ANNAPOLIS – In the prosperous state of Maryland, a baby is more likely to die before it turns 1 than any of the surrounding jurisdictions, except the District of Columbia, an analysis of birth and death records determined.
With an unemployment rate well below the national average, numerous high- tech businesses, a thriving economy, and top-notch health care institutions like the National Institutes of Health and Johns Hopkins, Maryland would seem to be a place where babies would get a healthy start.
Yet Maryland’s infant mortality rate is higher than the neighboring states of Delaware, Pennsylvania and Virginia, and surpassed in the region only by the District of Columbia, a unique jurisdiction and not directly comparable, experts say.
For every 1,000 babies born in Maryland in 1997, the most recent available statistics, 8.7 of them died before turning 1.
Those numbers aren’t shocking to Maryland officials who deal with the matter. They have been working for years to reduce the infant mortality rate through educational programs and outreach targeting at-risk mothers.
A Capital News Service analysis of data from the Centers for Disease Control found the infant mortality rate in Maryland was greater than Virginia’s, where for every 1,000 babies born, 7.7 died before age 1; Pennsylvania’s, where there were 7.6 infant deaths per 1,000 live births; and Delaware, where 7.9 infants died before their first birthday.
In the District of Columbia, 13.7 babies died for every 1,000 born. Experts cautioned that the District cannot be compared with states.
“I don’t think 8.7 is much different from 7.6,” said Jeannine Robinson, director of the Maryland Commission on Infant Mortality Prevention. “At first it looks really high when compared to other states. But (Maryland) is different from other states.”
Those differences include social factors: Maryland has a large minority population that accounts for a large portion of infant deaths. There is also a growing immigrant community in Maryland, Robinson said. Plus there are more at- risk mothers in this state than others. Special programs target all of these groups.
“In some communities when a baby dies folks just feel that the baby wasn’t supposed to live,” she said. “We are trying to educate folks that infant mortality is a problem and we should be trying to save baby’s lives.”
Before 1997, the state’s infant mortality rate steadily decreased, officials said. But in 1997, the rate increased, possibly because more women are having children at a later age.
“There has been a major shift in the age of women giving birth,” said Dr. Diana Cheng, chief of maternal health at the Center for Maternal and Child Health.
The number of women older than 35 having children doubled in the last 10 years, she said.
“A lot of women are delaying childbirth,” Cheng said. “Older women are just a higher risk, they tend to have more medical problems.”
A higher-than-normal rate of multiple births also boosted the year’s statistics. For example, there were 185 sets of triplets born in 1997, but only 132 sets in 1998, Cheng said.
African-American babies in Maryland are almost three times as likely to die before their first birthday, a trend that parallels the nation’s, the analysis revealed. For every 1,000 black babies born in Maryland in 1997, 15.5 of them died before turning 1.
“Historically there has been disparity and not just in Maryland,” said Barbara Squires, president of Baltimore City Healthy Start, a program that targets at-risk mothers and tries to get them prenatal care. “The research has not been good enough to try to narrow the discrepancy between blacks and whites. It’s very challenging.”
Baltimore, with 13.9 infant deaths per 1,000 births, and Prince George’s County, with nearly 12, had the highest infant mortality rates in Maryland for jurisdictions where statistics were kept separately.
County figures are less reliable than state data, experts say, because jurisdictional lines are porous. For example, if a mother living in Montgomery County delivers in Prince George’s the infant could be included in birth records for either county.
This analysis used the mother’s county of residence to calculate rates. Records for smaller counties with populations of less than 250,000 were grouped together for privacy, said officials from the National Center of Health Statistics, who compile the figures.
The state has recognized its infant mortality problem and is trying to solve it with a $1 million mass media campaign announced in February by Gov. Parris N. Glendening.
The governor’s program targets both Baltimore and Prince George’s County and will feature public service announcements for television and radio. Expectant mothers also will be given journals outlining health procedures and encouraging them to seek prenatal care.
The state also is planning to expand a mentoring program already successful on the Eastern Shore. Mothers in the program are assigned to mentors who give them advice and remind them to keep prenatal visits.
“It goes on the whole premise of if you support a woman that has very little support, she in turn feels better about herself, feels supported, then will keep more of her prenatal visits,” said Penny James, a coordinator for the Mid-Shore Motherhood Mentorship Program.
Some women with cultural or language barriers may feel isolated when they become pregnant, she said. The mentoring program identifies those women and connects them with resources to help with the pregnancy.
“A supported woman is going to have a healthier outcome,” James said.
Maryland is determined to drive down its infant death rate.
“The state of Maryland has special programs in almost every county to reduce infant mortality,” said Kathleen Buckley, director of the National Fetal and Infant Mortality Review. Buckley said it’s always good to see how other states are fighting infant mortality.
“Maybe one state is doing something really well that other states can learn from. The problem of infant mortality tells you not only about the health of the community at large but the social and economic well being of the community. In order to make things better you have to make sure families in the community have basic resources.”