What’s Behind NYC's Drastic Decrease in Infant Mortality Rates?

Posted April 07, 2015 by Wendy Loveland

Mario Drummonds
Mario Drummonds
The saying, “if you can make it here you can make it anywhere,” of New York City, holds true for even its youngest members. New York City’s infant mortality rate—4.6 deaths per 1,000 live births in the first year of life—is nearly 30 percent lower than the US rate. What’s the city’s secret? A multi-pronged, multi-sector approach that taps into the power of collaboration.

“You can’t case manage yourself out of this problem, nor will one program bring about transformation,” says Northern Manhattan Perinatal Partnership (NMPP)External Link CEO and Executive Director Mario Drummonds. “You need to work at a community and policy level and take a broader systems approach. This will bring us to our goal—to eliminate infant mortality.”

Drummonds’ agency coordinates a network of health outreach, education, case management and advocacy initiatives to improve the health of women, children and families in New York’s most disadvantaged communities. NMPP was responsible for developing a community plan that reduced Central Harlem’s infant mortality rate from 27.7 in 1990 to 6.1 in 2008.

While New York City’s latest (2013 dataExternal Link) infant mortality rate is at a historic low—due in large part to the efforts of community-based organizations like NMPP—disparities persist. The infant mortality rate for Black infants was 8.3 in 2013, versus a rate of 3.0 per 1,000 live births among White infants. Infant mortality rates were also higher for Puerto Ricans (4.8) and other Hispanics/Latinas (4.3). Infant mortality rates also varied by socioeconomic status, with areas with higher poverty reporting 1.9 times greater rates at 5.2 compared to 2.8 per 1,000 live births in areas with low poverty.

“Communities with the most infant deaths also have the poorest access to affordable housing, quality healthcare, nutrition and education,” says Megan Lessard, evaluator at NMPP’s Healthy Start program. “We must continue to target the social inequality at the center of this epidemic.”

Cross-sector collaboration is a significant part of NMPP’s strategy to address the economic and social determinants of infant mortality. Since 2001, the organization has led a campaign to secure over $100 million in tax-levy funding to address infant death in 10 neighborhoods throughout the city. Through the Infant Mortality Reduction Initiative (IMRI), funded by the New York City Council, NMPP collaborates with other community-based organizations, government agencies, providers and hospitals and other stakeholders to reduce infant mortality and close the racial-economic divide. NMPP is one of the IMRI’s five regional perinatal coordinating bodies (RPCBs) that provide direct services to women, infants and children and technical support to other community-based organizations. 

NMPP is also one of many organizations that make up the New York team participating in the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN), led by NICHQ. IM CoIIN is a federally funded, multiyear national movement engaging federal, state and local leaders, public and private agencies, professionals and communities to employ quality improvement, innovation and collaborative learning to reduce infant mortality and improve birth outcomes. 

Drummonds and Lessard offer the following advice to help organizations working to reduce infant mortality rates.

  1. Take an inventory of current operations. What is your mission? Who is your target? Do you need more capacity—and in which areas? Is staff trained in the same approach? What are your partnerships—currently and potentially—such as hospitals, other community-based organizations, government bodies and others? Discuss and document your answers to build a business plan for your organization.
  2. Work on multiple levels. “Reducing infant mortality is not only a clinical or case management issue. You must also create plans and work on a political, media, hospital/provider and community-based level,” says Drummonds. For example, NMPP launched a massive media campaign early on that caught the attention of the mayor, which led to funding from the city council. It also started the education process for women and the community. “Talk to your city council. Talk to your mayor. They are the ones who are going to fund these initiatives. Talk to the media, church leaders, and other community organizations that may not have anything to do with infant mortality but do connect with potential constituents,” says Drummonds.
  3. Expand the focus beyond the clinical needs of pregnant women. “We focus on the whole woman, taking into account her risk factors, and pregnancy status,” says Lessard. She explained that in addition to pregnant women, NMPP provides services to women of child-bearing age who have not yet had a baby (preconceptional), as well as women who have had a baby and are not pregnant (interconceptional).  
  4. Increase capacity by hiring qualified staff. NMPP focuses on policy, programmatic and clinical capacity building. “We make sure that all of our case managers were trained and executing on the same approach,” says Drummonds.
  5. Segment your potential constituents and develop targeted messaging. Women’s needs vary by where they live, their lifestyle and many other factors. “We ran focus groups for each segment and asked the participants what messages resonate with them,” says Drummonds.
  6. Collaborate, collaborate, collaborate. NMPP participates in consortiums where everyone in the targeted communities who are working on reducing infant mortality get together to share their experiences from the field. “This brings us all together and lets us hear and share information from the front line,” says Drummonds. “It helps us keep up with changes—and things are always changing—allowing us to improve our programs and messaging.”
  7. Offer educational series to women, versus a single workshop. “When women attend multiple workshops, on different days, they develop a supportive community with each other, which invariably helps change behaviors,” says Lessard. “The psycho-social component is very important.”
  8. Monitor and evaluate. As the adage says, ‘you can’t improve what you don’t measure.’ This and the fact that the environment is constantly changing means that it is crucial to have measures in place to consistently monitor and evaluate progress. 

“Eliminating infant mortality will require that we work on multiple levels, and collaborate,” says Drummonds. “No one organization can provide all the services needed. We need to also think of the influencers; the people who are in contact with our constituents. They may not provide direct services, but their influence and referrals have a direct impact. As we have seen in New York City, when we all work together, we create lasting results.”

  

To learn more about NICHQ's medical home work, visit NICHQ's Infant Health page

 


Share:

Add your comment

 
 

 

Archive

Tagcloud

breastfeeding new york state hospitals mom mother partners quality improvement epilepsy QI data AAP early childhood eccs coiin pdsas wic texas community support learning session IM CoIIN infant mortality children's health new technology engineering transgender collaboration collaborative learning engagement planning PDSA planning paralysis underplanning analysis paralysis vision eye health smoking smoke-free housing second-hand smoke nichq toolkit e-module infant health dental care oral health underserved populations health inequity public health Maternal and Child Health Journal tips leadership engagement Sickle cell disease indiana SCD medicaid perinatal regionalization safe sleep sudden infant death syndrome national birth defects prevention month birth defects pregnancy planning one key question prepregnancy health preconception health public breastfeeding support family engagement families patients experts insights CHOPT childhood obesity innovation food desert telemedicine TBLC breastfeeding supporting preterm birth prematurity racial disparities audiology ehdi follow-up illinois talana hughes vulnerable populations sports asthma soccer basketball obesity football SIDS Pokemon Go gamification smartphones interconception care birth spacing NASHP issue brief contraceptive use postpartum care CoIN HRSA early childhood trauma NHSA community health consumer advocacy womens health interconception health teenage health PATCH wisconsin missouri risk appropriate care community health workers SCD< infographic infant mortality awareness month inspirations childrens health national breastfeeding month maternal health patient engagement hearing loss hearing treatment pediatric vision vision screening eyesight pre-term birth early-term birth SCD clinic los angeles LOCATe CDC levels of care neonatal care maternal care smoking cessation project safe sleep practices neonatal abstinence syndrome NAS opioids maternal and child health MCH Family voices quality care mental health hydroxyurea SCDTDP men dads testing change data sharing state government city government apps sleep AJPM preconception care senior leadership breastfeeding support video series health equity health disparities access New York BQIH exclusive breastfeeding LARC long-acting reversible contraception unplanned pregnancies social determinants of health health innovations Best Babies Zone CoIIN baby boxes Rhode Island progesterone rooming-in Baby-Friendly parent partner patient and family engagement healthy weight healthy lifestyles primary care telementoring ECHO video conferencing socioemotional health childhood development pediatric Tennessee interview National Coordinating and Evaluation Center medical-legal partnerships mobile app disparities perinatal care overweight obese healthy weight clinic wellness pilot sites data collection education resources paternal engagement risk-appropriate care preterm infants high-risk babies Ten Steps public relations social movement reversible contraceptives medical home pediatric medical home patient transformation facilitator PTF skin-to-skin rooming in prenatal smoking information visualization charts SUID postpartum new mother webinar AMCHP QI Tips ongoing improvement fourth trimester partnership quality and safety coaching PDSA Cycle leadership support year end holiday message reflections gratitute Medicaid data doctor relationship PQC perinatal quality collaboratives vision care vision health evidence-based guidelines ASH health and wellness healthy living healthy eating home visitors home visiting programs March of Dimes APHA results evaluation supplementation formula reduction video infant loss social media advocacy leadership Berns Best Fed Beginnings Ten Steps to Successful Breastfeeding sustainability stress prenatal care data capacity epidemiologists surveillance data PFAC community partners preconception and interconception care motivational interviewing Native Americans ADHD NICHQ Vanderbilt Assessment Scale ADHD Toolkit system design care coordination skin to skin newborn screening ASTHO reduce smoking aim statement safe birth Texas Ten Step skin-to-skin contact 10 Steps staff training small tests acute care mother-baby couplet collective impact population health preconception Newborn Screening Program substance abuse breast milk formula milk bank crisis Huffington Post fundraising campaign first responders NYC improvement healthcare health system sickle cell diease treatment protocol family health partner maternity care Collaborative Improvement and Innovation Network Health Outcomes Measurement Cross-Sector Collaboration Knowledge Sharing Child Health Systems Design systems change