Premature Births: Huge Racial Disparities Remain Despite Slow Infant Mortality Drop

Beth Glicker, as part of the Nurse-Family Partnership program, coaches new mom Dinara Gabdula on nutrition, health and parenting. (Photo: Ryan Holmes, USA TODAY)
Beth Glicker, as part of the Nurse-Family Partnership program, coaches new mom Dinara Gabdula on nutrition, health and parenting. (Photo: Ryan Holmes, USA TODAY)

Despite a 13% drop in the national infant mortality rate over nearly a decade, there remains a stubborn gap between the rates for black Americans and other racial groups as well as between some Southern states and the rest of the country.

The most proven and promising way to reduce the disparities in premature births that lead to death — home visits by nurses — got a boost in the Affordable Care Act, but is reaching only a fraction of those in need, policy experts say.

The ACA funding of nurse home visits covered just 115,000 families in 2014, while about 1.8 million births a year — nearly half — are covered by Medicaid, the health care program for low-income families. Still, a 2012 report by the Pew Charitable Trusts found fewer than a third of state Medicaid programs fully covered home visits.

Black infants overall continue to die at a rate more than twice that of white babies and some parts of the country have racial gaps that are far wider. Black mothers are also twice as likely to have costly premature births due to factors including poor access to health care and existing health problems, which contributes to the United States having one of the highest death rates among developed countries.

It would cost state and federal Medicaid programs about $60 billion over 10 years to extend nurse home visits to all eligible mothers, but the savings from preventing premature births alone would be nearly $21 billion after that decade, the Center for American Progress estimates. Hospital stays for premature and low birth weight babies average about $15,000 and 13 days, compared with $600 and about two days for births without complications. Home visits by the Nurse-Family Partnership, the oldest and most studied program, average just $4,200 a year and last until children turn 2.

The emotional and economic impact is staggering. More than 23,000 babies a year die before their first birthdays, often after spending weeks or months in neonatal intensive care units. Mothers who received little or no prenatal care are about 40% more likely to have a child that dies in infancy.

Babies that are born very prematurely often have “severe mental and physical illnesses that are an additional strain for a mother who might have been scraping by to begin with,” says Janis Orlowski, a kidney doctor who is chief medical officer of the Association of Academic Medical Centers. When it comes to prenatal and early childhood care, “If the ethical reasons don’t sway, the financial ones should.”

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SOURCE: Jayne O’Donnell
USA TODAY