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Dr. Richard Feldman: Lawmakers can do much more to stem infant mortality

March 8, 2019

FeldmanIndiana has a horrible problem: infant mortality. We are seventh-highest among the states and have almost twice the rate compared to some states. The rate is also more than twice as high for African-Americans than for Caucasians and higher in those living in poverty.

One could consider our high infant mortality as rivaling some developing countries. This is reflective of our poor state of health, lack of early pregnancy care, deficiency of public health funding, and poor lifestyle choices.

Gov. Eric Holcomb made infant mortality one of his top priorities during this legislative session. He proposes funding for a pilot program for “obstetric navigators” for at-risk pregnant women in areas with the highest infant mortality rates. A good start.

The next logical step should be to intervene in the unacceptably high rate of smoking during pregnancy. The chief causes of infant deaths are conditions related to premature birth, low birth weight, congenital anomalies and sudden infant death syndrome. All are associated with smoking during pregnancy. The smoking rate among pregnant women in Indiana is almost 14 percent, nearly twice the national average. Really want to lower the infant mortality rate? Get serious about lowering this statistic.

Expansion of another public health program could make a profound impact on infant mortality in Indiana. Implemented by Goodwill, Indiana University Health, and Healthier Moms and Babies, the Nurse-Family Partnership is an evidence-based national program with 40 years of experience demonstrating significant improvements in the health and lives of high-risk, first-time mothers and their children living in poverty.

The no-cost program is intensive, holistic and individualized with regular home nurse visits; this provides moms with good parenting and child-development information, health-related education and role modeling. The nurse and mother make a 2-1/2 year commitment to each other that involves potentially 60 planned home visits, depending on maternal needs. Women voluntarily enroll at 16 to 28 weeks of pregnancy and continue until the child is 2 years old.

These low-income women face many burdens, including domestic violence and other emotional, social and physical challenges to a healthy pregnancy and motherhood. The women in the program have a median age of 25, 88 percent are unmarried, 21 percent are Hispanic, 52 percent are African-American, and 61 percent have completed high school. Knowledge means empowerment, and this program enables more confident, capable mothers.

The nurses help the mothers obtain early prenatal care, improve their diet, and prepare for a new baby. The nurses endorse breast feeding and reduced tobacco and alcohol use, and intervene in illegal substance use and opioid addiction.

Proven returns on investment include enhanced pregnancy outcomes, reduced risk for infant mortality, improved child health and development, less child abuse and neglect, high infant vaccination rates, reduced substance abuse, and improved economic self-sufficiency. Every $1 invested in the program saves society and government (including Medicaid) $7.10.

Although there is some funding from the state and federal government, other community partner sources, and in-kind support from various community organizations, the program serves only 36 counties helping 1,028 mothers. The Nurse-Family Partnership is requesting $10 million a year in the next biennium to enhance its outreach. What a splendid public health approach that deserves the attention of Indiana legislators for increased funding and expansion to address infant mortality and beyond.•

Click here for more Forefront columns.

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Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.

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