Dane County’s black infant mortality rate continues to be nearly three times the rate for whites despite infant death investigations, a safe sleep campaign and home visits to pregnant women and new mothers.
Health officials say the disparity is troubling because the county seemed to have eliminated the black-white gap a decade ago, which gained national attention as an apparent success story.
“It is frustrating on a number of levels,” said Daniel Stattelman-Scanlan, perinatal supervisor for Public Health Madison and Dane County. “Infant mortality is a key indicator of the health of a community, of how people are doing overall.”
Carola Gaines, a health educator at Unity Health Insurance and board member of the county’s African American Health Network, said the black-white infant mortality gap reflects longstanding problems such as racism, stress and economic disparities involving housing and jobs.
“We need to chip away at all of those things,” Gaines said. “It’s challenging, but we can’t stop the fight.”
In 2016, of 568 black babies born in the county, 10 died before their first birthday, a rate of 17.6 deaths per 1,000 births.
Of 4,265 white babies, 23 died before age 1, or 5.4 deaths per 1,000 births.
Rates can fluctuate from year to year, so officials prefer three-year intervals. For 2014-2016, the infant mortality rate in the county was 9.3 for blacks and 3.7 for whites per 1,000 births.
During the same three years, the rate for Asians was 3.2. For Hispanics it was 5.6, higher than in previous years.
Dane County’s black-white infant mortality gap seemed to disappear from 2003 to 2007. When officials announced the development in 2009, it garnered national media attention.
By 2008, they later learned, the gap had returned. It has since remained.
A multi-pronged approach
In recent years, doctors have emphasized one step pregnant women can take to reduce the risk of infant death: weekly injections of progesterone.
A formation of the hormone — called 17P, or Makena — was approved in 2011 for women with previous preterm deliveries. The shots, given after the 16th week of pregnancy, can reduce the risk of preterm birth, which is linked to infant mortality.
The injections are expensive and not always covered by insurance, Stattelman-Scanlan said. Wisconsin’s Medicaid program, including BadgerCare, covers them.
An effort to reduce second-hand smoke in the homes of pregnant women and babies, especially in black households, will take shape this fall, Stattelman-Scanlan said.
A fetal infant mortality review process, started by the health department in 2011, continues. A committee meets quarterly to study the details of each death to identify patterns and opportunities for improvement.
A safe sleep campaign, launched in 2014, is also ongoing. Through public messages and events, health officials advise parents to put babies to sleep on their backs, in their own, firm beds, free of toys or other loose objects.
A disproportionate number of black infant deaths have involved unsafe sleep conditions such as co-sleeping, or sharing a sleeping space, Stattelman-Scanlan said.
Black churches have embraced the campaign by holding “safe sleep Sabbaths” the past two Novembers, with pastors talking about safe sleep and volunteers holding demonstrations, Gaines said. The event will continue this year, she said.
UW Health started Centering Pregnancy, a program offering group prenatal visits in an effort to reduce preterm births, in 2014. The program, at a UW clinic on South Park Street, is expanding to UW’s clinic near West Towne Mall.
Help ‘a phone call away’
The health department has expanded its nurse-family partnership program, partly through the Affordable Care Act, or “Obamacare.” The program, which started in 2012 with two nurses, now has seven nurses who routinely visit the homes of vulnerable women who are pregnant with their first child until the children turn 2.
Shanon Holmes, 24, of Madison, has been involved with the program since early in her pregnancy with son Don’yae Mclemore, who is 18 months old.
On a recent visit, public health nurse Joanne Sorensen talked with Holmes about signs that Don’yae will be ready for toilet training and reviewed developmental steps for his age, which he met.
Don’yae thumbed through a “First Words” book, cuddled with his stuffed Mickey Mouse, closely examined Sorensen’s eyes, nose and mouth and wiggled inside a miniature tent in his bedroom.
Holmes, a single mother who works as an education assistant in the Madison School District, participates in the UW Odyssey Project for adults who face barriers to college. She said she’d like to become a social worker.
Sorensen helped her learn how to breastfeed, childproof her outlets and door handles and consider means of discipline other than spanking, she said.
“She’s a phone call away, she’s a text away,” Holmes said. “If I have a silly question, I can ask her without feeling judged.”