According to the Alabama Department of Public Health the state’s infant mortality rate of 9.1 infant deaths per 1,000 live births in 2016 is the highest since 2008. This represents the deaths of 537 infants who did not reach 1 year of age. There were 59,090 live births in 2016.
“Our infant mortality rate is troubling and disheartening and trending in the wrong direction. Challenges include ensuring mothers have access to healthcare before, during, and after pregnancy, reducing premature births, the opioid epidemic, and addressing persistent racial disparities,” said Acting State Health Officer Dr. Scott Harris.
For reasons not fully understood, disparities in infant mortality by race continue to persist. One major predictor of a woman’s likelihood of delivering a baby preterm is her race. The infant mortality rate for black infants was more than twice that of white infants. The 2016 black infant mortality rate was 15.1 per 1,000, a slight decrease from the 2015 infant mortality rate of 15.3.
According to Dr. Paul Jarris, chief medical officer of the March of Dimes, race or ethnicity does not cause preterm birth, but some racial and ethnic groups face challenges related to racism that have a profoundly negative impact on birth outcomes: inequities in health care, housing, jobs, neighborhood safety, food security and income. For white mothers, infant mortality increased from a record low rate of 5.2 in 2015 to 6.5 in 2016. Of note, the top three leading causes of infant death remain the same: congenital malformation, premature births, and Sudden Infant Death Syndrome.
The percent of preterm births increased in 2016 from 11.7 percent to 12.0 percent. Infants born preterm, before 37 weeks gestation, are more likely to die before their first birthday or face life-long disabilities or chronic health conditions. Low birth weight infants, defined as those weighing less than 5 pounds, 8 ounces, are more than 20 times more likely to die than infants of normal weight. The percent of low weight births in 2016 declined slightly from 10.4 in 2015 to 10.3 in 2016.
Approximately 75 percent of births in 2016 were to women who had adequate prenatal care; 2.1 percent of births were to mothers with no prenatal care. In many states, including Alabama, women whose incomes are not low enough for Medicaid but cannot afford health insurance can qualify for Medicaid once they become pregnant and coverage lasts throughout pregnancy and a few weeks after.
On a positive note, as seen nationally, the percent of birth to teenagers in Alabama continues to trend downward to its lowest ever recorded of 7.7 percent in 2016.
Maternal smoking decreased to 10.1 percent of all live births, the lowest ever recorded. Of the mothers who smoked during pregnancy, 8.1 percent of births were to teen mothers and 10.3 percent of births were to adults.
Strategies to reduce infant mortality in Alabama:
- Increase the use of progesterone to women with a history of prior preterm birth.
- Reduce tobacco use among women of childbearing age.
- Encourage women to wait at least 18 months between giving birth and becoming pregnant again.
- Expand the Well Woman Preventive visit to provide pre-conception and inter-conception care.
- Continue safe sleep education efforts.
- Continue collaborative efforts to address the opioid epidemic.
- Expand the Fetal and Infant Mortality Review activities at the community level.
Initiatives:
- Identifying, studying, and learning the factors that play a role in infant survival; implementing initiatives at the community level to improve infant health and vitality statewide.
- Establishing a Maternal Mortality Review Committee to analyze the maternal deaths that occur within the state so as to improve maternal health outcomes.
Graphs and detailed charts are available at alabamapublichealth.gov.