Infant Mortality Rate Jumps in the District

Infant Mortality Rate Jumps in the District

By Avram Goldstein
Washington Post Staff Writer
Wednesday, April 4, 2001; 2:46 PM

After four years of improvements, the District's infant mortality rate took a turn for the worse in 1999, city officials announced this morning.

The number of children who died before their first birthday jumped from 12.5 per 1,000 live births in 1998 to 15 in 1999, the latest year for which statistics are available. The infant mortality rate for African Americans, who comprise the vast majority of D.C. newborns, surged from 15 in 1998 to 18.5 the next year, and the white rate rose even more dramatically, from 3.1 to 8.2.

Infant deaths increased in Wards 3, 4 and 6, but the worst statistics by far were recorded in Ward 8, the area east of the Anacostia River that has the city's largest population and its highest concentration of poor children and families.

In 1998, 16 of 1,383 newborns in Ward 8 died in their first year. In 1999, that figure rose to 34 among 1,237 live births.

"We don't have a methodology to tell you exactly what happened," said DC Health Department Director Ivan C.A. Walks. "We know the increase was tied to low birthweight and infections. . . . We are determined to understand this better."

Infections, particularly Streptococcus B, are a major contributing factor in prematurity and low birthweight. Walks also said the number of babies who did not survive included a larger number of those delivered with at least one other sibling. In 1998, the deaths included nine infants involved in multiple births, and the next year that jumped to 22, Walks said.

The number of births to D.C. residents has been on a long and steady decline. In 1990, there were 11,806 births and 236 infant deaths. In 1999 that had dropped to 7,513 births and 113 deaths.

The rates do not count nonresidents born in District hospitals and do account for District residents born elsewhere. Collecting the data from vital statistics agencies in other jurisdictions is the main reason it takes more than a year to compile reports, officials say.

Although much remains unknown about the causes of persistent racial disparities in infant mortality, medical experts and social scientists view the rate as a key measure of a community's overall health and well being.

Researchers have not yet decoded the ways in which social, psychological, economic, environmental and medical factors contribute to low birth weight and prematurity – two of the biggest causes of infant death. Both risk factors are much more prevalent among blacks than whites, epidemiologists say.

Other factors, such as an increase in sexually transmitted diseases or multiple births, which often involve low birth-weight babies, can distort the rate, officials said.

The District made progress in reducing black infant mortality since it peaked in 1990 at 23 deaths per 1,000 live births – a rate found in undeveloped nations. At that time, the nationwide rate for African Americans was 18. In 1998 the national black rate had fallen to 14.1. The 1999 nationwide data is not available yet, Walks said.

Baltimore and Detroit, cities that have similar black populations, also experienced increases in overall infant mortality in 1999, the city said.

Walks said the Health Department is pursuing a multifaceted strategy to steer more pregnant women to full-fledged prenatal care, visit newborns' homes, improve data gathering and press the city's Medicaid health maintenance organizations to meet new performance standards in the care of mothers and babies.

At a media briefing Walks took the unusual step of forecasting a 20 percent reduction in the District's infant mortality rate for 2000 based on partial, preliminary data, which would bring the number of deaths back closer to recent years.

"We're confident we're going to maintain that," he said.