All babies deserve to thrive

How we treat and care for mothers and babies is a good measure of our priorities. Thinking about my own experience as a mother, the amount of support that I received from family and friends, especially when my daughter was little, is amazing. Every mother deserves to be supported and have access to the things that she needs to ensure her good health and the health of her baby: having someone to ask questions during pregnancy, connecting with caring healthcare providers, having access to affordable, quality child care when returning to work—and paid maternity leave. These are some of the ways we know help ensure that all babies thrive and do well.

Unfortunately, not all moms and babies in Michigan receive the support and care that they need. The most recent Kids Count in Michigan Right Start maternal and infant health report, Infant death rates decline in Michigan, other trends raise concerns, shows us that while some overall trends are improving, there are still disparities by race, place and income. This year’s report focuses on the infant mortality rate, which is improving in our state. However, the rates of babies who die before their first birthdays are particularly disturbing among African-Americans and Latinos. Comparing 2010 to 2015, infant death rates are rising in smaller, rural counties and income level continues to be highly related to the risk of infant deaths.

All of us can probably remember a time that we cared for or held an infant—or even helped a loved one welcome a new baby to their family. We can all also recall how delicate and fragile newborn babies are! As a new parent, I did not feel as prepared as I thought I would even after reading all of the books and reports that I could get my hands on. I could hardly figure out the car seat to get my baby home from the hospital—a first of many challenges!

im-home-visitBut, thankfully I had access to support and care. All families with little ones should too. This is why home visitation programs are extremely important in our strategy to reduce disparities in infant mortality and improve overall maternal and child health outcomes for everyone. Not only have home visiting programs demonstrated remarkable results, but they are geared toward helping those who need the most support.

Home visiting programs equip families with the tools they need to overcome any barriers or challenges they are facing during pregnancy or the first years of their child’s life. Trained professionals, sometimes nurses or social workers, make home visits with families who have voluntarily enrolled to have one-on-one conversations about any concerns that expectant or new parents might have. For example, if an expectant mom is having difficulty getting to her doctor for prenatal care, the home visitor will work with community partners to help her get to the appointments. Participants in these evidence-based programs experience improved access to prenatal care, reduced preterm births and more, which are critical to reducing infant mortality rates. Just listen to some of the experiences Michigan families have had.

While over 35,000 families are served in state-funded programs, there are many more families in need of services than are currently served. Home visiting programs have been rigorously evaluated and do improve health, increase financial security and reduce child maltreatment. State policymakers should consider expanding the reach of these programs with additional funding. Plus, the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program will expire at the end of September. Congress must reauthorize the program, but also increase its funding to reach more families.

If we are to ensure that all babies thrive well beyond their first birthdays, policies should be targeted to serve those most in need. With rising rates of infant deaths for Latinos and African-American babies being more than twice as likely to die before their first birthday as White babies, reducing racial disparities is a critical component in reducing infant mortalities. Home visiting is a part of this solution.

When I look at my daughter today as she darts all over the soccer field, I think about all the support I had and how she’s the strong kid she is today because of it. All Michigan kids deserve to have a foundation like hers.

— Alicia Guevara Warren

Medicaid Expansion Could Benefit Michigan Babies

 Full report in PDF

Too many Michigan infants are dying: Roughly 800 Michigan babies died in 2010. The state’s infant mortality rate has been higher than the national average for two decades. Its 2010 infant mortality rate (7.1 deaths per 1,000 births) ranked 37th among the states.1 Medicaid expansion could help reduce Michigan’s high infant mortality rate.

The infant mortality rate is one of a number of measures tracked on the MiDashboard as an accountability strategy initiated by the governor.2 It reflects multiple factors such as maternal health, health care access and quality as well as socioeconomic conditions. The infant mortality rate is an overall indicator of the quality of life in Michigan because it represents the well-being for the state’s youngest and most vulnerable citizens—infants.

RACIAL ETHNIC DISPARITIES PERSIST

 The most glaring disparity in infant mortality rates is between African American infants and white non-Hispanic infants: 14.2 per 1,000 live births compared with 5.5 deaths per 1,000 for white babies.

Low-birthweight—under 5.5 pounds—is considered to be the most important factor explaining the racial disparities between African American and white infant mortality rates. African American mothers have roughly double the low-birthweight rates of white mothers—14% compared with 7% among white mothers.

INCREASED ACCESS COULD REDUCE RISK

The Medicaid expansion, which the federal government will fund at 100% from 2014 through 2016, under the Affordable Care Act extends eligibility to all individuals with an income under 138% of the poverty level.3

Roughly half of all Michigan births were eligible for Medicaid in 2010. The problem is that almost half of these uninsured low-income women, who are at the highest risk for unhealthy births, were eligible only during the pregnancy.4 The Medicaid expansion would allow access to care for more women before and between pregnancies, improving women’s health, birth outcomes and overall infant/child health.

Over a quarter of the newly Medicaid eligible in Michigan due to the Affordable Care Act are women are of childbearing ages (19-44).5 Medicaid expansion in conjunction with policies that work to improve the health of women and mothers could substantially improve birth outcomes.

Expanded eligibility for Medicaid family planning services could also mean significant cost savings for the state. Roughly 60% of women eligible for Medicaid delivery reported their pregnancies were unintended, compared with 27% of privately insured women.6 The estimated state minimum cost of each Medicaid birth is roughly $11,000 without complications.7

More than two of every five infant deaths in Michigan occur within the first 24 hours of birth.8Preterm birth (less than 37 weeks), low-birthweight and inadequate access to prenatal care all put babies at a higher risk of death in their first year.

Research has connected factors including nutritional deficiency, smoking, low maternal pre-pregnancy weight, single motherhood, socioeconomic status and race to low-birthweight.

In 2011, roughly 30 percent of all Michigan births were to mothers who had received less than adequate prenatal care, as measured by the month care began and the number of prenatal visits.

MICHIGAN IS ADDRESSING INFANT MORTALITY

The Michigan Department of Community Health received roughly $800,000 in fiscal year 2013 to begin implementing the Infant Mortality Reduction Plan. For fiscal year 2014, the governor recommended $2.5 million to continue those efforts. Progress so far included the following:

  • Development and implementation of an Adolescent Health Risk Behavior Assessment with the MI Quality Improvement Consortium to reduce unintended pregnancies.
  • Work in high-risk communities to use evidence-based teen pregnancy prevention programming.
  • Production and distribution of public service announcement to promote safe sleep practices in partnership with the Department of Human Services.
  • Update and promotion of safe sleep online training for health and child care providers.
  • Implementation of a Medicaid policy to require birthing hospitals to use evidence-based guidelines for elective delivery before 39 weeks to eliminate medically unnecessary early deliveries. 

WE CAN DO MORE TO REDUCE INFANT DEATHS

Contact legislators to:

  • Support the Medicaid expansion with full benefits to be included in the Community Health FY2014 appropriations bill (HB4213).
  • Approve the Governor’s recommended $2.5 m to implement the Infant Mortality Reduction Plan.

Support policies to:

  • Implement a lifespan approach to maternal and child health by improving women’s health well before conception and between pregnancies.
  • Address and target reducing infant mortality rates in communities of color.
  • Ensure timely prenatal care for all women.
  • Expand access to treatment for chronic diseases, oral health, mental health, and smoking cessation for pregnant women, all of which are associated with poor birth outcomes.
  • Implement PRIME—Practices to Reduce Infant Mortality through Equity—by developing a core curriculum, toolkits, and workshops on combating racism and fostering individual and corporate strategies to educate the public, and health and human services staff on the social determinants of infant mortality.

ENDNOTES:

 1. Data are the latest available from the Michigan Department of Community Health and KIDS COUNT Data Center. [http://datacenter.kidscount.org/data/acrossstates/Rankings.aspx?loct=2&by=v&order=a&ind=6051&dtm=12719&tf=133.
2. The 2012 rate cited on the Dashboard is actually the 2008-09 average rate in the 2012 report from America’s Health Rankings. [http://www.americashealthrankings.org/About/SummaryDescriptionofallMeasures]
3. G.M. Kenney et al. Opting in to the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could Gain Coverage? The Urban Institute, Aug. 2012. [http://www.urban.org/UploadedPDF/412630-opting-in-medicaid.pdf]
4. Michigan Department of Community Health. Pregnancy Risk Assessment Monitoring System Survey Data. Lansing, Michigan: MDCH, Lifecourse Epidemiology and Genomics Division, 2010 
5. The Urban Institute. Op. Cit.
6. Michigan Department of Community Health. Pregnancy Risk Assessment Monitoring System Survey Data, 2010.
7. Michigan Council on Maternal and Child Health. Does Pregnancy Prevention Funding Work?
8. Jane Zehnder-Merrell. Kids Count in Michigan Data Book 2011. Lansing. Michigan League for Human Services. Page 12.