Saturday, November 2, 2013

Revelations at the 2013 Indiana Infant Mortality Summit

02 November 2013

The 2013 Indiana Infant Mortality Summit sponsored by the Indiana Department of Health was held at the JW Marriott in Indianapolis on Friday 01 November 2013. Attendees were welcomed by Dr. VanNess, Indiana State Health Commissioner, who was followed by Governor Mike Pence's opening remarks. David Lakey, M.D. Presented Infant Mortality: Lessons Learned. Panelist presentations on 'Infant Mortality as a public health issue' were given by Niceta Bradburn - Indiana’s Infant Mortality History, Christina Ryan - Levels of Care, Miranda Spitznagle - Tobacco Use and Pregnancy, Norm Hess - 39 Week Quality Improvement Campaign, and Virginia Caine, M.D. - Disparities.

To begin here is the definition of infant mortality used for the Summit.
The death of a baby before his or her first birthday is called infant mortality. The infant mortality rate is an estimate of the number of infant deaths for every 1,000 live births. The rate is often used as an indicator to measure the health and well-being of a nation, because factors affecting the health of entire populations can also impact the mortality rate of infants.

When it comes to rating the well-being of Hoosiers we are consistent in our dismal performance across numerous measures. Indiana ranks near the bottom, 45 of 51 jurisdictions, when it comes to infant mortality. Only one time in 113 years has it been below 7.0: that was 6.945. in 2011 the rate was 7.7 deaths per 1,000 live births. That translates to 643 lives lost. Our current child mortality ranking is slightly worse than our overall health ranking -- 41 of 51. This produces an impact on business location in Indiana. An unhealthy population is less likely to show up to work and be productive and are more expensive for those providing sick care coverage to them. In essence Hoosiers are choosing to reduce employment opportunities in Indiana for themselves and thus – from reduced tax revenues – the resources available to combat infant mortality.

A significant contributor to this overall dearth of well-being and infant mortality is tobacco smoking. Although it is widely known that an in utero child is directly harmed by the chemicals delivered to it from the mother's lungs, 16.6% of pregnant women in Indiana [2011] fail to love their children and instead choose to harm them through their cigarette use. This is in contrast to the 9.1% nationally which is still deplorable but 45% less. When it comes to the wealthy failure to love their unborn children increases dramatically. 30% of the Medicaid Moms in Indiana smoke cigarettes while pregnant. In Boone county, where I reside, the rate is between 35 and 39%, much higher than Marion County. I mention that because there exists a false presumption that it is the minorities who don't care about their children.

When the statewide rank of 16.6% is broken down by race/ethnicity these results are revealed: Whites 17.9%[highest], Blacks 13.3%, Latinos 5.1% [lowest]. Another myth is that this number is skewed upward by the uncaring and irresponsible youth. This presumption is consistent with the longstanding tradition of parents blaming the children for their failures. It is, in fact, the children who are more responsible and are ignoring the traditions of harm that their parents sought to embed within them. The highest rate of smokers is among the 45-54 age range. The second highest is 25-34. Not hardly the youth that take the brunt of blame for societal ills.

Another way that Hoosier mothers who are pregnant choose to risk the well-being of their unborn children is through obesity. Obesity increases the probability of premature birth to 25%. Indiana ranks as the eighth most obese, a substantial improvement from some recent rankings as high as third. In essence, anyone who condones obesity as just another lifestyle choice is also choosing to accept having more babies die from the complications of premature birth. One of the unavoidable consequences of reducing the stigma of obesity is that it has resulted in significant cost, including the death, of babies. Are you one who succumbs to political correctness and avoids offending anyone or do you value the lives of unborn children?

Saving the best [or perhaps the worst] for last is the absolute deplorable choice of mothers to inflict harm upon the development of their unborn children through premature birth. These mothers are choosing to subject their children to potential life threatening conditions in addition to long term health and development adversities. Elective inductions prior to full-term increase the probability of cesarean section, respiratory distress and cognitive deficiencies as well as behavioural difficulties. Babies delivered at 35 weeks as opposed to full term have brains that are one-third less in weight.

The plan of the Indiana Department of Health includes reducing smoking and obesity while promoting and increasing safe sleep practices and breastfeeding.

The benefits of breastfeeding to both mother and child are overwhelming. Yet we still have a high proportion of mothers who choose not to breastfeed or seek to prematurely ween the child [prior to three years of age]. Latinos have the highest rate of breastfeeding while blacks have the lowest. I suspected that there would be a correlation between prenatal care in the first trimester and breastfeeding – surmising that both reflected the same lack of care. This did not hold true though. Mothers who chose to receive prenatal care by race/ethnicity are Black 56%, Latino 57%, and White 70%.

Even with lower prenatal care rates Latino women do not give birth to children with nearly the adverse effects that black women do. The adverse effects still exist when standardized for education level. Black college educated women have more than double the rate of low birth weight as compared to white women. The rate is also much higher than that for Latinos.

One of the factors that I thought would be a major contributor to infant mortality was lack of father involvement. Although it was not mentioned during the presentations it was in my later conversations with the participants who confirmed the suspected correlations. The data on marriage seems to confirm this. Although there are unmarried parents who function and support each other and their children, both born and unborn, better than married parents the norm for unmarried parents is a lack of father involvement in the pregnancy which declines over the lifetime of the child. The rates of unmarried parents are; Black 79.9%, Latino 48.6%, and White 37.8%.

I came away from the Summit being reassured that the harms which befall the unborn children and those in their first year are nearly all preventable and are the result of the decisions made by parents. As with most harms that parents inflict upon their children, infant mortality is just another of the acceptable consequences that parents often feel is the result of the inconvenience that would be imposed upon them if they were to make logical lifestyle decisions that demonstrated love for their children.

Governor pence had some poignant remarks about the infant mortality issue. In emphasizing the importance of father involvement he said, “I have a PhD in D-A-D” and provided related anecdotes. He challenged participants to “think fresh about how we confront this challenge” and cautioned that “government will not do this alone.”

While infant mortality is usually the result of choice it is not nearly as often as intent. Those who made the choice to subject their babies to the potential for death still feel the heartbreak of that loss. I trust that I have provided some information here that can give you the knowledge to make responsible choices and to help those who are pregnant or plan to become so do the same. As Governor Pence said, “This is not about reducing numbers but about reducing heartbreak.”

If your client is a father in a paternity or dissolution action wanting to be more involved in the life and well-being of his child then please visit my website and contact my scheduler to make an appointment to meet with me. There is no charge for initial attorney consultations.

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©2008, 2013 Stuart Showalter, LLC. Permission is granted to all non-commercial entities to reproduce this article in it's entirety with credit given.

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