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Racial divide persists in Pittsburgh's infant mortality rate

Debra Erdley
| Tuesday, Jan. 3, 2012

Pittsburgh is a great place to have a baby -- if you're white.

It's another world for black babies.

A haven for advanced medical research, and a city celebrated as America's Most Livable by Forbes magazine, Pittsburgh carries another less-known distinction: Allegheny County's infant mortality rate for black children younger than 1 was among the nation's highest at 20.7 deaths per 1,000 live births in 2009, the latest statistics available.

That is more than five times the 3.9 deaths per thousand among white babies here, and slightly above the 20.09 rate the Central Intelligence Agency reported for infants in the Third World nation of Libya.

The numbers horrify Raeann Sims, a 911 emergency dispatcher and mother of two black toddlers.

"It kind of made me paranoid," said Sims, 21, of East Hills. She and sons Josiah, 11 months, and Isaiah, 2, whom she calls "my little king and my little prophet," live with her fiance, Shawn Jefferson.

No one can pinpoint why black babies die at such a high rate here. Always high compared with the national rate, Pittsburgh area's rate of death among black babies had been creeping down for a decade, at one point reaching 16.2 per thousand, before rising again in 2009.

Dr. Henk ten Have, director of the Center of Healthcare Ethics at Duquesne University, said researchers long have considered infant mortality to be a marker of a population's health because it measures the well-being of a group's most vulnerable members.

Dr. Bob Cicco, a neonatolgist at West Penn Hospital in Bloomfield, began practicing in Pittsburgh in 1980 and is a member of the county Health Department's Child Death Review Panel, which studies reports behind the numbers. He said researchers believe a number of medical and social factors lead to black infant mortality in the United States.

Those factors include the mother's diet and smoking, spacing between pregnancies, poverty, health care, infant sleeping practices and even the stress of living with racism -- researchers note that stress releases hormones that can trigger early labor.

Such things can affect poor women and affluent, educated black women, said Angela Ford, director of the University of Pittsburgh's Center for Minority Health.

Ford said researchers have found that blacks here also are far more likely to suffer from high blood pressure, diabetes and heart disease.

"But the infant mortality numbers tell a big story," she said, adding that she finds it troubling that the story attracts little attention.

Ray Firth, director of policy initiatives at Pitt's Office of Child Development, said many physicians are aware of the numbers and are working to improve them.

"But it doesn't come in the public's eye. These difficulties are individual family situations. People don't go public with their family situations, so there isn't enough attention," Firth said.

Cicco said black infant deaths can be grouped into two categories: those that occur in the first month of life, often linked to prematurity, and those that occur from 1 month to 1 year and frequently are tied to Sudden Infant Death Syndrome.

Getting a baby to full-term birth could help with one category, Cicco said, and promoting safe sleeping habits -- not sleeping with babies in the bed and placing infants on their backs in cribs -- could affect the SIDS numbers.

Raeann Sims gave birth to Isaiah two months early; he weighed 4 pounds, 9 ounces and remained hospitalized for 17 days before her doctor determined he was healthy enough to go home.

Sims said her first pregnancy was difficult because of her asthma and a bad relationship she was in at the time.

"I was under a lot of stress," she said.

Home visitors from Healthy Start helped her deal with stress.

The federally-funded program targets infant mortality rates by connecting at-risk women with home visitors, beginning with pregnancy and continuing until a child's second birthday.

Healthy Start also provides a program for men that encourages fathers to nurture infants and toddlers.

When Sims learned about the mortality rates for black infants, she was eager to do what she could to ensure her babies get the best chance at healthy lives.

When she carried Isaiah, she said, Healthy Start staffers encouraged her to go to prenatal appointments and helped her find community resources. They taught her how to perform infant massages and about safe sleeping practices, giving her confidence to disregard the well-meaning advice of family and friends who questioned why she would lay her son on his back in a crib without stuffed toys or fluffy blankets.

"I had a SIDS door hanger (a placard that explained its connection to sleeping habits) on his bedroom door," Sims said.

Healthy Start caseworker Natasha Davis, who has a toddler and is expecting her second child, has become a trusted confidante for Sims, who, in turn, has become an informal ambassador for the program.

Healthy Start considers Sims a success story: Josiah was born full-term, weighing 8 pounds, 9 ounces.

Healthy Start Director Cheryl Flint said the program gained credibility by recruiting women from neighborhoods to become caseworkers and nurses, and by connecting with institutions such as black churches and beauty shops.

"We ask the community to be a part of it," she said.

Even so, caseworkers say building trust with clients is a never-ending job. They frequently schedule 25 home visits to complete 15.

Healthy Start boasts much lower black infant mortality rates than the county's total: 2.74 per thousand between 2007 and 2009 among its clients, who represent about a third of black mothers in Allegheny County.

State Sen. Jim Ferlo, D-Highland Park, who has sponsored Senate resolutions to encourage discussion of the issue, said it is long past time for people to act.

"I think it is important to make this a cause celebre, " Ferlo said. "We need elected officials, those with resources, the religious community and those in the community. It has got to be a comprehensive approach to bring all of these leaders to the table to address this."

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