$10 million in federal funding over five years announced to support Healthy Start initiatives.
BOSTON—Black babies dying at higher rates than other babies in Boston. For years it has been a stark reminder that inequities and disparities in health outcomes can exist even in places with a world-class health care system.
After more than a decade of concerted effort to improve the health of Black women and their children, the Boston Public Health Commission (BPHC) today released a data brief showing that progress is being made, and announced new funding to continue its work. The data released today show:
- Significant improvement in the Black Infant Mortality Rate (IMR)
- Historic narrowing of the IMR gap between Black infants and White infants
- Reduction in preterm births for Black infants born in the city, and
- Decreases in the number of Black infants born at low birth weight
"I am pleased that we are making progress on this longstanding public health problem, but we cannot be satisfied until we've eliminated this disparity," said Mayor Martin J. Walsh. "The funding that we are announcing today will allow us to redouble our efforts, and seek new and innovative strategies to ensure that Boston's youngest residents have an equal chance at the most basic opportunity of all: a healthy start to life."
The Commission analyzed infant mortality —defined as babies dying within the first year of life— over 12 years, breaking down the data into three 4-year periods. The data show that Black IMR decreased from 13.1 deaths per 1,000 live births in 2001-2004, to 7.4 in 2009-2012, a rate 44% lower than the 2001-2004 rate. This improvement is equivalent to 59 fewer Black infant deaths from 2005 to 2012.
"These data are encouraging and a reminder that no matter what the issue, or how intractable the problem seems to be, that communities can and must work to eliminate health inequities. This is not a victory, but it is progress and it validates the comprehensive approach we've taken to work with our partners across the city to improve the health of Black women before, during and after they have given birth," said Dr. Barbara Ferrer, the BPHC executive director.
For decades the gap in mortality between Black and white infants has been increasing, a fact not unique to Boston. In the United States, from 1935 to 2007, the gap between White and Black infant mortality grew. In 1935, the IMR for Black infants was 58% higher than White infants in the United States. By 2007, the Black IMR was 135% higher than the White infant mortality rate.
Consistent with trends seen nationally, the BPHC data released today show the persistent gap may be narrowing. The IMR gap between Black and White infants shrunk by 25% between each of the three time periods analyzed from 2001-2012. That means that the Black IMR went from being 4 times the White IMR in 2001-2004, to 2 times the White IMR in the 2009-2012 time period.
The Commission also noted improvements in low birth weight and preterm births among Black infants in Boston; an important finding given that premature births and low birth weight are major contributing factors to infant mortality. Compared to 2001-2004, the 2009-2012 rates of low birth weight and preterm Black infants were 10% and 16% lower, respectively.
The BPHC's efforts to improve the Black low birth weight, preterm births, and the IMR have been broad and comprehensive, reflective of the complex constellation of factors that contribute to worse birth outcomes for Black infants in the city. In addition to supporting traditional public health prevention and prenatal programs, since 2008 the Commission has increasingly sought to address the impact of poverty, racism and the resulting stress on the health of Black women.
A variety of programs focused on promoting the health of women before and between pregnancies, and initiatives designed to support women and their families during and after pregnancy have played a major role in Boston's work to reduce Black infant mortality.
"Birth outcome reflect every single part of a women's life. To make improvements, we must have a collaborative and holistic approach to the care and treatment of women, throughout the life span" said Dr. Deborah Allen, Director, Bureau of Child, Adolescent and Family Health. "Through citywide partnerships with residents, community health centers, birth hospitals, multiple community agencies and a unique alliance with the Boston Housing Authority, we've been able to create a climate of support and care for women."
Building on the success of these previous efforts, the Commission also announced today that it has been awarded $10 million for the next five years to continue its Healthy Start initiatives. The federal funding will support programs that serve pregnant women, fathers, parenting groups and other community engagement projects. It will also support continued work with health care providers throughout the city to identify new opportunities to improve health and social supports for women of all races. The funding will also enable the launch later this year of the "One Key Question" initiative in Boston.
The One Key Question initiative, developed by the Oregon Foundation for Reproductive Health, encourages providers to ask women of childbearing age a simple but important question: "Do you want to become pregnant in the next year"? The focus of the program is to promote preconception health and planned pregnancy, which gives women a chance to deal with any health issues and risks they may face prior to pregnancy.
To learn more about the improvements in Boston's Black IMR, download Closing the Gap, Decline in Black Infant Mortality Rates in Boston, 2001-2012.