The state’s rate of infant deaths is still among the highest in the nation — and large racial disparities lurk within the numbers — but state health officials said they considered the number a good sign for efforts to curb the state’s infant mortality problem.
“The trend is definitely downward,” said Albert Woolbright, a statistician for the Alabama Department of Public Health.
State numbers show that eight of every 1,000 children born in Alabama in 2011 died within the first year of life (statistically, the precise figure is 8.1). As sad as that number is — it represents 481 infant deaths — it’s an improvement over recent years. After years of decline, infant mortality spiked toward the end of the last decade, hitting 10 per 1,000 births in 2007.
For social scientists, infant mortality has long been an indicator that measures the general level of poverty in a society, in part because of the lack of access to medical care in poor countries. Alabama in the 21st century has posted some of the highest rates of infant death in the country, comparable to rates in Poland or Costa Rica.
State officials say the decline over the last few years is likely due to a decrease in smoking and a nationwide decline in the rate of teen pregnancy. Mothers-to-be who smoke are 20 percent more likely to have babies who die as infants, health officials say. Teen moms, too, are more likely to lose their infants to health problems.
According to the Centers for Disease Control and Prevention, the rate of teen pregnancy nationwide has been steadily declining since 1991 — and is at its lowest point since 1946, according to the latest CDC figures.
Janice Smiley, director of the state’s Perinatal Health Program, said it’s not clear why the teen pregnancy rate is dropping, though she said some credit is due to nationwide programs against teen pregnancy.
“There’s been a move away from abstinence-only education to an approach that teaches abstinence but also tells teens what they should know if they do intend to have sex,” she said. Smiley said health programs are also encouraging kids to make life plans outlining just how many children they intend to have, and at what time of life.
While teen pregnancy numbers have been declining nationwide the Southeast still has the highest rates in the nation, while New England and the upper Midwest have the lowest rates.
Infant mortality rates are sharply different in Alabama’s black and white communities, with 13 of every 1,000 African American infants in the state dying in the first year of life, or about twice the rate of whites.
State officials say there’s a gap, though a smaller one, in health care access, with 73 percent of white mothers getting adequate care, compared to 69 percent of black moms-to-be.
Medicaid, the state health care program for people in poverty, plays a major role in that care. Fifty-three percent of deliveries in the state are paid for by the program, Woolbright said. That’s an increase from 45 percent 12 years ago.
Officials of the Perinatal Health Program largely stayed out of the debate over Amendment One, a constitutional amendment that authorized taking $437 million from the Alabama Trust Fund to shore up the state’s general fund budget over the next three years, largely due rising Medicaid costs.
The amendment passed nearly 2-to-1 on Sept. 18. But state legislators have said they’ll still have to find a way to bring the program’s costs down over the next three years.
Dr. Wally Carlo, director of newborn nurseries at UAB Hospital, said he couldn’t immediately estimate how many of his very young patients are covered by Medicaid.
“It’s not like there are two sets of practitioners, one for Medicaid and one for everyone else,” he said. “Every child is going to get care.”
Carlo said Medicaid helped with infant mortality by providing care for expectant mothers before the birth.
“If a mother does not come in until late in the pregnancy, or until the labor, her chances are not as good,” he said.