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What Can Healthcare Providers Do to Help Reduce Infant Mortality Rates?

Read what fellow providers have to say!

Vijaya K. Hogan, DrPH
Infant mortality is, in essence, a social problem that results in medical consequences for the infant. In addition to providing good care, one thing providers can do to improve infant mortality rates is to be strong advocates for the social and environmental changes in the larger community that will improve the lives of their most vulnerable neighbors. Physicians possess the power of a respected voice in communities by virtue of the hard-earned "MD" next to their name, and can leverage their power to affect the multitudes in addition to affecting "one patient at a time."

Vijaya K. Hogan, DrPH
Clinical Associate Professor
Department of Maternal and Child Health
Gillings School of Global Public Health
The University of North Carolina at Chapel Hill
Nan Streeter, M.S., R.N.
While not all infant deaths are preventable, we do know that there are some practical things that a provider can do to reduce the risk of infant death, including:
  • Ensuring that a woman with a high risk pregnancy delivers at a facility that has both tertiary level maternal-fetal and neonatal capacity to care for the highest risk mothers and infants; delivering at a hospital with only tertiary level neonatal capacity doesn't address the need for tertiary care for the mother to ensure the best possible outcomes
  • Prevention of subsequent preterm birth among women with a history of preterm birth with 17P.
  • Advising women BEFORE pregnancy to get their weight within normal ranges because obesity impacts fertility and pregnancy outcomes
  • Avoiding elective inductions until the 39th week, unless medical indications warrant induction
  • Advise women about the danger signs of pregnancy, such as decreased fetal movement
Nan Streeter, M.S., R.N.
Utah Department of Health
Deputy Director, Division of Family Health and Preparedness
Director, Maternal and Child Health Bureau
Kay A. Johnson, MEd, MPH
Give attention to preconception health in each clinical visit for a woman of childbearing age. Include a discussion of the reproductive health plan for every woman, every time.

Kay A. Johnson, MEd, MPH
CDC Office of Minority Health and Health Disparities (OMHD)
Health care providers should advise their patients about factors that affect birth outcomes, such as maternal smoking, drug and alcohol abuse, poor nutrition, stress, insufficient prenatal care, chronic illness or other medical problems.

CDC Office of Minority Health and Health Disparities (OMHD)
CDC Office of Minority Health and Health Disparities (OMHD)
What can Communities and Individuals do to Help Reduce Infant Mortality Rates?
Communities can play an important role in this effort by encouraging pregnant women to seek prenatal care in the first trimester and educating communities, providers, pregnant women and family members on factors that affect infant mortality such as smoking, substance abuse, poor nutrition, lack of prenatal care, medical problems, chronic illness, and sudden infant death syndrome (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 slept on their stomachs or sides were at a higher risk for SIDS. A separate but proximate sleeping environment is recommended such as a separate crib in the parents' bedroom.

CDC Office of Minority Health and Health Disparities (OMHD)
Angel Hopson
You can't teach what you don't know. Providers should be well informed about risk factors that contribute to high rates of infant mortality, know who is at higher risk and why.

Physicians can write Infant Safe Sleep recommendations on prescription pads or have them pre-printed.

Providers should also promote exclusive breastfeeding. It is easy to have a pre-printed fact sheet of benefits of breastfeeding.

Angel Hopson,
Maternal, Child, and Adolescent Health
Fetal and Infant Health Program Coordinator
Los Angeles Department of Public Health
Dona Booe, President/CEO of Kansas Children's Service League
The single most important effort providers can make to reduce infant mortality is to increase access to evidence-based home visitation programs like Healthy Families America.

The Kansas Children's Service League Healthy Families America (KCSL HFA) program serving more than 550 families a year among 18 Kansas counties has found a 98% success rate in preventing child maltreatment among infants and young children ages birth to 5. The families served enter the KCSL HFA program prenatally or at birth with multiple risk factors and a 50% likelihood of child maltreatment with no intervention (DuMont, et. al., 2011; Wiese & Daro, 1995).

The KCSL HFA program is built upon a National Program Model demonstrating "markedly lower rates of confirmed Child Protective Service reports and initiation of child welfare services through Age 7 for a subgroup of mothers who had confirmed Child Protective Service involvement prior to random assignment" (DuMont, et al., 2010).

In fact, the Healthy Families program found an 88% reduction in the average number of acts of very serious child abuse for children under the age of one and "after considering earnings and savings associated with reduced child welfare system involvement and other government programs, Healthy Families New York generated a return of more than $3.00 for every dollar invested in this subgroup of families (DuMont, et al., 2008, Child Abuse & Neglect).

Further, the KCSL HFA program also works to improve birth and health outcomes. As found in the Healthy Families New York (HFNY) randomized control trial study, "pregnant women who enrolled in HFNY at or before a gestational age of 30 weeks were about half as likely as pregnant women in the control group to deliver LBW [low birth weight] babies. The earlier in their pregnancies that women were offered HFNY, the greater the impact on low birth weight. HFNY was particularly effective in reducing LBW among black and Latina mothers, two groups that persistently experience high levels of poor birth outcomes (Lee et al., 2009, America Journal of Preventive Medicine).

Dona Booe, President/CEO of Kansas Children's Service League
Adrienne Foster, Executive Director of Kansas Hispanic & Latino American Affairs Commission
Thomas T. Chiu, MD, MBA
As a neonatologist, we try every day to save baby lives in the neonatal intensive care units. Our efforts will help to lower the incidence of infant mortality but only to a limited extent. The focus of our work should be concentrated on prevention and education-enhancing prenatal care, treating medical ailments and infections before deliveries and preventing adolescent pregnancies will make a bigger impact on infant mortality than just focusing on treatments after birth.

Thomas T. Chiu, MD, MBA
Professor and Chairman
Department of Pediatrics
University of Florida College of Medicine - Jacksonville
Jeffrey L. Goldhagen, M.D.
Infant mortality is the result of the complex interplay of biological, genetic, social and environmental determinants. Health care providers are in a unique position to address all of these contributing factors through clinical care, advocacy and the generation of relevant public policy. With advances in our understanding of the life course sciences and the impact of the pre-conceptional health of women on birth outcomes, it is imperative that physicians respond to the social epidemiology of women's health beginning in early childhood.

Jeffrey L. Goldhagen, M.D.
Professor and Chief Division of Community Pediatrics
University of Florida College of Medicine-Jacksonville
Member, Northeast Florida Healthy Start Coalition, Inc.



Content Last Modified: 7/11/2011 3:44:00 PM
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