Epicenter of infant mortality - Limited health care has chilling effect on some families

from the Brooklyn Heights Courier

A human tragedy continues to unfold in central Brooklyn.

The communities at the heart of the borough persist as an epicenter of infant mortality, due in large part to the fact that access to quality, timely health care is limited, both for mothers-to-be and their young infants.

Sadly, this situation endures despite the fact that there have been some gains made in certain areas, thanks to intensive grass-roots efforts at working with mothers-to-be in neighborhoods traditionally under-served in the arena of health.

Indeed, the risk of death is more than three times as high for a black baby in his or her first year of life as it is for that baby’s white counterpart, and more than twice as high for a Puerto Rican infant as for a Caucasian infant, according to Ngosi Moses, the executive director of the Brooklyn Perinatal Network (BPN).

The impact of this on Brooklyn residents is anything but theoretic. The borough is second to the Bronx in the rate of infant mortality (with an average of 6.6 infant deaths per 1,000 live births, compared to 7.1 in the Bronx), according to the New York City Department of Health and Mental Hygiene (DOHMH).

In addition, Moses stressed, six of the 10 community districts in the city with the highest infant mortality rates are in Brooklyn, with five in central Brooklyn. “Some parts have had improvements, but not what we would like to see,” noted Moses.

Even more frightening, while New York City infant mortality rates have decreased overall (to 6.1 per 1,000 live births in 2004, a six percent reduction from 2003), the rate for black infants has risen, particularly in certain neighborhoods, Moses said.

“One of our big concerns is that national trends in black infant mortality went up, and it also went up in New York City,” she explained. “We have seen disparities increase from two-fold to three-fold.”

Increasing Disparity

Using DOHMH statistics from 2004, Moses pointed out that the disparity in infant mortality rate between blacks and whites, “Has been increasing over the past four years as blacks’ infant mortality rate increased by 16 percent while the white infant mortality rate declined by almost the same amount (15 percent) over the same period.”

These frightening statistics were outlined in a May 4th letter from Moses to community residents, urging support for efforts by BPN and other community-based organizations to keep funding in the city budget for their work.

Moses pointed out in the same letter that, “The infant mortality rate for Hispanics of Puerto Rican descent is 7.5 (per 1,000 live births), which is 67 percent higher than that of all other Hispanics” (4.5 deaths per 1,000 live births).

DOHMH acknowledged in a 2005 statement on the agency’s website, “Infant mortality rates vary by borough, with higher rates in New York City’s poorest neighborhoods.”

And, said DOHMH Commissioner Thomas Frieden, in discussing the statistics, “While overall rates have decreased, several communities account for a disproportionate share of infant deaths. And, as in previous years, the rates for black and Puerto Rican infants were higher than other groups.”

According to the DOHMH statistics for 2004 quoted by Moses, Community District 17, which includes East Flatbush, has the second highest infant mortality rate citywide, and the highest in Brooklyn, with 12.3 infant deaths per 1,000 live births.

For the purpose of calculating infant mortality, deaths are considered as infant mortality if the child dies before his or her first birthday.

Right behind CD 17 is Community District 13, which includes Coney Island and Brighton Beach, with an infant mortality rate of 11 per 1,000 live births. CD 13 has the second highest infant mortality rate in the borough, and the third highest citywide. CD 13 is the only one of the six Brooklyn CDs in the group which is not a part of central Brooklyn.

Community District 16, which includes Brownsville, is third in Brooklyn and fourth citywide in infant mortality, with 10.7 infant deaths per 1,000 live births. The individual neighborhood of Brownsville, according to DOHMH, had “The highest infant mortality rate in the city” (12.2 deaths per 1,000 live births) in 2004.

Community District 5, which includes East New York, had the fourth highest rate of infant mortality in the borough, and the sixth citywide, with 10.2 infant deaths per 1,000 live births.

Community District 9, which includes south Crown Heights was fifth in the borough and eighth in the city in infant mortality; there, 9.8 infants died before their first birthday per 1,000 live births.

Community District 8, which includes north Crown Heights, is not far behind, with 8.8 infant deaths per 1,000 live births, giving it the sixth highest infant mortality rate in the borough, and the ninth highest citywide.

Looking Deeper

What’s going on here? Studies have attributed the striking disparity, at least in part, to, “Socio-economic conditions (high poverty and income inequality) in families at risk; patterns of racial segregation and other forms of discrimination that might affect both incomes and access to health services; and inadequate levels of health care access by mothers in poorer neighborhoods,” according to a fact sheet distributed by BPN.

The higher infant mortality rate correlates as well to a higher rate of premature births and low birth-weight babies. Babies born prematurely, with low or very low birth weights, are at increased risk of many different health complications – not only the possibility of an early death, but long-term physical and learning disabilities that can be a lifelong disadvantage. Yet, in inner city neighborhoods, interventions to help prevent such births are limited by a variety factors.

“Distrust of the system, lack of access, quality of care, timeliness of access, things to do with culture, migrating from one culture to another” all play a role in hobbling these mothers’ ability to give birth to thriving babies, said Moses.

“A lot of people show up for delivery at an emergency room without having prenatal care,” she acknowledged. “A lot of women get care late or not at all. A lot of immigrants feel they don’t have to because they wouldn’t have, at home. They don’t realize what stresses in this country can make pregnancy more risky than at home.”

Added Pressure

And, Moses added, the situation isn’t likely to improve as health care facilities in central Brooklyn shut their doors.

“We do know that, in the central Brooklyn area, maternal child health services are disappearing rapidly,” emphasized Moses, citing the recent closures of St Mary’s Hospital, a maternal-child health service at Kingsbrook Jewish Medical Center and the Lyndon B. Johnson Community Health Center.

These closures included the shut-down of two WIC (Women Infants Children) centers, which provided support to mothers who urgently need it. “These sort of things aggravate the situation,” she stressed.

Given the fragility of the support system for the most at-risk mothers, organizations such as BPN, Moses said, play a key role in brokering the relationship between young mothers and mothers-to-be and health services that are crucial to their babies’ well-being.

Yet, she noted, the city each year tries to divert funding away from the CBOs and toward larger organizations that, Moses contended, can’t navigate as effectively through the community to reach those who are in crucial need of such services.

“We pride ourselves in reaching many of the women who are hard to reach and helping them to get care, and we think a lot of decreases in infant mortality happened because of programs like ours, but it’s still too high in many areas,” said Moses.

Money Well Spent

This year, BPN and other organizations advocated for $10 million to fund local CBOs that are dedicated to turning the situation around. Ultimately, said Moses, they succeeded in having $7.5 million in funding targeted at high-needs areas restored to the budget as the Infant Mortality Reduction Initiative (representing a $4.8 million city allocation, plus state matching funds), thanks, in large part, to support from two Brooklyn City Councilmembers, Letitia James and Yvette Clarke.

“I think they set the tone to say we are supportive of these organizations,” remarked Moses. “I think they made a huge difference in how DOHMH will see us from now on.”

“If we don’t focus on the health care needs of infants, these children won’t go on to become productive members of society and to attain educational achievement,” noted James. “That’s really what this is all about.”

The money awarded to CBOs for use through IMRI is money well-spent, Moses contended. A relatively small investment, per pregnant mother, can pay huge dividends. “Preventing the birth of two low birth-weight babies can fund a $180,000 health promotion program that will provide more than 50 at-risk pregnant women with intervention to reduce their risk of bearing low birth-weight babies,” said Moses in the BPN fact sheet.

Indeed, she noted during an extended interview, “For $6,000 worth of prenatal care (for a woman who begins to receive it at the end of the first trimester of pregnancy), you are likely to end up with a healthy child,” Moses said. “If you don’t get care and you end up with a premature baby or a low birth-weight baby, or if the mother has risk factors, costs start at about $90,000. For a very low birth-weight baby, that doubles to $180,000. And, that’s only for the first period. Annual costs remain at that level.”

This all adds up, said Moses, to, “Millions of dollars spent that could be saved if early investment is done.”

School Days

Just think of education costs alone. Approximately half of children in special education, said Moses, were low birth-weight babies who had “challenges developing, and were slow learners.”

Lack of prenatal care, “Impacts the health of the child and costs taxpayers millions of dollars for one child, compared to a child that had a normal birth,” she stressed. “When you take the additional burden on society, the cost is enormous, and it’s a drain on communities that don’t have a lot of resources to begin with.”

Looking ahead, said Moses, a key to reversing the situation is to fund targeted programs in communities with high infant mortality rates, in conjunction with economic development in these communities. “There needs to be a redistribution of resources, targeting them sufficiently to communities at high risk,” Moses contended.

Right now, she said, “Providers are cash-poor and they are required to provide all the help to families who are cash-poor. That’s a recipe for disaster. We are given a little but told to do a lot, that numbers matter. Economic development would tie directly to making sure the organizations in the community are funded to provide jobs.”

That, Moses said, would be an investment in the future that could reap huge dividends – not merely in financial terms but in terms of building families whose members are happy, healthy and productive members of society.