MEMPHIS, Tenn. — The infant mortality rate in Memphis is up, illustrating the challenge faced by health officials, hospitals and community leaders who are fighting to reduce the number of babies who die before their first birthday, officials said.
Two straight years of significant decline led officials last year to praise a concerted, community-wide effort to address the infant mortality rate, a measure considered to be a good indicator of the general health of a community.
But an uptick in the rate has caused some concern, tempered by hope and determination.
The health department in Shelby County, which includes Memphis, reports that the infant mortality rate in 2012, the latest year for which data is available, was 10.6 deaths per 1,000 live births. That's up from 9.6 in 2011 and 10.3 the year before, though not as high as the nearly 15 babies per 1,000 live births reported by the county 11 years ago.
The health department has enlisted help from national and community organizations, social workers, faith-based groups, businesses and hospitals in its campaign. They've sought to improve what experts call the "social determinants" of health, including education, income and living conditions. Other targets are reducing teenage pregnancies and improving prenatal care, nutrition and stress management for expecting mothers.
But, despite several programs designed to make pregnant women healthier and protect at-risk babies, the 2012 increase shows that the battle against infant deaths is a difficult one.
"We're hoping that 2012 was an anomaly and that things will turn around and head back down again," Yvonne Madlock, director of the Shelby County Health Department, said Wednesday. "But it does point out to me that it does take sustained, continuous, collaborative effort to really move the needle in a consistent fashion on an issue as complex as infant mortality."
Shelby County ranked worst in infant mortality in 2003, according to an Associated Press analysis of Centers for Disease Control and Prevention data for large U.S. counties with more than 12,000 births that year. Ranking just below were the counties that include Detroit, Philadelphia and Milwaukee, along with Prince George's County, Md., in suburban Washington.
The rate of 15 baby deaths per 1,000 live births in 2003 was worse than many developing nations, including French Guiana, Kuwait, Lithuania and others.
Nationally, the United States' infant mortality rate was 6.05 per 1,000 live births in 2011, the most recent year for which national statistics were available, according to the CDC. The 2011 rate is a marked improvement from 2003, when it was 6.84.
The CIA World Factbook, meanwhile, estimates that the U.S. rate for 2013 will be 5.9 deaths per 1,000 births, higher than about 50 other nations.
From 2005 through 2011, the U.S. infant mortality rate declined most rapidly for black women, the CDC says, but there is still a disparity between blacks and whites. In Shelby County, the death rate among black babies in their first year was 14.1 per 1,000 births in 2012, up from 13 the year before. Still, the 2012 rate is much lower than the 21 deaths per 1,000 births nine years earlier.
Factors that put babies at risk in their first year include premature births, low birth weights, birth defects and other causes. A main problem is sub-standard prenatal care, while other obstacles include poor long-term health care for women, smoking and drug use by expectant mothers and Sudden Infant Death Syndrome.
Pregnant mothers with low income and no insurance have a harder time getting good prenatal care and good advice about how to prepare for a birth, experts say. As a result, the county has implemented strategies such as home visitation programs, where counselors visit expectant mothers in their homes and remind them to eat healthy foods, attend doctors' appointments and take their medications.
The counselors also give them simple but important tips, such as advising them that babies should always sleep in cribs and alone rather than in beds with their parents or siblings.
Also available is the Centering Pregnancy program, which allows groups of pregnant women to attend doctors' appointments in groups so they can share experiences and educate themselves about the challenges of pregnancy.
The health department also makes a strong effort to make sure low-income pregnant women have insurance coverage. A separate statewide campaign targets preventable, sleep-related deaths.
Most programs offered by Shelby County and Tennessee come at no cost to the pregnant woman. They are funded by grants, tax dollars and private donations.
Most recently, the county launched the B4BabyLife mobile app campaign, which features information about pre-conception, breastfeeding and safe sleeping. It also provides contact information for public health clinics as well as information specifically for fathers.
"We need sustained effort in the medical area, in the support area, a sustained effort that has to happen over a continuum of time," Madlock said.
In Memphis, Le Bonheur Children's Hospital has home visitation programs, including one that meets with low-income teenage mothers. Another hospital campaign focuses on the danger of shaking babies.
The hospital also has a 60-bed neo-natal intensive care unit, one of only two in Tennessee, where the death rate was 7.2 babies per 1,000 live births in 2012.
"Every child that's born has the potential to do something great in the world, and so every loss is something that the whole world loses," said Meri Armour, president and CEO of Le Bonheur. "So yes, we view it very seriously. ... We have a lot more work to do."