The alarming reality of infant mortality in Memphis continues to be on the minds of local and state officials. This summer, two initiatives were launched to address the issue: a study of infant death calculations and a public-private coalition that will provide home visitations to first-time mothers.

 

The clarion call on infant mortality was sounded in a three-part investigative series reported by The Commercial Appeal in 2005. As a result, Governor Phil Bredesen held an Infant Mortality Summit in April 2006, which brought together healthcare providers, medical professionals, legislative, and community leaders to study the problem.

 

Then, as now, Memphis reports the highest number of infant deaths of any U.S. city, 193 in 2007 — almost twice the national average. Black infants are three times as likely to die as white. And, according to Antionette Holman, the coordinator of the Shelby County Infant Mortality Reduction Initiative, the majority of infants who die before their first birthday are born prematurely. In fact, many premature infants die within the first 30 days of life. The causes behind prematurity and infant mortality can be attributed to such complex factors as poverty, poor nutrition, a lack of prenatal care, and the stress many African American women experience in their daily lives. But experts say another factor may be how infant deaths are tabulated in Tennessee.

 

Governor Bredesen's office requested the Urban Child Institute study that question this summer. The resulting policy brief, released in mid-July, shed considerable light on the inconsistencies that exist when tabulating fetal death, live birth, and infant death around the state.

 

Tennessee has no standard reporting criteria when it comes to how infant mortality is assessed. In Memphis, doctors are required to report "any sign of life" when determining whether a fetus has survived birth. However, this kind of threshold can be subjective, noted Urban Child Institute researcher Catherine Joyce. 

 

What Joyce and fellow research associate Marc Goodman-Bryan found was "that an extremely premature and low birth-weight infant who dies immediately after birth despite showing some signs (such as breathing or moving) may be counted by one county as a fetal death, while another county would consider it a live birth followed by an infant death. The first county, because it uses some threshold of gestational age or birth weight to distinguish between fetal death and infant death, will tend to have a lower IMR than the second, which uses an "any sign of life" criteria."

 

The World Health Organization (WHO) considers the threshold of a living fetus to be at 500 grams and 22 weeks gestation. The American Academy of Pediatrics (AAP) stands by a more conservative estimate of 400 grams and 23 weeks. By comparison, doctors in Memphis consider a fetus to be living at 90 grams, which corresponds to 16 weeks gestation. 

 

"When we imposed the American Academy of Pediatrics standards, Shelby County was still way higher but it becomes minimized when we try to compare differences between Shelby County and other counties. It becomes less exaggerated when we use the 400g/23 week criteria," stated Joyce.

 

Researcher also found there are wide variations in infant mortality rates between counties. "It is not clear however," wrote the authors, "whether this reflects actual differences in mortality or differences in how counties record and report information on birth outcomes. Without statewide standards for calculating IMRs, meaningful comparisons cannot be made."

 

It will bear watching to see if Bredesen's office takes action and creates a standard all counties can follow to improve reporting on infant mortality. Such a move would allow for more meaningful comparisons among counties in Tennessee.

 

Also working on the issue is the Shelby County's Fetal and Infant Mortality Review Team (FIMR). Team members are being hired by Mayor A C Wharton to review every infant mortality case, "in an effort to answer the question of why black women are far more likely than any other ethnicity to lose a child," Wharton told reporters, and to determine the exact cause of death. The group was announced during a press event in May that launched a weeklong focus on infant mortality.

 

On a second front is the creation of the Shelby County Early Success Coalition, a group of more than 30 local and state agencies working together in an effort to combat child maltreatment. The group is working to develop a home visitation program for 100 first-time mothers. The coalition will receive about $2.4 million from the U.S. Department of Health. The primary aim of the group is to determine what resources at-risk pregnant women and new mothers need particularly during a baby's first three years of life.

 

According to a Le Bonheur official, "The CCP was selected by the State of Tennessee Department of Health to implement the Nurse Family Partnership (NFP) in Shelby County, but requires broad community involvement. NFP is a nationally recognized program that uses nurses to provide home visitation services to low-income, first-time mothers. It has the highest rating of evidence-based practice and the strongest evidence of any current home visitation model."