Drop in infant death rate isn’t reflected across racial divide

The Affordable Care Act has helped fund home visits and save lives; many call for expansion of programs

Despite a 13% drop in the national infant mortality rate over nearly a decade, there remains a stubborn gap between the rates for black Americans and other racial groups as well as between some Southern states and the rest of the country.

The most proven and promising way to reduce the disparities in premature births that lead to death — home visits by nurses— got a boost in the Affordable Care Act, but it reaches only a fraction of those in need, policy experts say.

The ACA funding of nurse home visits covered 115,000 families in 2014, while about 1.8 million births a year — nearly half — are covered by Medicaid, the health care program for low- income families. Still, a report in 2012 by the Pew Charitable Trusts found fewer than a third of state Medicaid programs fully covered home visits.

Black infants overall continue to die at a rate more than twice that of white babies and some parts of the country have racial gaps that are far wider.

Black mothers are twice as likely to have costly premature births because of factors including poor access to health care and health problems. This contributes to the USA having one of the highest death rates among developed countries.

It would cost state and federal Medicaid programs about $ 60 billion over 10 years to extend nurse home visits to all eligible mothers, but the savings from preventing premature births alone would be nearly $ 21 billion after that decade, the Center for American Progress estimates.

Hospital stays for premature and low birth weight babies average about $ 15,000 and 13 days, compared with $ 600 and about two days for births without complications.

The emotional and economic impact is staggering. More than 23,000 babies a year die before their first birthdays. Mothers who received little or no prenatal care are about 40% more likely to have a child that dies in infancy.

Babies that are born very prematurely often have “severe mental and physical illnesses that are an additional strain for a mother who might have been scraping by to begin with,” says Janis Orlowski, chief medical officer of the Association of Academic Medical Centers.

The Center for American Progress estimates expanding the Nurse- Family Partnership to Medicaid- eligible firsttime mothers nationally would prevent 20,000 deaths and more than 400,000 premature births over 10 years. Other studies have found the NFP visits reduced child abuse and neglect by nearly 50% and arrests of the children by age 15 by up to 60%.

This evidence prompted the center to call on the federal government in November to give states the option of covering nurse home visits with Medicaid funds and to loan states additional money needed to expand the programs more.

There’s broad bipartisan support for home visits. Proponents includes former president George W. Bush, who was first to propose federal funding for it; House Speaker Paul Ryan, who included it in his 2014 poverty plan; and President Obama, who last month proposed $ 15 billion in funding over 10 years to continue and expand the ACA’s home visits.

While the U. S. infant mortality rate is higher than nearly all of the other 33 members of the Organization for Economic Cooperation and Development, some of the difference relates to what others count as a pre- term birth.

The pain caused by an infant’s death can emotionally cripple mothers for years, even if they have access to mental health services, says Joyal Mulheron, who founded live- evermore. org and lost her third child at 5 months old to a congenital abnormality.

Mulheron, who went into debt paying for therapy, has been meeting with church, community and hospital officials to connect with low- income minority mothers who have lost children.

Here in Fairfax County, one of the country’s wealthiest, resources are relatively abundant for low- income new mothers. The infant mortality rate in the county is just 4%, lower than the best state in the country.

Across the Potomac River in Washington, D. C., health officials have cut the infant mortality rate by more than half.

But in one of the city’s poorest wards, the rate is about 10 times higher and close to that of the capitals of Cambodia and El Salvador, according to a report last year by Save the Children.

Beth Glicker, a former labor and delivery nurse does home visits.

Among her challenges is grappling with immigrant clients who are “all horrified to be pregnant,” she says.

“This was not their goal,” says Glicker. “They came here to work.”

Many of the women are victims of domestic violence and were abused as children, “but they want to do better for their children,” Glicker says.