Public Health Approaches to Reducing U.S. Infant Mortality

I'm Dr. John Iskandar. Welcome to CDC Beyond the Data. I'm here today with Dr. Wanda Barfield from CDC's Division of Reproductive Health. So, Wanda we heard today an encore presentation on the topic of infant mortality reduction, a very key marker of public health. What new data or information can you share with us about this, this vital topic? Well, John, since the premiere of the Public Health Approaches to Infant Mortality there's been a lot of exciting work that's been going on. First of all it's really great to say that infant mortality is continuing to decline. Infant mortality in 2011 was found to be 6.05 deaths per thousand live births in the US, and that's for infants less than one year of age. But some of the other things that are really exciting is that the factors that contribute to infant mortality are showing improvement as well. So for example preterm birth we're seeing reductions in infants who were born less than 37 weeks and that's reduced in 2013 to 11.38% which is an all-time low. We're also seeing improvements in systems of care that may help to reduce the risk of infants who are born very preterm. Other areas that are, are exciting opportunities that we're seeing at the state level and this is something where we all need to work together collaboratively- public health, clinical care providers, leaders in state insurance, as well as leaders in hospital systems, to improve the care to infants and mothers. So we've seen then continued decreases in the overall infant mortality rate- decreases in, in preterm birth which according to your Grand Rounds talk is one of the important risk factors and also some, some progress at, at some other levels as well. Now, people may be aware that there are- historically have been racial and ethnic disparities in infant mortality. I understand there are also some geographic disparities. What can you tell us about that? Yes. So you bring up an important point. In addition to still the stark disparities by race that we see with African-Americans having a risk of infant mortality two times that of non-Hispanic whites, we're also seeing disparities with regard to geographic regions and we know for example in the US South in southern parts of the US that we see higher rates of infant mortality. The good news though, is that many of those states are really trying to address the issue of infant mortality and they've been focused mostly on five areas that is the prevention of preterm birth through the reduction of what's called 'early elective deliveries,' also the reduction of smoking in pregnancy. Do you know that one in 10 women during pregnancy are smoking? That's an opportunity for good intervention as well as the risk of something called 'sudden unexpected infant death' which is also- incorporates a disorder called SIDS or Sudden Infant Death Syndrome. They're also trying to focus on safe sleep environments to reduce that risk. But then the other big component is trying to reduce the risk for women prior to pregnancy. How can we improve preconception health? Health of women before they are even pregnant because we know that chronic diseases can contribute to infant mortality through complications in labor and delivery during pregnancy. All right, so we have seen then, really, a range of, a range of initiatives, some that, some like smoking cessation that can be implemented at the clinical provider level. Others that are more occurring at, at the, at the state level, some of our audience may be involved in public health- yes- at state or local levels. Can you talk about some of the state level initiatives to try to sort of learn from what works at that level? Yes. So during Grand Rounds we talked about the beginnings of state initiatives that are focused on reducing infant mortality. One in particular is called the 'Collaboration on Innovation and Improvement Network to Reduce Infant Mortality' and that involves leaders at the state level, it also involves federal involvement from HRSA, Maternal Child Health Bureau, from the Centers for Medicare and Medicaid, as well as CDC, and other federal organizations as well as large clinical and national organizations such as March of Dimes, AMCHP, AAP, ACOG and many other groups working all together to try to help reduce infant mortality. The focus right now is mostly on the southern states. However, this effort is now being launched nationwide and we should soon see efforts that go on throughout the country to reduce infant mortality. So, a- large collaborative efforts involving not only CDC and state and local health departments, but many other partners, but one that really based on what you've just shared with us seems to be saving babies lives and having an important- that's correct- public health impact. Are there any developments in the near term or-or you know what are the-the next frontiers in further reducing infant mortality? So some of the exciting areas for example is, trying to focus on helping pregnant women to quit smoking and as you may know we recently launched the Tips for former-from Former Smokers campaign that's been developed through the office of Smoking and Health at CDC. This particular tips campaign is featuring a mother who had an infant who was born premature and she provides a very important and powerful message about the need to quit smoking even during pregnancy. Ideally, to not smoke at all, but if there's an opportunity to quit it can really make a difference. Also some of the work that we're doing with the National Institute of Health and others is the idea of transitioning from back to sleep to safe to sleep. So that includes a safe sleep environment for infants particularly under one year of age. So making sure that infants are sleeping on their back, that they're alone and in a crib, making sure that there aren't other factors in the bed such as blankets or stuffed animals that help to reduce the SIDS risk, and that was discussed during the talk and during the Grand Rounds about some of the specific risk factors that can be implemented to reduce the risk of SIDS. Very, very, very interesting. I'll-I'll also share since were both commissioned officers that this is the 50th anniversary of the Surgeon General's first report on smoking and there is a report that people may wish to consult which provides a comprehensive overview including issues related to smoking in pregnancy. It's really frankly shocking that one in 10 pregnant women still smoke but I'm glad to hear from you that there are steps being taken to address that. Some of the other areas that were also focusing on at CDC and in collaboration with states is what are called, 'perinatal quality collaboratives.' These are state-based initiatives in which states think about areas that they can improve the quality of care to pregnant women and infants, and it may include also opportunities to not only reduce infant death but maternal death and associated morbidities. That's been an exciting work that CDC has done in collaboration with state health departments and I think that again thinking about the opportunity for high-risk infants to be born at the most appropriate facilities so that they receive the care is also an important issue. We still need to focus on reducing the likelihood of an infant being born premature, especially very premature, but until we do we need to make sure that these infants are delivered at the best facilities possible. So, a wealth of largely positive information. Yes. Thank you very much for sharing that with us today. Please join us next month for the next episode of CDC's Beyond the Data.