Trying to Explain a Drop in Infant Mortality

Ta-Shai Pendleton, with her daughters, Savannah and Zaniah, did not have a full-term pregnancy until she moved to Dane County, Wis.
MADISON, Wis. — Seven and a half months into Ta-Shai Pendleton’s first pregnancy, her child was stillborn. Then in early 2008, she bore a daughter prematurely.
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Brandice Hatcher, center, has been getting assistance since learning in June she was pregnant. “I didn’t know how to be a parent,” she said.
Soon after, Ms. Pendleton moved from a community in Racine that was thick with poverty to a better neighborhood in Madison. Here, for the first time, she had a full-term pregnancy.
As she cradled her 2-month-old daughter recently, she described the fear and isolation she had experienced during her first two pregnancies, and the more embracing help she found 100 miles away with her third. In Madison, county nurses made frequent home visits, and she got more help from her new church.
The lives and pregnancies of black mothers like Ms. Pendleton, 21, are now the subject of intense study as researchers confront one of the country’s most intractable health problems: the large racial gap in infant deaths, primarily due to a higher incidence among blacks of very premature births.
Here in Dane County, Wis., which includes Madison, the implausible has happened: the rate of infant deaths among blacks plummeted between the 1990s and the current decade, from an average of 19 deaths per thousand births to, in recent years, fewer than 5.
The steep decline, reaching parity with whites, is particularly intriguing, experts say, because obstetrical services for low-income women in the county have not changed that much.
Finding out what went right in Dane County has become an urgent quest — one that might guide similar progress in other cities. In other parts of the state, including Milwaukee, Racine and two other counties, black infant death rates remain among the nation’s highest, surpassing 20 deaths per thousand in some areas.
Nationwide for 2007, according to the latest federal data, infant mortality was 6 per 1,000 for whites and 13 for blacks.
“This kind of dramatic elimination of the black-white gap in a short period has never been seen,” Dr. Philip M. Farrell, professor of pediatrics and former dean of the University of Wisconsin School of Medicine and Public Health, said of the progress in Dane County.
“We don’t have a medical model to explain it,” Dr. Farrell added, explaining that no significant changes had occurred in the extent of prenatal care or in medical technology.
Without a simple medical explanation, health officials say, the decline appears to support the theory that links infant mortality to the well-being of mothers from the time they were in the womb themselves, including physical and mental health; personal behaviors; exposure to stresses, like racism; and their social ties.
Those factors could in turn affect how well young women take care of themselves and their pregnancies.
Karen Timberlake, the Wisconsin secretary of health services, said that in Dane County, the likely explanation lay in “the interaction among a variety of interrelated factors.”
“Our challenge is,” Ms. Timberlake said, “how can we distill this and take it to other counties?”
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