Dane County's black infant mortality rate, which dropped for several years and became a national success story, shot up again to four times the rate for whites over the past three years, leaving health officials stumped.
The rate of black babies who die before their first birthday soared in 2008, after low rates from 2002 to 2007 drew attention as a glimmer of hope in solving an intractable problem across the country.
The rate remained somewhat high in 2009, and the just-released rate for 2010 is considerably more — 19.2 deaths per 1,000 births compared with 3.5 for whites — a three-year trend confirming the black-white gap that seemed to have vanished has returned.
"We feel like we lost something good that we had," said Dr. Tom Schlenker, director of the Madison-Dane County Health Department. "We don't know what has been going wrong in the past three years, but it's very worrisome."
Frances Huntley-Cooper, a retired county social worker now on the city-county board of health, said she was disappointed.
"I don't know if it's the economy - people being frustrated, stress," she said. "We need more information so we can develop a plan to prevent this."
A fetal and infant mortality review committee, to meet for the first time next week, will study each death and try to identify patterns and opportunities for improvement, Schlenker said. Committee members might interview some parents and health care providers involved, he said.
The health department will consider expanding prenatal home visits and nutrition programs if funding is available, Schlenker said. "We're going to look at how we can make them more effective or have them reach more people," he said.
Schlenker said the increase in deaths is surprising because black women appear to be using prenatal care as much as before, and most health services in the Madison area haven't changed much in recent years.
Last year, however, Meriter Hospital dropped its prenatal care coordination program. The hospital gave obstetricians contact information for the county's program, Meriter spokeswoman Mae Knowles said.
Other such programs, which include home visits, help with transportation and other services, are available through Dean Clinic and the Madison School District.
The South Madison Health and Family Center-Harambee, a social services resource center opened in 1995 that Schlenker said likely helped prevent some infant deaths, closed last year, in part because of declining funding.
"My fear is that the system is not working as well now as it did for a number of years," Schlenker said. "Or maybe it's just been overwhelmed by the increasing needs of the population."
Public health nurse help
Schlenker said he invited Madison's hospitals and medical providers to help the health department address the problem.
UW-Madison researchers have been examining the situation in Dane County and comparing it with southeast Wisconsin, where the black-white gap has remained. A study is looking at whether nonprofits helped reduce deaths among black babies last decade, said Jeanan Yasiri, executive director of the UW Center for Nonprofits.
Nicole Tyson said she moved from Racine to Madison last year when she was pregnant because she heard the services for pregnant women were good in Dane County.
Tyson, 29, who has sons ages 1 and 5, gave birth to a healthy girl, Alaysia, at Meriter in January. She wanted to breast-feed her newborn but didn't do so with her boys and said she wasn't sure she could do it.
Susan Wildrick, a nurse with the city-county health department, coached her and helped her relieve some initial breast-feeding pain. "She gave me the ability to continue even when I was discouraged and wanted to stop," Tyson said.
Wildrick also shared recipes for healthy chili, stressed the importance of putting Alaysia to sleep on her back and helped Tyson bypass a waiting list for a dentist when her teeth hurt. She had four pulled.
"I help the mothers take an active role in having good health for themselves and their babies," Wildrick said.
Numbers small, cost big
The troubling statistics involve a relatively small number of infant deaths.
Last year, 30 babies died in the county, of 5,927 births. Of 522 black births, 10 babies died. Half of them were born prematurely.
Six black babies died in 2009 and 10 died in 2008. From 2002 to 2007, an average of three black babies died each year.
The black infant mortality rate, which averaged about 19 deaths per 1,000 births before 2002, dropped to about 6 deaths per 1,000 births over the following years, similar to the rate for white babies.
The decline was highlighted by the Atlanta-based Centers for Disease Control and Prevention because a racial gap remained in most of the country, and was covered by The New York Times and Newsweek.
Averaged over three years to account for variations in any one year, the black infant mortality rate rose to 17 deaths per 1,000 births between 2008 and 2010, compared with 4 deaths per 1,000 births for whites over that same period.
The toll of the reappearing gap is measured in dollars as well as lives, Schlenker said. "Babies are dying, and the premature babies who survive only do so at great cost and oftentimes with lifelong disabilities," he said.
He said he still thinks the positive trend last decade was real, but so is the pattern for the past three years.
"Unfortunately, it's not a fluke," he said.