Health Department

Guest Column: Infant Mortality
by Kimberlee Wyche-Etheridge, M.D., M.P.H.

What do South Korea, Cuba, Slovenia, Anguilla and Singapore have in common? A baby born in these countries has a better chance of surviving past his first birthday than in the United States. Infant survival in the US is one of the worst for industrialized countries, and our ranking has been getting worst. Even more disturbing, African American babies die twice as often, and have survival rates similar to those in Chile and Costa Rica.

Sadly we live in a country that boasts an abundance of Neonatal Intensive Care Units and a medical budget bigger than all others, but yet in North Nashville one out of every 50 babies born is destined to have a funeral instead of a birthday. We have got to do better.

Last week, Mario Drummonds from the Northern Manhattan Perinatal Partnership spoke in Nashville. He discussed how in Northern Manhattan the rate that babies survive their first year has improved by 70% over a 10 year period. What did they do right?

Mr. Drummond’s organization realized that even the healthiest of women are less likely to deliver a healthy baby if their community is not healthy, and they have little control over their lives. In many of Nashville’s neighborhoods, women live with more stressors than protective factors. Few have opportunities available to increase their health or wellbeing. Faced with similar issues, here are some of the principles presented that transformed the work in NYC.

  • There must be a move beyond just prenatal care and instead, improve health and wellbeing across the life course.
  • Families must be strengthened and empowered by building networks of support at the neighborhood levels.
  • The immediate needs of vulnerable women must continue to be addressed, but the bigger issues cannot be ignored. These include health coverage, affordable housing, job opportunities, quality education, and access to healthy food.

    These themes are not new. In fact under the umbrella of Project Blossom, a community coalition focused on improving local birth outcomes, Nashville's Public Health Department and its partners have highlighted and worked towards introducing these principles through new projects and collaborations. Several programs have been established, or retooled to maximize the impact on birth outcomes. Models of prenatal care that give women more control and social support are being piloted and supported. Knowledge building programs for young adults have been established. Other programs have linked young mothers with mentors to develop support systems for better health and wellbeing. Home visiting, a traditional approach, has continued to empower women with information and also link them to services that can support social, mental and physical health needs.

    No one initiative can improve Nashville’s birth outcomes alone, and unfortunately, programs are costly. On the other hand, we spend $40,000 to $250,000 on each baby born too early, too small, and often too fragile to survive. Realizing the stakes and the potential savings, we need to focus our energies on healthier conditions for women work together to ensure that more babies celebrate their first birthday.

    By Kimberlee Wyche-Etheridge, M.D., M.P.H.
    Director of Family, Youth, and Infant Health
    Metro Public Health Department