend investing in programs and policies addressing nutrition, parenting, and early education to reduce disparities in adverse birth outcomes. Although there are existing nutrition programs such as Women Infants and Children (WIC), not all expectant mothers benefit from the supplemental nutrition program. Addressing nutritional deprivation in one generation may undo gene-environment interactions that contribute to adult diseases. Children raised in at-risk environments are likely to incur poor developmental and health outcomes. While parenting programs targeting low-income families have yielded mixed results, quality relationships between caregivers and children have been well documented to yield positive youth behaviors.
There is a strong case for the positive impact of early childhood education leading to a greater likelihood of workforce productivity in adulthood. Thus early childhood education programs that incorporate home visits, and parent and child education have demonstrated social benefits including increased earnings, reduced interactions with the criminal justice system, and a return of $10.83 for every dollar invested.
A case study conducted over the period of eight years in Milwaukee, Wisconsin demonstrated an improvement in preterm births and low birth weight in African American infants born to expectant mothers who were enrolled in early prenatal care programs complemented with culturally tailored case management services. Some of the services included program staff attendance to court hearings, support with child protective services family meetings, and prenatal health care provider visits. The ultimate goal of the additional case management services was to accomplish stress reduction.