The rate at which newborns in Maryland die before their first birthday is among the highest in the nation. Though Maryland is also one of the wealthiest states in the country, its 2007 infant mortality rate of 8.0 deaths per1,000 births is higher than those of all the European Union countries as well as places such as Singapore, Hong Kong and Cuba.
In Baltimore, the rate was 11.3 deaths per thousand births last year, comparable to those of Uruguay and Ukraine. And the figure for African-Americans infants was nearly three times that of whites.
Why do so many infants die in Maryland, and what can be done to reduce this appalling loss of life?
Experts say the primary causes of infant deaths are low birth weight and premature births. Infants weighing less than 4 pounds at birth are at significantly greater risk of dying in their first year than babies weighing 5 pounds or more. So-called "micro-preemies" - infants born under 30 weeks of pregnancy and weighing less than 2 pounds - are at the highest risk of all.
The higher infant mortality rate among African-Americans is a reflection of the higher rate of low birth weight and pre-term births among black women.
Although these risk factors are well known, efforts to reduce infant deaths have met with mixed results. Researchers say there's no magic bullet to bring the numbers down. They do agree that infant mortality rates reflect the overall health of women of childbearing age, which in turn is affected by poverty, substance abuse and stress as well as by chronic illnesses such as hypertension, diabetes, obesity, asthma and in-utero infections.
Those rates are also indicators of how poorly many women are served by the current health care system, whose programs are often uncoordinated and spread over several different agencies. If Maryland's high infant mortality rate represents a crisis, it is also a crisis in women's health.
That's why reducing infant mortality must start with improving women's overall health and access to medical care. In Baltimore, for example, health commissioner Joshua Sharfstein is drafting just such a plan. It would begin to address the entire life course of women's health issues, not just the period around pregnancy and birth. The goal should be to ensure that girls and young women get the care they need to be healthy early in life, so that when they reach childbearing age they can avoid the kinds of chronic illnesses and other risk factors that lead to poor birth outcomes.
