Hundreds Kick Off National Infant Mortality Movement

August 19, 2014
By Kristen Holmstrand

Dr. Lauren Smith Addresses Those in Attendance at the CoIIN Conference, July 2014
NICHQ’s Senior Strategic Advisor Lauren Smith, MD, MPH, addresses the room during a session of the IM CoIIN Summits.

Last month, hundreds of federal, state and local public health officials, Medicaid directors and public and private agency representatives from across the United States gathered together in Arlington, VA, for the Infant Mortality Summits. These meetings were an official kickoff for the expansion of the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) to add 31 U.S. states and eight territories to the 19 states already involved. The IM CoIIN represents a massive, national effort to change the infant mortality rate in the United States.

Why is this work so important?

The United States has one of the worst infant mortality rates among industrialized nations. According to 2010 statistics, 6.15 babies out of every 1,000 born in the U.S. die before their first birthday. This compares with an average of 5.0 babies for all other industrialized nations. In fact, the U.S. infant mortality rate is more than double that of countries such as Sweden and Japan1. And, American minority populations are disproportionately affected: the risk of infant death for babies born to non-Hispanic black women is more than two times greater than the risk of infant death for non-Hispanic white women.

“We sit in a neighborhood that has very, very bad birth outcomes, yet we have some of the most gifted healthcare professionals in the world in that same neighborhood. It is absolutely mind-boggling that we could continue to have these problems when we have such excellent care right there,” says Dawn Denno, senior director for Community and Population Health at Cincinnati Children’s Hospital and a presenter at the Summits. “So, you have to start asking, ‘Why is this happening?’ And, it’s much bigger than just the healthcare system. From my perspective, we need to dive into this. It’s immoral that we’re letting this happen in our community.”

Infant mortality is a complex and multifaceted issue, and numerous organizations across the country are working to reduce the U.S. rate and ensure that more babies reach their first birthday and beyond. The IM CoIIN aims to bring those organizations together, along with state public health departments and other key stakeholders, so that people can share what works (and what doesn’t), learn and innovate together, and coordinate and combine their efforts whenever possible for maximum impact. The partner organizations supporting this effort include the National Institute for Child Health Quality (NICHQ), the Maternal and Child Health Bureau (MCHB) of the U.S. Department of Health and Human Services’ Health Resource and Services Administration (HRSA), the Association of Maternal and Child Health Programs (AMCHP), the Association of State and Territorial Health Officials (ASTHO), Cincinnati Children’s Hospital Medical Center, CityMatCH: The National Organization of Urban MCH Leaders, the Institute for Healthcare Improvement (IHI), the March of Dimes, the National Academy for State Health Policy, the Center for Healthier Children, Families & Communities and many individual experts in quality improvement, child health and infant mortality.

The CoIIN Conference Held in Virginia July 2014
Participants at the IM CoIIN Summits listen to opening remarks by Michael Lu, MD, MS, MPH, Associate Administrator, Maternal and Child Health, Health Resources and Services Administration, US Department of Health and Human Services.

The overarching goal of the Infant Mortality Summits was to give each state’s team time, support and ideas for determining how to reduce infant mortality in their home state. In addition to hearing from federal and state officials and representatives from the states who participated in the first wave of IM CoIIN work (i.e., HRSA regions IV [Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee], V [Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin] and VI [Arkansas, Louisiana, New Mexico, Oklahoma, Texas]), each team met to generate a preliminary list of specific strategic priorities. Teams also received data from HRSA about the infant mortality rates specific to their state and used that data in preparing their priorities.

State strategic priorities, like the issue of infant mortality itself, touch multiple areas of child health—from prenatal care of pregnant mothers to safe sleep positions for babies. The first group of states to work on CoIIN focused on reducing early elective deliveries; expanding access to interconception care (between pregnancies) through Medicaid; reducing smoking among pregnant women; promoting infant safe sleep practices; and improving perinatal regionalization (a geographically-targeted approach to assure risk-appropriate care for mothers and infants). Priorities identified by the IM CoIIN expansion teams may overlap with those of the initial group or they may be completely different, depending on the particular needs and issues faced by the states in these regions.

Racial disparity: A top priority

One issue that will likely become a strategic priority is racial disparity. This was a common and strong theme at the IM CoIIN Summits, and many state teams went home with addressing “social determinants of health” as one of their top priorities.

“We cannot continue to allow black babies to die at two to three times the rate of whites…It is wrong to accept that we have to wait another 35 years before black babies born in our country have the same survival opportunity as white babies born today,” said Arthur James, MD, FACOG, senior policy advisor for infant mortality at the Ohio Department of Health and an associate professor at Ohio State University, during his presentation at the Summits.

Teams from the Western and New England regions of the U.S. learned at the Summits about the work already begun in the Southern and Central U.S. to address the difference in infant death rates between black and white babies. Many of the expansion teams also face the challenge of significant disparities in the infant mortality rates for their Native American populations.

Later this month, teams from the eight U.S. territories will meet for their Infant Mortality Summit in Hawaii, beginning their strategic priority work as well. “Graph of the day: The United States has a really high infant mortality rate.” January 9, 2013.