New infant mortality data: Positive trend, but large disparities by place

Infant mortality, a metric widely used to compare the health and well-being of different populations, has declined slightly in D.C. (and across the nation) over the past decade. New data from the D.C. Department of Health (DOH) measured infant mortality at 9.9 infant deaths per 1,000 live births in 2009 (the national rate was 6.4). A decrease in infant mortality is excellent news, but city-wide statistics can mask disparities among wards and different population groups (especially by race and income). That finding is true nationally and in D.C., where infant mortality by ward ranges from a low of 2.6 to a high of 18.4. (For a closer look at vital statistics by ward and race/ethnicity, see the D.C. KIDS COUNT Data Center.)

The D.C. rate has declined since 2005. We hope that trend will continue. D.C.’s infant mortality rate is higher than the overall U.S. rate, but it is lower than comparable cities. In 2009, Baltimore and Detroit experienced rates of 13.5 and 14.8, respectively.

Infant Mortality Rate by D.C. Ward (2005 and 2009)

When looking below city-wide data, other notable trends emerge, though it’s important to use caution when examining these data because of the small numbers (for example, Ward 6 had only 2 infant deaths in 2009 and an infant mortality rate of 1.9). While infant mortality rates decreased in every ward between 2005 and 2009, some wards have much higher rates than others. Wards 2, 3 and 6 had very low infant mortality rates in 2009, while Wards 5, 7 and 8 rates were significantly higher. Some wards – most notably 1, 3 and 6 – also had sharper declines than others.

Differences by race/ethnicity are striking, as well. Among black and white women, infant mortality has declined, but large gaps separate infant mortality rates by race. In 2009, the rate among black women was 14.6; among white women it was 2.6. For Hispanic women, the rate was 8.0.

Disparities in infant mortality rates may be associated with risk factors such as preterm births, low birth weight, access to health care and socioeconomic factors. Disorders related to prematurity and low birth weight, many of which can be prevented by improvements in women’s health care in general and prenatal care more specifically, are among the leading causes of infant mortality. More than half (63%) of the infant deaths in 2009 occurred during the first month of life, and better health care before and during pregnancy could have prevented many of them. Like infant mortality rates, data on prenatal care also show disparities by ward and race, indicating that improved care may be a way to reduce infant mortality.

Considering these disparities, we have several questions:

  • What factors are underlying the infant mortality trends? For example, how much is the decline in infant mortality related to increases in median family income in the city (up 12 percent between 2000 and 2010)? How much might it be related to changes in the racial diversity of D.C., with a growing population of whites (who, as noted above, tend to have lower infant mortality rates)?
  • How has the city progressed on the goals in its 2007 Infant Mortality Action Plan to increase home visiting and collaboration and coordination among public and private agencies working to prevent infant mortality?
  • Do women in certain District neighborhoods lack equitable access to prenatal care? In other words, do services match where need is?
  • Has the city (or a local organization) mapped where women giving birth live in relation to where providers of prenatal health services are located?

While answering these questions is just a start, of course, that would go a long way toward helping the District deploy resources more effectively to lower infant mortality.