Infant Death Rates in Mississippi

Erik Eckholm had an interesting but disheartening article in yesterday’s New York Times, “In Turnabout, Infant Deaths Climb in South,” about the escalating infant mortality rates in the deep south, particularly Mississippi. The article raises and briefly examines the common attributional question: Is the trend a consequence of disposition (“Some women just don’t have the get up and go”) or situation (from lack of transportation to hopelessness). We have excerpted a few pieces of the longer article below. But first, consider the following two maps depicting, from top to bottom, rates of childhood poverty and adult obesity.

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For decades, Mississippi and neighboring states with large black populations and expanses of enduring poverty made steady progress in reducing infant death. But, in what health experts call an ominous portent, progress has stalled and in recent years the death rate has risen in Mississippi and several other states.

 

The setbacks have raised questions about the impact of cuts in welfare and Medicaid and of poor access to doctors, and, many doctors say, the growing epidemics of obesity, diabetes and hypertension among potential mothers, some of whom tip the scales here at 300 to 400 pounds.

“I don’t think the rise is a fluke, and it’s a disturbing trend, not only in Mississippi but throughout the Southeast,” said Dr. Christina Glick, a neonatologist in Jackson, Miss., and past president of the National Perinatal Association.

To the shock of Mississippi officials, who in 2004 had seen the infant mortality rate — defined as deaths by the age of 1 year per thousand live births — fall to 9.7, the rate jumped sharply in 2005, to 11.4. The national average in 2003, the last year for which data have been compiled, was 6.9. . . .

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Most striking, here and throughout the country, is the large racial disparity. In Mississippi, infant deaths among blacks rose to 17 per thousand births in 2005 from 14.2 per thousand in 2004, while those among whites rose to 6.6 per thousand from 6.1. (The national average in 2003 was 5.7 for whites and 14.0 for blacks.)

The overall jump in Mississippi meant that 65 more babies died in 2005 than in the previous year, for a total of 481.

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Dr. William Langston, an obstetrician at the Mississippi Department of Health, said in a telephone interview that officials could not yet explain the sudden increase and were investigating. Dr. Langston said the state was working to extend prenatal care and was experimenting with new outreach programs. But, he added, “programs take money, and Mississippi is the poorest state in the nation.”

Doctors who treat poor women say they are not surprised by the reversal.

“I think the rise is real, and it’s going to get worse,” said Dr. Bouldin Marley, an obstetrician at a private clinic in Clarksdale since 1979. “The mothers in general, black or white, are not as healthy,” Dr. Marley said, calling obesity and its complications a main culprit.

Obesity makes it more difficult to do diagnostic tests like ultrasounds and can lead to hypertension and diabetes, which can cause the fetus to be undernourished, he said.

Another major problem, Dr. Marley said, is that some women arrive in labor having had little or no prenatal care. “I don’t think there’s a lack of providers or facilities,” he said. “Some women just don’t have the get up and go.”

But social workers say that the motivation of poor women is not so simply described, and it can be affected by cuts in social programs and a dearth of transportation as well as low self esteem.

“If you didn’t have a car and had to go 60 miles to see a doctor, would you go very often?” said Ramona Beardain, director of Delta Health Partners. The group runs a federally financed program, Healthy Start, that sends social workers and nurses to counsel pregnant teenagers and new mothers in seven counties of the Delta. “If they’re in school they miss the day; if they’re working they don’t get paid,” Ms. Berdain said.

Poverty has climbed in Mississippi in recent years, and things are tougher in other ways for poor women, with cuts in cash welfare and changes in the medical safety net.

In 2004, Gov. Haley Barbour came to office promising not to raise taxes and to cut Medicaid. Face-to-face meetings were required for annual re-enrollment in Medicaid and CHIP, the children’s health insurance program; locations and hours for enrollment changed, and documentation requirements became more stringent.

As a result, the number of non-elderly people, mainly children, covered by the Medicaid and CHIP programs declined by 54,000 in the 2005 and 2006 fiscal years. According to the Mississippi Health Advocacy Program in Jackson, some eligible pregnant women were deterred by the new procedures from enrolling.

One former Medicaid official, Maria Morris, who resigned last year as head of an office that informed the public about eligibility, said that under the Barbour administration, her program was severely curtailed.

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Oleta Fitzgerald, southern regional director for the Children’s Defense Fund, said: “When you see drops in the welfare rolls, when you see drops in Medicaid and children’s insurance, you see a recipe for disaster. Somebody’s not eating, somebody’s not going to the doctor and unborn children suffer.”

Visits with pregnant women and mothers in several Delta towns suggest that many poverty-related factors — including public policies, personal behaviors and health conditions — may contribute to infant deaths.

Krystal Allen, a cousin of Jamekia Brown’s, was 17 when she had her first baby. When he was 4 months old, she said, he developed breathing problems. Ms. Allen took the child to an emergency room, where he was put on a vaporizer and given an antibiotic and a prescription and they were sent home, where they slept for a few hours.

“When I woke up I thought he was sleeping, and I was getting ready for church,” Ms. Allen said. “But he was dead.”

Now 21, a mother of two with a third on the way, Ms. Allen lives in a sparsely furnished house in Hollandale with her unemployed boyfriend and his mother. Her children live with her parents.

Ms. Allen greeted visitors with breakfast in hand: a bottle of Mountain Dew and a bag of chips.

Janice Johnson, a social worker with Delta Health Partners, urged her to eat more healthily. “I’m going to change my diet one day,” Ms. Allen replied.

She had been to a doctor for one visit but had to sign up for Medicaid to get continued care. That required a 36-mile trip to an office in Greenville.

“Can’t you go this Friday?” Ms. Johnson asked.

“Well, if my mom is going to Greenville,” Ms. Allen replied, “and if she has gas in the car.”

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For the complete article and additional images click here.