To analyze the 2003 Massachusetts birth and infant mortality data and provide reports to selected communities with the highest infant mortality and teen pregnancy rates in an effort to empower the communities to address the problem.
For more than ten years the Massachusetts Department of Health has reviewed and analyzed birth and infant mortality data which is then summarized and disseminated to the communities with the highest rates. The recipients of the community birth packets are expected to increase public awareness about the problem and mobilize the community to take action.
The infant mortality rate (IMR) is a standard health indicator which reflects a population’s maternal and child health as well its socioeconomic determinants. It has two components: neonatal and post-neonatal mortality rates. The neonatal mortality rate includes only those deaths occurring within the first 28 days of life. Post-neonatal mortality rate includes infant deaths which occur between 29 days and one year. Since fetal deaths rates are also indicative of maternal health, this year for the first time, Massachusetts also analyzed the feto-infant mortality rates to provide a more complete assessment of the perinatal periods of risk.
The teenage pregnancy rate is also an indicator of population health and the socioeconomic determinants of health. Teenage pregnancy is associated with a higher prevalence of low birth weight and premature births, increased rates of infant morbidity and mortality, developmental delays, low educational attainment for both the parent and offspring, and increased rates of poverty.
Data from the Massachusetts 2003 Birth Book, linked files, and Masschip were collected and analyzed for the communities with the highest teen pregnancy and infant mortality rates to determine trends and patterns. Additionally, fetal and infant death certificates were reviewed for selected communities to determine cause of death and existing patterns. Summary reports contained in the community packets were distributed to their respective communities as well as the local press.
The 2003 Massachusetts infant mortality rate of 4.8 deaths per 1,000 live births was the second lowest IMR in Massachusetts history and the lowest in the United States. However; there were disparities by community and race/ethnicity. The communities with the highest infant mortality were: Lowell, Arlington, Barnstable, New Bedford, and Lynn. All noted communities had decreased IMRs over the past ten years. Race/Ethnicity disparities have remained stable over the past ten years, with black infant mortality rate (12.7) nearly 3 times that of white non-Hispanic infants. Notably, the black-white disparity gap exceeds the community-Massachusetts disparity gap. There has been no community in Massachusetts in the last ten years with an infant mortality rate equal to or exceeding the infant mortality rate of blacks. Worcester had 11 infant deaths of which 2 were attributed to positional asphyxia secondary to bed sharing. The 2003 teen birth rate for Massachusetts was the lowest in state history and the second lowest in the United States. Decreasing teen pregnancy trends were seen in all racial ethnic groups and all communities except for Pittsfield. From 1990, the black non-Hispanic teenage pregnancy rate had the largest decrease (55%); however the current teen birth rate of 40.3 is 3 times the white non-Hispanic rate (13.7). The 2003 Hispanic teen birth rate of 78.3 is nearly twice the rate for blacks.
- Instead of analyzing the IMR data to assess disparities within communities, some with relatively small numbers which may represent an isolated event, the emphasis should be placed on racial/ethnic disparities which have shown sustained wider gaps.
- Worcester should launch an educational campaign addressing the dangers of bed sharing emphasized in the Back to Sleep Program.
- The causes of death should be reviewed and linked to prenatal records and birth certificates to correlate feto-infant mortality with causes such as quality of care, maternal health conditions, and preventable deaths such as Sudden Infant Death Syndrome (SIDS), to better target prevention strategies as recommended by PPOR.
- Community programs targeting teen pregnancy prevention should be culturally and linguistically appropriate for Hispanic teens to eliminate disparities.
- Continue to provide teen birth data to communities and empower them to provide more comprehensive teen pregnancy prevention services.
Hafsatou Diop, MD, MPH, Massachusetts Department of Public Health
Wanda Barefield, MD, MPH, Massachusetts Department of Public Health
Nancy Wilbur, PhD, Massachusetts Department of Public Health