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Black infant mortality rate falls

Hub works to close racial gap on care

By Kay Lazar
Globe Staff / July 25, 2011

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In a sign that Boston could be taking a step forward on one of its most challenging problems, new state data to be released today show that the number of black infants who died before their first birthday plunged by nearly 50 percent between 2008 and 2009.

Sixteen black infants died in 2009 in Boston, according to the latest available numbers from the Department of Public Health, compared with 30 a year earlier.

That translates to the lowest death rate for Boston’s youngest black residents in 20 years, a statistic that is prompting cautious optimism from city leaders, who say that years of hard work to drive down racial disparities in infant mortality may finally be bearing fruit.

“We have tried to use science to guide our initiatives, making sure families have the social supports they need, particularly around housing,’’ said Barbara Ferrer, executive director of the Boston Public Health Commission.

Ferrer said health officials will have a better sense of the progress after seeing the numbers for 2010, to make sure the latest plunge is not a one-year phenomenon. There have been other, less dramatic declines in past years, only to have the numbers go back up.

The latest numbers show that Boston’s 2009 black infant death rate was 7.7 for every 1,000 births. A year earlier, the rate was 14.6.

And for the first time in two decades, the 2009 data indicate that the gap between the black and white infant death rates narrowed significantly. Instead of rates three and four times higher, the 7.7 black infant death rate was much closer to the white rate of 5.0. The Hispanic rate held steady at roughly 8.0.

Twenty years ago, the black infant death rate was roughly twice as high, a statistic that alarmed medical and political leaders and sparked a call to action.

In sections of Roxbury, Dorchester, and Mattapan, black infants were dying so frequently in the early 1990s that people were referring to the neighborhoods as “death zones,’’ said Elmer Freeman, a Northeastern University specialist in the study of health care disparities, who at the time was head of the Whittier Street Health Center in Roxbury.

Freeman and other advocates urged city leaders to focus on driving down those numbers, a campaign that started with paying closer attention to the health of pregnant black women and has since evolved into a more comprehensive approach by hospitals, community centers, and the Boston Public Health Commission.

Despite years of work, the gap between deaths of black and white babies remained frustratingly persistent, prompting Mayor Thomas M. Menino in 2005 to describe health care disparities as the most pressing medical problem facing the city.

That year, the black infant death rate plunged to 8.7, the second lowest in two decades. The next year it jumped to 13.2.

After that, the city’s public health commission revamped programs to more aggressively reach out to women and families, providing home visits staffed by nurses, social workers, and public health advocates.

Specialists say they learned that simply narrowing the gap in prenatal care for black and white women does not necessarily vanquish the disparity in infant deaths.

“We have moved toward the social, political, and economic factors that have to do with housing and access to care and child care and parenting plans and domestic violence,’’ Freeman said. “These are the stressors that really have an impact on people’s health.’’

That is the message Menino is expected to deliver today as he unveils the new infant death rate data at a National Urban League convention in Boston.

Another positive sign in the data: The rate of black babies born with dangerously low birth weights is also the lowest it has been in 20 years.

Pediatrician Sean Palfrey, a professor of pediatrics and public health at Boston University, said underweight babies are the most vulnerable because they have a tough time fighting off lethal infections, especially in the first few months of life.

Palfrey said the mosaic of public programs put in place to help black families before, during, and after a baby’s birth is getting stronger and more vibrant, but he worries that state and federal cutbacks may threaten their future.

“It worries me that those numbers won’t hold up as well when the data comes in for 2010 and 2011,’’ Palfrey said.

“The problems in our economy have deepened since 2009, and more people have had problems with food insufficiency and homelessness,’’ he said.

Freeman, too, said he is concerned.

“I am ecstatic for Boston, but there are other cities in the state, such as Worcester, where infant mortality is still high,’’ he said.

“While we should pat ourselves on the back, we shouldn’t rest on our laurels.’’

Kay Lazar can be reached at klazar@globe.com

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