combating infant mortality disparities

Trying to Explain a Drop in Infant Mortality

Andy Manis for The New York Times

Ta-Shai Pendleton, with her daughters, Savannah and Zaniah, did not have a full-term pregnancy until she moved to Dane County, Wis.

By ERIK ECKHOLM

Published: November 26, 2009

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.

Multimedia

Graphic

Closing the Infant Mortality Gap

Enlarge This Image

Andy Manis for The New York Times

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.

Enlarge This Image

Andy Manis for The New York Times

Brandice Hatcher got help from a program that provided a security deposit for her apartment.

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?”

Article continues at:

http://www.nytimes.com/2009/11/27/us/27infant.html?_r=1

a time to give thanks

this semester of nursing school has made me a somewhat hateful person. i (along with my fellow nursing students) have had to slug through an immense amount of busy work, an acute lack of teaching in two of our classes and a few particular professors who become defensive like you wouldn't believe whenever students ask them questions about things like, oh, i don't know, syllabi, assignment comments/grading, the logic of having like six things due on the day before an exam... so in the past couple of weeks, when i haven't been slaving away on projects or papers or stealing time away to study for my med-surg class, the most critical clinical class we are taking right now, i feel like i've been raging about school. and it hasn't helped that i've entered the phase of health care provider training when i'm thinking about morbidity and mortality of the people around me all the time. i've just seen a lot more dying people and a lot of patients with diseases that are all too familiar to the health conditions of some family and friends.

but today, on my absolute favorite holiday of the year, one that centers upon the sole premise of giving thanks, i feel incredibly grateful. in nursing school, my fellow students are amazing. absolutely amazing. the support and camaraderie within our class has gotten me through my most enraged moments and given me laughs when i've needed them the most. i definitely don't know everyone in our class of 80+ people-- we're not on campus enough to spend a lot of time together outside of class. but of my classmates i've come to know in my three clinical rotations so far, my seat mates in lecture, my health assessment partners, my occasional T and shuttle bus companions-- thank you for making this semester bearable and for reminding me every day about why we all started nursing school in the first place. i love you guys and there is no way i could do this without you.

obama health care reform = anti-choice america??

finally getting around to reading about the abortion concession (the stupak amendment) made in the health care reform passed by the house of representatives-- i had NO idea the concession was so extreme! is this really the message we want to send on the eve of 2010? hey women, you want an abortion, pay for it out-of-pocket because we don't consider it a medical procedure worthy of the same coverage as any other health care service. are we really preparing to send more and more women for back-alley, coat-hanger abortions? this concession could have unimaginably horrific consequences for women's health should the senate pass the same version of the bill.

if this issue outrages you as much as it outrages me, please call the office of Harry Reid, the Senate Majority Leader. The only way to stop these restrictions from being part of health reform is to keep them out of the bill offered in the Senate, which is a process Reid is in control of this week. Call on Thursday, because the Senate won't be fully open tomorrow (info, phone # and script courtesy of my dear friend alison)

Reid's office number is 202-224-3542.

YOU: "Hello. I'm calling regarding abortion coverage in health-care
reform. I understand that we'll need to compromise on abortion issues
in order to pass the bill through the Senate, but I think the Stupak
amendment goes too far. It's more than just a ban on public funding in
health insurance. With the Stupak amendment, many women would lose the
coverage they already have. I'm calling to ask Senator Reid to include language in the Senate bill that is closer to the compromise language
that the Senate committees already approved."

also, here is an article on the stupak amendment:

House: Yes to Extreme Anti-Choice Politics, No to Women’s Health and Privacy

NARAL Pro-Choice America says fight is not over

November 7, 2009

Washington, D.C. – Nancy Keenan, president of NARAL Pro-Choice America, called House passage of a stunning last-minute anti-choice amendment to health reform an outrageous blow to women's freedom and privacy — and she vowed to fight to remove this provision as the process goes to the Senate.

The amendment, offered by anti-choice Reps. Bart Stupak (D-Mich.) and Joe Pitts (R-Penn.), was adopted late tonight by a margin of 240-194.

The Stupak-Pitts amendment makes it virtually impossible for private insurance companies that participate in the new system to offer abortion coverage to women. This would have the effect of denying women the right to use their own personal private funds to purchase an insurance plan with abortion coverage in the new health system — a radical departure from the status quo. Presently, more than 85 percent of private-insurance plans cover abortion services.

"This vote is a reminder to America's pro-choice majority that, despite our gains in the last two election cycles, anti-choice members of Congress still outnumber our pro-choice allies," Keenan said. "It is unconscionable that anti-choice lawmakers would use health reform to attack women's health and privacy, but that's exactly what happened on the House floor tonight. Even though the bill already included a ban on federal funding for abortion and a requirement that only women's personal funds could pay for abortion care, Reps. Stupak and Pitts took their obsession with attacking a woman's right to choose to a whole new level. We will hold those lawmakers who sided with the extreme Stupak-Pitts amendment accountable for abandoning women and capitulating to the most extreme fringe of the anti-choice movement. In short, the fight is not over. That's why we will continue to mobilize our activists and work with our allies in Congress to remove this dangerous provision from the health-care bill and stop additional attacks as the process moves to the Senate."

ARTICLE CONTINUES AT:

http://www.prochoiceamerica.org/news/press-releases/2009/pr11072009_househcrbillstupak.html

first application is in!!!

after a torturous week of studying my brains out for the med-surg test that made me want to cry, i spent this past weekend torturing myself with the dreaded yale essay, by far the most rigid essay i have to write for my applications. yesterday i finished what i hope is the final version of the essay, which is the only thing standing between me and a submitted application.

in the meantime, i got home tonight and banged out the two essays i needed to write for emory and sent in the application!!! i don't know where in the world i found the energy, but suddenly words just flowed from my fingertips to the computer screen and i loved what i wrote. LOVED. i still don't know if i love my yale essay, or if i ever will, but i've got nothing but love for what i wrote for emory. now the school just needs to accept me and we're good to go.

cannot even begin to describe how elated i am to have one application finished... so i'll just use an excessive amount of exclamation points !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

infant mortality rates: US vs. industrialized world

Am F-R-I-E-D after six straight hours of studying for my third med-surg exam of the semester. I will say that I love studying in the reading room at Copley Libary, easily one of my favorite places to bury my head in books.

Counting down the days (T-minus five weeks!!!!!) for this semester to be over and have a glorious month off!

In news totally unrelated to nursing school, this article caught my eye today. It focuses on why infant mortality is higher in the US than in other industrialized (and some non-industrialized nations).

Premature Births Are Fueling Higher Rates of Infant Mortality in U.S., Report Says

By DENISE GRADY

Published: November 3, 2009

High rates of premature birth are the main reason the United States has higher infant mortality than do many other rich countries, government researchers reported Tuesday in their first detailed analysis of a longstanding problem.

In Sweden, for instance, 6.3 percent of births were premature, compared with 12.4 percent in the United States in 2005, the latest year for which international rankings are available. Infant mortality also differed markedly: for every 1,000 births in the United States, 6.9 infants died before they turned 1, compared with 2.4 in Sweden. Twenty-nine other countries also had lower rates.

If the United States could match Sweden’s prematurity rate, the new report said, “nearly 8,000 infant deaths would be averted each year, and the U.S. infant mortality rate would be one-third lower.”

The first author of the report, Marian F. MacDorman, a statistician at the National Center for Health Statistics, said in an interview that the strong role prematurity played came as a surprise to her.

Dr. Alan R. Fleischman, medical director for the March of Dimes, said the new report was “an indictment of the U.S. health care system” and the poor job it had done in taking care of women and children. The report, Dr. Fleischman added, “puts together two very important issues, both of which we knew about but hadn’t linked tightly.”

Article continues at:

http://www.nytimes.com/2009/11/04/health/04infant.html?_r=1&hpw

obama ends HIV travel ban!

for the past 22 years, the united states has banned travel and immigration of people living with HIV into the country. obama moved today to end this travel ban, effective in 2010!!

http://www.whitehouse.gov/the-press-office/remarks-president-signing-ryan-white-hivaids-treatment-extension-act-2009

a three year old's birthday

today is the haitian boy's third birthday. i haven't talked about him in awhile, but i've been visiting him and his mum at the rehabilitation hospital where they're staying while the boy continues to receive weekly chemotherapy. he is walking on his own now! in the past couple of months, for the first time in his life, he can crawl and walk and run. his gait is still impacted by the weight of the tumor he carried for so long-- when he walks, his feet point outwards and his steps are slightly uneven. but his spine is working to straighten itself out. not only that, his face is full and his body has filled out-- he looks like a proper rolypoly toddler now. and he is beginning to talk more and more. this is the first time in his life where he can interact with people independently, instead of being confined to a hospital bed with the weight of the tumor in his belly. may he live to see his 103rd birthday, free of cancer.

i last visited the boy and his mother last week, when i brought by some lipstick and nail polish for the mum. in my terrible spanish, we're able to communicate somewhat, and the last time i was there, when i asked her if she needed anything, that is what she requested. so we sat and i did her nails while her son ran joyously amok in the hospital room. she talked about how anxious she is about her two older children who are still in haiti, who she hasn't seen since december 2008 because of her little son's hospitalization. she doesn't know what she's going to do when she goes home, because she has no money for them and her family has no money. there is a little bit that can be given to her by the hospital staff in haiti, but i know it isn't much and certainly not enough to support her children through school and ensure that she and her family live in stability. my boyfriend and i have committed to helping her and her family in any way that we can.

on my way home, to my lovely apartment in jamaica plain where i never lack for anything, i thought about the mother and the haitian boy, and of the families across the world who lack the human rights we take for granted (food, shelter, clothes, education, voting rights, etc.) and i thought about the concluding plea of nicholas kristof and sheryl wudunn in their book half the sky, urging their readers to become philanthropists in any way they can to support the poor, particularly women and their families. it is so easy to convince ourselves that we don't have the means to do anything except struggle to keep ourselves afloat, and sometimes, we don't. but even beyond money, there is so much that can be done to advocate for the poor and to acknowledge how privileged we are to be educated and free and to learn about and support people who are not educated and not free.

one thing to do, if you have a chance, is to check out half the sky. it is a pretty quick read and talks about real change happening (and change that could happen) for women and their families all over the world.

if you don't have time to read the book, check out this website:

http://www.halftheskymovement.org/