Ensure Infant Health

Back in the mid-1980s, a shocking statistic emerged in New Haven: the infant mortality rate for African American babies was higher than that in many underdeveloped countries. That dismal statistic jump-started a citywide response.

Infant mortality rates⁽¹⁾ (IMR) are an important public health indicator for assessing and comparing the health and well-being of populations. The Commission on Child and Infant Health, a collaboration between health officials, community leaders and child care advocates, was convened by The Community Foundation for Greater New Haven in 1985 in order to address the high infant mortality and morbidity rates in New Haven. Two years later, the overall IMR spiked to 20.2 deaths per thousand births and went event higher - 31 per thousand - for minorities in New Haven.⁽²⁾

Although the overall infant mortality rates have declined since the 1980s (thanks in large part to the work of the Commission and its successor New Haven Healthy Start), there are still marked disparities between the rates for white and Hispanic infants as compared to African American infants. Looking at the most recent data available, from 2008, the IMR in New Haven was 2.5 times higher for black infants (25) as compared to white infants (10) and Hispanics (11).⁽³⁾ The three-year average rate, considered more accurate for IMR, was even more disparate: overall 11 infant deaths per 1,000 live births, with a rate of 6 for white infants, and 19 for black infants (2006-2008 data).

The overall IMR rates in New Haven are much higher than those in the suburbs:

New Haven                            15.6
Inner Ring Suburbs⁽⁴⁾            6.0
Outer Ring Suburbs⁽⁵⁾             3.8
Valley⁽⁶⁾                                    2.9

Advocates and researchers have tied the poor outcomes to several factors, including smoking, substance abuse, poor nutrition, lack of prenatal care, medical problems, chronic illness, sudden infant death syndrome (SIDS), and the stresses of daily life, including racism. While many of these factors disproportionately affect poor women, racism affects African American women across the socio-economic spectrum.⁽⁷⁾ Where individuals live can also affect their health.⁽⁸⁾

What The Community Foundation is doing

After convening the Commission on Child and Infant Health, The Community Foundation applied for federal funding to start a Healthy Start program in New Haven. Since receiving its first federal grant in 1997 to begin New Haven Healthy Start, The Community Foundation has raised nearly $17 million to administer the program. From then to now, the New Haven Healthy Start (NHHS) team has been working to reduce the infant mortality and morbidity rate in the City of New Haven, providing services to more than 20,000 pregnant women and infants through partnerships with maternal and child health care providers to identify gaps in the delivery of pre-natal and post-natal care. The Community Foundation remains the only community foundation in the nation to administer a federal Healthy Start program.

As an African American resident of East Haven, Natasha Ray is a perfect fit for her job as Consortium Development Coordinator for the program. "This work is very important to me," she says, "because I am a mom of four low birth weight babies," ranging from 1 pound 10 ounces to 5 pounds 9 ounces. (The baby born smallest has some developmental disabilities). She began volunteering with Healthy Start right after her last child was born, and was hired three years later.

She says in the 2005-09 Project period of Healthy Start, "We got really strategic and specific to the African American population. We needed an aggressive approach to African American women." She explains that earlier the program focused on working with the city's hospitals and health centers, but has expanded its reach to include homeless shelters and the city's housing authority. "We have 'Baby Buddies' who act like a supportive next door neighbor," she says. "If they see someone in need of care, they notify us." And NHHS is also expanding its focus to a life-course health perspective.⁽⁹⁾

"We're trying to raise awareness everywhere we can," says Ray, "through teen baby buddies, Facebook," as well as more traditional channels. NHHS data show that women in the program have better birth outcomes than the broader community. The overall infant mortality rate among program participants from 2005 to 2009 was 4.0 deaths per 1000 live births. The percentage of low birth weight infants born to program participants during 2009 was 6% ⁽¹⁰⁾ compared to 11% of births to New Haven residents in 2008 ⁽¹¹⁾.

NHHS program participants continue to experience better birth outcomes compared to women in similar cities throughout Connecticut. Approximately 80% of program participants are residents of New Haven while the remaining 20% are from surrounding towns, including West Haven, East Haven and Hamden. ⁽¹²⁾

Members of the NHHS Consortium of Care include the New Haven Health Department, Yale-New Haven Hospital, Hospital of St. Raphael, Cornell Scott-Hill Health Center, Fair Haven Community Health Center , New Haven Family Alliance (Male Involvement Network) , New Haven Home Recovery , Diaper Bank , Christian Community Action , Life Haven Shelter Inc. , Community Action Agency , Yale School of Medicine, Yale Consultation Center , Connecticut Voices for Children , New Haven Housing Authority and the CT Department of Public Health.

Yaritza Roman is an NHHS Outreach/Case Manager working with New Haven Home Recovery. Her enthusiasm for the program, and her clients, bubbles over as she talks. She focuses on reducing infant mortality rates among African American women, "guiding the women along in their pregnancies," she says, "to meet their pre-natal appointments and make sure they're eating healthy, providing support and following through on whatever they say they're going to do." Her clients are homeless, either at the shelter or doubled up with family or friends.

She's worked with a lot of pregnant teens. "At first it's very hard to engage them; they, like normal teenagers, have the 'I don't care mentality,' but once engaged they are good listeners and take advice. Working with older women is sometimes more challenging because they already know what they know. I don't want to come across as a know-it-all or give them wrong information or scare them off."

Her work was especially satisfying in the month of September (2011). "I've had three happy, healthy baby outcomes -- all over 6 pounds -- and I've been talking about this for weeks. They were 6-6, 6-10 and 8-8 and I'd like to think that if the 8-8 baby mom had not had guidance and benefited from casual conversations, it would have been a low birth weight baby. I always try not to make our meetings clinical," Roman says. "It's more casual, so the moms open up." She says she engaged that mom at the level of suggesting she crush her pre-natal vitamins if she was having trouble swallowing them. "And we provide incentives to ensure a healthy start-- new pajamas, brand new books, baby baskets. It's about building a relationship."

Roman describes some of the stress these women are under, around housing and feeding themselves and their other children. Many are also survivors of domestic violence or sexual abuse. "The last thing they're thinking of is themselves. I think this program provides specific support just for that; I think just being there. It's not until someone reminds them, 'You're important too!' that they realize they have to take care of themselves so they can take care of their families."

Heather Reynolds is a certified nurse-midwife, an associate professor at the Yale School of Nursing and Co-chair of NHHS Perinatal Partnership. She knows well the tragedy of infant mortality and the problems associated with low birth weight. She was part of the Special Commission on Child and Infant Health from the beginning.

"We looked at some of the barriers to women accessing early and continuous pre-natal care, including having a voice in the care they received," she says. "We began assessing psycho-social and physical needs and connecting them to resources." The Commission evolved into the Perinatal Partnership, which is an advisory body to Healthy Start. There's also a Community Consortium to weigh in on whether the program is meeting families' needs or not, which includes the Male Involvement Network of New Haven Family Alliance.

Reynolds points out that the city's infant mortality rate spiked again recently, due to a number of factors, including increasing obesity of women of child-bearing age, leading to pregnancy-related problems. Conversely, obesity increases the difficulty in conceiving, leading some to in-vitro fertilization and possible conception of twins or higher multiples, which brings its own set of risks like pre-term labor and likely low birth weight deliveries. "African American and Latina women have higher levels of obesity," she says, underlining the racial disparities. She adds that a lack of mental health services or dental care can contribute directly to poor perinatal outcomes, and the economic downturn has made accessing care harder for some and raised the stress level for many. She's hopeful that City-sponsored Health Matters will get members of the community involved. "We can start to look at what kind of programs would be helpful. It may not require a lot of money, but participation from the community."

What else is being done

The New Haven Health Department, with the help of many community partners, was selected to serve as a pilot site for the Health Equity Alliance⁽¹³⁾, a project of the Connecticut Association of Directors of Health (CADH).⁽¹⁴⁾ The goal of the Health Equity Alliance (HEA) is to create the conditions necessary for people to be healthy rather than treating them after they have already become sick. This will require dramatic change in focusing the city’s policy reforms and investments towards prevention while working to eliminate health disparities. An outgrowth of this work has been the formation of Health Matters, an ambitious movement to improve the health status of the City of New Haven and make New Haven one of the healthiest cities in the nation! ⁽¹⁵⁾

New Haven has also been designated one of five cities to participate in a collaboration of the National Healthy Start Association, the Association of Maternal and Child Health Programs and CityMatCH specifically to address the role of racism in higher rates of infant mortality and low birth weight. In 2008, with funding from the Kellogg Foundation, these three organizations created the Partnership to Eliminate Disparities in Infant Mortality to eliminate racial inequities contributing to infant mortality in U.S. cities.

What you can do

Communities play an important role in this effort by encouraging pregnant women to seek prenatal care in the first trimester and educating providers, pregnant women, spouses, partners and family members about factors that affect infant mortality. With regards to SIDS, parents and caregivers should become familiar with the risk factors and always place sleeping infants on their backs. Research has demonstrated that babies who sleep on their stomachs or sides are at a higher risk for SIDS. A separate but proximate sleeping environment is recommended, such as a separate crib in the parents' bedroom, to avoid rolling over on the child.⁽¹⁶⁾

Communities and individuals can also advocate changes at the policy level. Disparities in infant mortality rates are an example of the larger issue of health disparities. In April, 2011, the U.S. Department of Health and Human Services released two strategic plans to reduce health disparities and achieve health equity in the U.S.⁽¹⁷⁾

Individuals can also contribute to any number of NHHS partner organizations, many of which are on giveGreater.org, or directly to The New Haven Healthy Start/Male Involvement Network Fund at The Community Foundation. Already have a fund at The Community Foundation? Make a grant recommendation to support a NHHS partner by logging on to DonorCentral. You can create change with just a click of the keyboard.
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⁽¹⁾ Number of deaths among infants aged less than a year per 1,000 live births.
⁽²⁾ More infants can be saved: City renews health attack on preventable deaths (New Haven Register Editorial, 1/21/01)

⁽³⁾ State of Connecticut, Department of Public Health. published data. Table 2B: Connecticut, 2008: Resident Births, Deaths, Fetal Deaths, and Infant Deaths by Race and Hispanic Ethnicity for Counties, Health Districts and Towns.
⁽⁴⁾ East Haven, West Haven, Hamden
⁽⁵⁾ Bethany,Branford,Cheshire,Guilford,Madison,Milford,North Branford,North Haven,Orange,Wallingford,Woodbridge
⁽⁶⁾ Ansonia, Derby, Oxford, Shelton, Seymour

⁽⁷⁾ African American Infant Mortality Commission Fact Sheet; Joint Center for Political & Economic Studies - Health Policy Research & Publications

⁽⁸⁾ Why Place Matters: Building the Movement for Healthy Communities

⁽⁹⁾ Rethinking MCH: The Life Course Model as an Organizing Framework
^{(10), (12)} Data Source: The Community Foundation for Greater New Haven, New Haven Healthy Start Program Database
⁽¹¹⁾ Data Source: Connecticut Department of Public Health, Vital Statistics, 2008, via website: www.ct.gov
⁽¹³⁾ http://www.ctdatahaven.org/know/index.php/Health_Equity_Alliance
⁽¹⁴⁾ http://www.healthequityalliance.us/.
⁽¹⁵⁾ http://ctdatahaven.org/know/index.php/New_Haven_Health_Matters