Alison Jacobson
The year 2023 is a reminder to healthcare professionals in maternal and infant health disciplines that the U.S. is not where it should be but also that we know more about the reasons why, and this tells us what we must do in 2024 and beyond.
In November, the Vital Statistics Rapid Release report from the National Center for Health Statistics told us that the 2022 provisional infant mortality rate for the U.S. rose 3% from 2021, the first year-over-year increase in 20 years, after a 22% decline between 2002 – 2021. (1)
Rates also went up for babies born preterm, with significant increases from maternal complications and bacterial sepsis. We also saw SUID rates increase significantly for non-Hispanic Black infants, further widening the disparities with non-Black infants.
In addition, the 2023 March of Dimes report card (2) gave the U.S. a D+ grade for the second consecutive year in a row due to its preterm birth rate and persistent racial disparities in maternal and infant health, ranking it “among the most dangerous developed nations for childbirth.”
What One Challenging Region Can Tell Us:
Exploring the underlying causes is key to changing this, and to that end, we are working with the Healthy Mothers Healthy Babies Coalition of Georgia and the U.S. Health & Human Services to assess infant safe sleep policies with regard to structural racism and to develop community-based practices designed to reduce Black infant sleep-related mortality in the Atlanta, Georgia region.
Georgia has the 11th highest rate of Sudden Unexpected Infant Death (SUID) in the U.S., according to the Centers for Disease Control. SUID includes sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed (ASSB), and death by unknown cause during the first year of life.
The project is an opportunity to understand better the challenges families face in adopting infant safe sleep recommendations developed by the American Academy of Pediatrics and those by other government agencies, and to create specific solutions to reduce the rates of infant deaths. These results would also benefit healthcare providers as they assist families in making decisions regarding infant-safe sleep practices.
The program will be evaluated by the Morehouse School of Medicine’s Center for Maternal Health Equity, and the results, disseminated to community partners and national networks to support the development of new local, state, and national policies.
What Lies Beneath:
This dovetails with First Candle’s commitment to recognizing the many factors that contribute to sleep-related infant death. We have been educators for several decades and were a partner in the original Back to Sleep®️ campaign in the 1990s, which led to a 50% drop in SIDS deaths, after which the decline leveled off, and babies continued to die.
This led us to look more closely at what was stopping families from adopting infant-safe sleep practices. Through the results of qualitative and anecdotal approaches, we came to realize the critical role that social determinants of health, cultural convictions, and real-world parental challenges play in how families make their decisions – a critical thing to learn because we all now increasingly understand that SIDS risk is tied to maternal and infant health both before and after birth.
And this, in turn, led to going out and reaching families where they are through community-based approaches such as our Let’s TalkCommunity Chats, where local partners and peers who have been through our infant safe-sleep training create a space where families can be heard and connected to resources. The reactions have been encouraging, and we believe community-based programs such as this are a hands-on way to save infant lives.
So our concern remains high, but we are also looking forward to this new year, creating more Let’s Talk programs throughout the country and continuing close work with our partners in Georgia to understand better the life contexts that drive behaviors around infant safe sleep and family practices.
We look forward to sharing information gained from the Georgia study as it progresses and to responding to interest from healthcare professionals, government agencies, and other groups about our work with providers and families to advance infant safe sleep better.
References:
- Vital Statistics Rapid Release, Number 33 (November 2023) (cdc.gov).
- MarchofDimesReportCard-UnitedStates.pdf
Disclosure: The author is the Executive Director and Chief Executive Officer of First Candle, a Connecticut-based not for profit 501(c3) corporation.