Infant mortality rates in the Southwest have been steadily declining over the years. But recent data from New Mexico show a surprising spike in 2012. The state has surpassed national infant death rates for the first time since the 1990s.
According to the Associated Press:
The state Department of Health announced this week that the death rate among infants one year or younger increased from 5.2 infant deaths per one thousand live births in 2011 to 6.9 in 2012. This marks the first time since 1994 that the state rate has exceeded the national rate, which was 6.0 infant deaths per 1,000 births in 2011.
"The increase in infant mortality was unexpected because the risk factors for poor birth incomes have been steadily declining in recent years in New Mexico," said Mary Shepherd, an epidemiologist with the State's Department of Health.
"The teen birth rate has decreased 30 percent in the past five years, the percentage of babies that are born pre-term has declined in the past five years, and the percentage of pregnant women receiving an appropriate level of pre-natal care has increased from a decade ago," Shepherd said.
In other words, the spike comes as a complete surprise. In surrounding states, the infant mortality rate has dropped significantly over the years. From 2005 to 2011, New Mexico, Arizona, Nevada and Texas all saw decreases in their infant mortality rates. Texas went from a rate of 6.5 to 6.1 between those years, and Arizona dropped from 6.9 to 5.97. A time-lapse video from America's Health Rankingsprovides a look at infant mortality rates around the country since 1990.
"The leading causes of infant mortality at the national level are birth defects, pre-term birth or being born too soon before 37 weeks, sudden infant death syndrome, maternal complications and unintentional injury," said Lacy Fehrenbach with the Association of Maternal and Child Health Programs (AMCHP). "The good news is that in that six year period we also saw declines among four of the leading causes."
"It's certainly concerning to us any time we see an increase in infant mortality as New Mexico has reported for 2012," said Fehrenbach. "I think it reinforces the need for us to refocus our efforts to prevent poor birth outcomes and infant death, however, we must really consider the data closely and look at it compared to other states and the nation."
According the Office of Minority Health, minorities are often most impacted:
African American mothers were 2.3 times as likely as non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all. American Indian/Alaska Natives have 1.6 times the infant mortality rate as non-Hispanic whites. Puerto Rican infants were twice as likely to die from causes related to low birthweight, compared to non-Hispanic white infants. The infant mortality rate is 1.7 times greater for Native Hawaiians than for non Hispanic Whites.
However, in New Mexico, something different is happening.
"Hispanics did have an increase, but the greatest increase was in white, non-Hispanics," said Shepherd. "American Indians actually had a decrease in infant mortality in 2012. There was a greater increase among male infants than female infants which is consistent with prematurity."
One area worth exploring, notes the AMCHP, is pre-conception health. This is the idea that a newborn's health is largely driven by environmental, community and cultural exposures the mother has, including social determinants like economic status and stress.
"We know that poverty affects health, and poverty is hard to reverse, particularly through health interventions," said Brent Ewig, also with the AMCHP. "So that makes that more difficult to improve community health in the populations that are disproportionally most affected by both poverty and poor educational opportunities as well as job opportunities."
According to Shepherd, the problem with this recent round of data is that officials can describe what's happening, but they can't explain why. The main reason is they're only looking at death certificates.
"Our next step is to link the death certificates back to birth certificates so we can know more about the characteristics of the mothers, the characteristics of the birth hospital, [and] any kind of pregnancy complications," said Shepherd. "All of these will provide useful information to understand why this is happening."
Ewig said the infant mortality rate in a state or the nation is a measure of how well society takes care of its women and children. And understanding exactly what's happening is critical to intervening and preventing deaths in the future.
"We need some better analysis and we need that basic public health infrastructure of epidemiologists and disease detectives, data experts, that can help us future this out," said Ewig. "What's at stake is the lives of babies and families and that's not abstract, that's very real."