Breaking the link between poverty and infant death in St. Louis
In the zip codes surrounding St. Louis’ nationally-ranked children’s hospitals, a disproportionate number of babies never make it to their first birthday.
North of the Delmar Loop, in 63113, the infant mortality rate is 20 deaths per 1,000 live births, according to the most recent five-year averages kept by the state. That’s more than three times the U.S. rate, and on par with countries like Nicaragua and the Marshall Islands. But just a few miles away from 63113’s empty cribs, less than four out of 1,000 babies born in the Clayton's 63105 zip code die in their first year.
“It’s not just that infant mortality high, it’s that the race disparity is particularly pronounced,” said Dr. Katherine Mathews, an obstetrician at St. Mary’s Hospital. “There’s a lot of embedded inequity in our St. Louis region.”
High infant mortality rates often correlate with the level of poverty in a community, but healthcare providers say that many of these deaths are preventable with adequate prenatal care and resources for mothers. The Maternal, Child & Family Health Coalition (of which Mathews is a part) launched a new initiative called FLOURISH St. Louis this year to improve infant mortality throughout the region. But making a dent in those statistics is no easy task.
High levels of stress associated with poverty during a mother’s pregnancy can make it more likely that a baby will be born prematurely or at a low birth weight. Unsafe living conditions, tobacco use and unmanaged health problems, such as diabetes, also have an impact.
“For women who don’t have their diabetes under control, and don’t have access to care to support them to bring it under control, there’s an increased risk of birth defects and even infant death,” said Mathews, the obstetrician who sits on the Coalition’s board.
In Missouri, women qualify for Medicaid coverage while pregnant if they make up to 196 percent of the federal poverty level, that's about $2,602 a month for a two-person family. But two months after they give birth, women lose that coverage if they make more than about $3,000 a year, which is 18 percent of the federal poverty level for the size of their new family. If a mother loses coverage and can’t manage her diabetes without the coverage, that puts her future pregnancies at risk, said Mathews.
Those types of issues are much harder for an initiative like FLOURISH to address, said one of the group’s organizers, Lora Gulley.
“What we’re seeing are basic needs: from challenges with good paying jobs, quality housing, education. Those things that you don’t traditionally don’t associate with infant mortality,” Gulley said.
Every year, more than a hundred babies never reach their first birthday in St. Louis City and County. Among African American babies, the infant mortality rate is three times as high as it is for whites, according to the For The Sake of All study.
It’s not clear why this race disparity is so stark; it persists even when researchers control for the mother’s income. A 2008 National Institute of Health study concluded that experiencing racism correlated with lower birth rates among African Americans. Elements of institutional racism, like access to education, healthcare and economic mobility also play into how much stress a mother experiences during her pregnancy, Gulley said.
“These are things that should be afforded to every citizen in our community, but there isn’t equal access to those things,” she added.
According to records from the Missouri Department of Health and Senior Services, the vast majority of deaths before a child’s first year occur due to “conditions of the perinatal period.” A significant number of infants die due to birth defects. Only a small portion die from accidents, homicide or Sudden Infant Death Syndrome, or SIDS.
FLOURISH initiative hopes for a cohesive approach
About 40 parents gathered for a roundtable discussion held by the FLOURISH initiative this week at Lucas Crossing Elementary School in Normandy to contribute ideas for combating the problem. They recommended providing public information about the importance of prenatal care, offering assistance to expectant mothers and holding parenting classes.
“Watching women have their children, it pulls on your heartstrings. When you see someone that’s worked so hard to bring a life into this world and done everything right just to get to the finish line and go home with no baby,” said Carnadria Smith, a doula and a mother of three.
She said she’d like to see more African-Americans working in the birthing industry, and more awareness about the care that is available.
Organizers at FLOURISH say they will consider public input and data to create a set of action steps to improve infant mortality rates in the city of St. Louis and St. Louis County. The group has an influx of funding from the Missouri Foundation for Health, which is also funding an effort in Southeast Missouri called the Bootheel Network for Health Improvement.
According to Gulley, they’ll likely integrate a lot of the programs that already exist and already have funders. Simply coordinating those efforts might just make a difference.
“If we knew the answer, we would have solved it long ago,” Gulley said. “The patchwork has not led us in the direction that will really, truly move the needle.”
Follow Durrie on Twitter: @durrieB.
The Missouri Foundation for Health is a major donor to St. Louis Public Radio.
A previous version of this article incorrectly stated the Medicaid income limit for pregnant women. It is 196 percent of the federal poverty level, not 100 percent.