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NYC Reports Largest Decline In Infant Deaths

Ruzanna Harutyunyan's picture

New data from the Health Department show that the city’s infant mortality rate fell again in 2007, reaching the lowest level ever recorded. The 2007 rate – 5.4 deaths per 1,000 live births, down from 5.9 in 2006 – marked the sharpest one-year decline since 2001, when the city’s rate declined to 6.1 from 6.7 per 1,000 live births. Of the 128,961 babies born in New York City in 2007, 697 died before the age of one year, 43 fewer than in 2006. The city’s infant mortality rate remained significantly lower than that of the nation, which was 6.7 in 2006, the most recent year on record.

The number of local births surged by 3,455 during 2007, and births to Asian women accounted for half of the increase. News reports suggest that many Chinese couples timed their pregnancies to coincide with the Year of the Golden Pig, a particularly auspicious year in the Chinese lunar calendar.

The city’s infant-mortality rate has fallen by half since the early 1990s, but deep disparities persist, with black babies dying at the highest rates of all racial and ethnic groups. The infant mortality rate was 9.8 per 1,000 live births among blacks, 6.3 among Puerto Ricans, 4.3 among other Hispanics, 3.9 among whites, and 3.1 among Asian/Pacific Islanders.

“We are heading in the right direction, but substantial disparities remain,” said Dr. Thomas R. Frieden, New York City Health Commissioner. “Infant death rates remain unacceptably high among blacks and Puerto Ricans and in low-income neighborhoods. We need to expand services for these groups and communities, and we also need to work to reduce inequities that persist in income, education, health care, safe neighborhoods and access to healthy affordable food and regular physical activity.”

The Health Department is working on many fronts to help women stay as healthy as possible before pregnancy, obtain quality health care during pregnancy, and provide the care and support their babies need to thrive. The agency’s key initiatives include breastfeeding education, safe-sleep education, cribs for families that can’t afford them, and nurse home-visiting during pregnancy and early childhood.

Promising declines in neighborhoods with historically high rates

While infant mortality has fallen in all boroughs in recent years, death rates are lowest in Manhattan and highest in the Bronx. Brooklyn’s rate is on par with the city average, and Queens and Staten Island fare somewhat better than the city as a whole.

For the first time ever, no New York City neighborhood had a rate above 10 deaths per 1,000 live births. A complete table of rates by borough and neighborhood is below. Neighborhood rates are presented by community district in three-year rolling averages. Rolling averages avoid fluctuations in the infant mortality rate due to a small number of deaths in a single neighborhood. The past five years have brought especially sharp declines in the traditionally hard-hit neighborhoods of East Tremont (Bronx), Crown Heights North (Brooklyn) and Queens Village (Queens).

Factors contributing to infant mortality

The leading causes of infant mortality in 2007 were the same as for the past several years – birth defects, prematurity/low birth weight, cardiovascular disorders and injury. Birth defects accounted for the largest percentage (21%) of infant deaths and were mainly the result of genetic disorders, cardiovascular and lung malformations, and neural tube defects.

Black infants were nearly twice as likely as white infants to be born premature/low birth weight. The high proportion of premature/low birth weight infants among blacks explains most of the black-white disparity in infant mortality. Babies born very prematurely (before 33 weeks) or very low birth weight (less than 3 pounds, 5 ounces) are at particularly high risk; they represent less than 2% of all live births but almost 60% of all infant deaths.

Babies born in multiples (twins, triplets, etc.) often arrive prematurely, causing an increased risk of death. The infant mortality rate for multiples was 19.2 per 1,000 in 2007, down from 25.5 a year earlier. The decline is due to a smaller proportion of multiples delivered extremely preterm (before 28 weeks). Like any one-year change, however, it should be interpreted cautiously.

Deaths due to intentional and unintentional injury (external causes) accounted for 9.3% of all infant deaths in 2007, and account for 21% of deaths among babies more than 28 days old. Suffocation, a common cause of unintentional injury death, can often be prevented by safe sleep practices such as avoiding bed-sharing and soft bedding, and putting infants to sleep on their backs in a crib or bassinet.

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A woman’s health before and during pregnancy is a strong predictor of infant mortality. The risk is significantly higher for babies whose mothers smoke, use drugs or alcohol, or suffer from obesity, diabetes or high blood pressure. In 2007, infant mortality rate was elevated for infants of women with preeclampsia, or pregnancy-induced hypertension (17.4 per 1,000), chronic hypertension (15.0 per 1,000 live births), and chronic diabetes (7.8 per 1,000 live births).

As in previous years, infants born to teenagers died at a higher rate (6.8 per 1,000) than those born to women in their 20s (5.0 per 1,000). Likewise, education remained a powerful predictor of infant mortality, with babies born to college graduates dying at less than half the rate of those born to women with less than a high school education (2.9 versus 6.1 per 1,000). Yet college-educated black women suffered a higher infant mortality rate (6.9 per 1,000) than either college-educated white women (1.8 per 1,000) or white women with a high school education or less (5.7 per 1,000). Researchers are working to determine how social and economic adversity and racial discrimination contribute to this disparity. Genetics are not the determining factor in these gaps.

Health Department efforts to reduce infant deaths

* The Nurse-Family Partnership (NFP) is an evidence-based nurse home-visiting program at 10 locations throughout New York City. The program’s nurses work with low income, first-time mothers, their infants, and their families to improve health and safety, build secure relationships and promote education and employment. NFP now serves more than 1,000 families and is the largest such program in the United States.

* The Infant Mortality Reduction Initiative, funded by the City Council, works with community-based organizations in the most-affected neighborhoods, supporting outreach, referral services, case management, peer education and other activities.

* The Newborn Home Visiting Program offers a home visit to families with new babies in targeted communities in Brooklyn, Harlem and the Bronx. Besides promoting breastfeeding, safe sleep and infant safety, Health Department workers help address household hazards such as lead paint and missing or damaged window guards, and they help families gain access to health care and social services. The program visited nearly 5,000 families in 2007.

* The Safe Sleep Initiative works with families and community agencies to prevent unintentional injury. Health educators provide Safe Sleep education and training to community organizations. The Cribs for Kids program works directly with parents and provides cribs to those in need.

* The Breastfeeding Initiative works with hospitals and communities to increase breastfeeding initiation, duration and exclusivity. It also provides Certified Lactation Counselor training, webcasts and conferences for hospital and community staff.

* The Healthy Teens Initiative helps health care providers deliver comprehensive sexual and reproductive health care to adolescents. The Health Department also works with schools to promote comprehensive sex education and direct teens to community-based services.

How you can protect your babies’ health

* Plan your pregnancy. Unplanned pregnancies are more likely to result in low birth weight, infant death, and poor development.

* Women who are healthy before and during their pregnancy are more likely to have a healthy baby:

o Have a regular doctor or health care provider to help you stay healthy before you become pregnant.
o Maintain a healthy weight and eat a healthy diet.
o Don’t smoke.
o Don’t use drugs.
o Don’t drink alcohol while trying to get pregnant or while pregnant.
o Keep chronic illnesses such as diabetes and high blood pressure under control.
o Take folic acid (in most multi-vitamins) to help prevent serious birth defects.

* Breastfeed your baby.

* Put your baby to sleep on its back, on a firm mattress, alone, without pillows, stuffed toys, or blankets near its face to avoid suffocation.