High incidences of drug abuse, teen pregnancy and poverty have pushed Baltimore to third among big cities in the number of children who die before they reach their first birthday, said city health officials reacting yesterday to a report by the Children's Defense Fund.
"To be ranked third in the nation is pretty depressing to us," said Elias A. Dorsey, acting commissioner of the Baltimore Health Department.
"I think we need to do more outreach, but I can't get away from the fact that the addiction problems are hurting us," Mr. Dorsey said. "When you're addicted, nothing else much matters."
Although infant mortality in Baltimore was strikingly higher among blacks than it was among whites, white Baltimoreans also showed high infant-mortality rates relative to other U.S. cities.
Infant mortality among whites was the third highest among U.S. cities, at 12.9 deaths per 1,000 live births. The mortality rate among Baltimore's black children was ninth among U.S. cities in that category, at 20.4 deaths per 1,000 live births.
Overall, the study based on 1988 National Center for Health Statistics data showed that 18 of every 1,000 children born in Baltimore died before their first birthday. Only two other cities with populations larger than 500,000 had higher infant mortality rates -- Washington, with 23.2, and Detroit, with 21.0. The rate was higher in Baltimore than it was for any prior year dating back to 1980 except for 1987, when the rate here was 19.2.
Health officials said the high death rate among Baltimore's infants is particularly troubling because such mortality is an indicator of the quality of health within a region. High rates of infant mortality are typically associated with Third World nations with poor health-care systems.
The high rates in Baltimore are frustrating to health-care advocates and city health officials because they know the principal cause of infant mortality -- low birth weight -- and how to prevent the deaths, through prenatal care, nutrition counseling and persuading expectant mothers to avoid drugs, alcohol and cigarettes. More than 12 percent of Baltimore's babies weigh less than 5 1/2 pounds at birth. Those who survive often experience serious medical complications and developmental problems.
