Maureen Hayden CNHI Statehouse Bureau
The Batesville Herald-Tribune
---- — INDIANAPOLIS -- Indiana Gov. Mike Pence told public health officials from around the state that the rising number of babies dying in Indiana before they reach their first birthday is “deplorable” and challenged them to think of new ways to combat the state’s worsening infant mortality rates.
“This is not about reducing numbers. This is about reducing heartache,” Pence said Friday, in his opening remarks at the state’s first-ever Infant Mortality Summit.
More than 500 people who attended the summit heard Indiana Health Commissioner Dr. William VanNess say it was “just not acceptable” that Indiana now has one of the worst infant mortality rates in the nation. The rate was 7.7 deaths out of every 1,000 babies born in 2011 (the latest numbers available) compared to the national rate of 6.05 deaths per 1,000 births. That’s make Indiana’s infant mortality rate the 6th highest in the nation.
VanNess said the implications of those numbers are cause for alarm. “Infant mortality is the number one indicator of health status in the world,” said VanNess, an Anderson, Ind., doctor who took on the role of the state’s top health officer earlier this year.
He also acknowledged that public health officials face a major challenge in bringing the infant death rate down since the causes are multiple and complex. There are a range of risk factors for pregnant women, including obesity, smoking and lack of prenatal care, that contribute to higher infant death rates.
Indiana doesn’t fare well: Almost one-third of pregnant women in Indiana don’t receive prenatal care in their first trimester; almost 17 percent of pregnant women are smokers, compared to the national rate of 9 percent; and the state ranks 8th in the number of obese citizens.
The decision to tackle the infant mortality rate also comes at a time when resources are declining: VanNess said state and county health department budgets, two-thirds of which are funded by the federal government, will continue to see cuts.
Miranda Spitznagle, director of the state’s Tobacco Prevention and Cessation Commission, said the state spends $28 million a year for health costs related to infants who’ve been born to mothers who smoke. Yet in May – as a summit attendee pointed out -- the state legislature cut funding for smoking-cessation programs, down to $5 million a year from the $8 million in last year’s budget.
Several summit attendees noted that access to prenatal care is especially difficult in rural areas, where the number of obstetricians are declining rapidly. Of 92 counties in Indiana, 30 have no obstetrical services.
Summit attendees also heard about the racial disparity in infant deaths in Indiana. Dr. Virginia Caine, director of the Marion County Public Health Department, said the number of black infants dying in their first year of life is almost twice the number of white infants dying. One of the fastest growing causes she said was Sudden Infant Death Syndrome: In 2011, 111 black infants died from SIDS, while 61 white infants died from SIDS.
Summit speakers included Dr. David Lakey, an Anderson, Ind., native who now heads the Texas Department of State Health Services. Lakey talked about how he worked with a broad coalition of government, community, and health industry leaders to reduce his state’s high infant mortality rate.
“We have a moral obligation to confront this issue,” Lakey said.
He spoke about the challenges of designing and implementing a statewide plan to reduce infant mortality in what he called the “very conservative” state of Texas, where lawmakers slashed funding for primary healthcare for low-income women in 2009. Some of that funding, including money for family planning, was later restored as part of a comprehensive plan to reduce infant deaths in Texas.
Lakey said Texas state legislators were persuaded to restore the funding in part by an economic argument, since 57 percent of all births in Texas are paid for by Medicaid. He said the average cost to Medicaid for a prematurely born baby is $71,000 compared to $420 for a full-term infant.
One major change approved by the Texas legislature that Lakey credits for helping bring down the number of infant deaths: It ordered the Texas’ Medicaid program to stop reimbursing doctors for early elective deliveries – births that were induced early for convenience and without a medical reason. Up until then, 1 out of every 4 births in Texas was an early elective delivery.
Lakey advised summit attendees to get momentum for their cause by appealing to Indiana state lawmakers: “You have to have one of those causes, that when legislators comes back to their communities after the session, they can feel proud that they attacked something important for their constituents.”
“You have to have a noble cause,” he continued. “And I don’t think there is a cause that can line folks up better than to talk about increasing the chances that every baby born in your state will have a healthy, happy first birthday. Who can argue that’s not a role government should play, that every baby has a healthy happy first birthday?”
Maureen Hayden covers the Statehouse for the CNHI newspapers in Indiana. She can be reached at email@example.com