A chilling statistic: In Polk County, black babies are four times more likely than white babies to die before their first birthday. Why?

From 2015-2017, the three-year death rates broke down to 19.4 deaths among black babies and 4.8 deaths among white babies per 1,000 babies.

Black babies born in Polk County are four times more likely to die before their first birthday than white babies, a devastating gap that health officials and advocates are struggling to close.

The disparity “is very significant and very disturbing,” said Dr. Joy Jackson, director of the Florida Department of Health in Polk.

From 2015 through 2017, 180 Polk County babies died before their first birthday. The three-year death rates broke down to 19.4 deaths among black babies and 4.8 deaths among white babies per 1,000 babies.

While families mourned each life lost, health officials were compiling statistics, looking at causes and patterns in an attempt to figure out what can be done to prevent deaths.

The fact that black babies die more frequently than white babies is not unique to Polk County. During that period, statewide the black infant death rate was 2.5 times higher than the white rate. Nationwide the rate was 2.3 times higher.

"Numbers don't lie,” said Tonya Akwetey, who has a master's degree in public health and works as community liaison and fetal infant mortality review coordinator for the Healthy Start Coalition of Polk, Highlands and Hardee counties.

Multiple issues are involved in infant deaths and solving those issues involves multi-pronged efforts.

“There's stress and its impact on infant health, co-sleeping, access to care and transportation issues, safe use of car seats, chronic illnesses that go undiscovered, and whether diabetes, high blood pressure and other conditions are being managed,” Akwetey said.

While educating the public and changing habits to promote safe sleeping and the proper use of infant car seats are massive and slow-moving undertakings, it is even more complex to tackle other infant mortality issues.

For native-born African-Americans there's the issue of racism-related stress that is part of the fabric of life, said Akwetey.

The impact of that stress can be seen in the numbers, she said.

With all things being equal — income, educational levels and neighborhood — a baby born to an African-American mom in the United States is at higher risk of death than a black baby born to an African or Caribbean mom living in the United States, she said.

Dr. Armando Fuentes, chair of maternal fetal medicine at Nemours Children's Hospital in Orlando, explained stress impacts fetuses because “cortisol levels increase with stress, which decreases blood flow to the placenta.”

The impact of stress may also be a factor in the infant death rates among teen mothers, Jackson said.

The latest statistics that break out ages of moms and race are from 2013. That year in Polk County, the death rates for babies borne by black teens was 11.7 and borne by white teens, 8.5.

Ninety percent of teen moms in Polk County are single, Jackson said.

“This is not a moral statement about being an unmarried mom but a recognition that being a parent is difficult and single parents have less support in general,” Jackson said.

 

Some of the infant deaths, especially sleep-related deaths, are completely avoidable said Joyce Arand, a registered nurse with a master's degree in social work who as an associate vice president at Lakeland Regional Health oversees women's and children's services.

“The Florida Department of Health in Polk, Lakeland Regional Health and other health organizations have robust campaigns educating the public about safe sleep practices and breastfeeding's role in helping to avoid sleep-related deaths,” Arand said.

Not just parents but also grandparents, great-grandparents and other caregivers need to understand that it is not safe to cuddle the baby while drowsy, nor to put the baby down to sleep on his or her belly. Many people erroneously think that if the baby is on its back it can choke on its vomit, but the structure of the throat prevents that, Arand said.

“We now know a baby should be placed on its back in a crib with a tight-fitted sheet and no blankets, pillows or plush toys. To keep warm, a baby can be in a sleep sack or onesie. If swaddled, the baby's arms need to be left outside,” Arand said.

Akwetey said that even though she knew all the information about unsafe sleeping, she could have lost her son Emmanuel, now almost 5 years old, in an unsafe sleeping accident.

“I was really tired one day when he was about 3 months old. I was nursing him in bed and fell asleep. I woke up and he was wedged face down between the bed and portable crib.

“He was crying but I am a very sound sleeper so I don't think it was his cries that woke me. I can only attribute it to my faith in God that I woke up,” Akwetey said.

“Most of the time when you fall asleep with the baby, nothing happens. But you don't want to be that one person it happens to. It is a preventable death. People need to talk about this, know about this, know that it is not just people who are on drugs; it can happen to anyone. We advocate no co-sleeping until the baby is at least 1 year old.”

The statistics on sleep-related deaths for 2017 have not been finalized, Akwetey said, but a look at death certificates shows that among 10 infant suffocations last year in Polk County, six were black infants and four were white.

 

Since 2015, Akwetey has been facilitating a group of local professionals studying the numbers and the causes of infant mortality and searching for solutions. And this year, she is a member of a newly formed community committee exploring how to reach women with information and services.

“We are recruiting actively engaged women in Polk County to help us come up with initiatives and strategies to impact the black infant death rate,” Akwetey said. Anyone interested in learning more about it can call 863-534-9224 and ask for Lynn Marshall, Ph.D., a Health Start employee who is leading the committee.

Committee member Desirae Ofori, 34, of Auburndale, came across the black-white disparity statistics while researching for her blog, Sincerely, Mrs. Mommy, that she started after she became pregnant with Samson, now 3.

When she first saw the racial gap, “it was shocking,” Ofori said. “If you are not into it, don't have people talking with you about it, you have no clue about the disparity, especially first-time moms.

“We may automatically assume the difference is related to low income and no insurance, but even among middle class, educated women the death rate is higher among African-American women,” Ofori said.

Ofori, a professional artist who describes herself as a research junkie, said, “We are trying to gather more information, look at why, what are we lacking in our community.

“One thing we need is for black women to be more educated and be more advocates for themselves. As black women, we are strong; we have learned to take what happens. But we need to be adamant about our health. We need to make sure the medical world pays attention to us, that we know enough about our bodies when a doctor says just take a Tylenol, we can say 'something is wrong'.”

 

Although the statistics are alarming, there is cause for limited optimism as there has been year-by-year improvement locally.

In 2015, 33 black babies died before they reached their first birthday (a death rate of 22.2 per 1,000 infants). In 2016, 30 black babies died (a death rate of 19.5 per 1,000) and in 2017, 26 black babies died (a death rate of 16.6 per 1,000).

Part of that progress may be attributed to changes in access to neonatal care and fetal monitoring services, which help identify health issues and start treatment before the baby is born.

“A few years ago we were suffering a crisis for neonatologists in Polk County,” said Dr. Michael Ham-Ying, chief clinical officer for Central Florida Health Care, a federally qualified community health clinic, most of whose patients have low incomes.

In 2015, very few neonatologists would accept uninsured and Medicaid patients with high-risk pregnancies in Polk County, and for many the nearest place they could access specialty care was in  Hillsborough County, Ham-Ying said. There, the Florida Department of Health provided a regional perinatal intensive care center satellite facility.

Realizing their patients were having difficulties getting the specialty care they needed, Ham-Ying and an obstetrician from the clinic visited the center, hoping to work with staff there to improve conditions for Polk County women.

“We saw patients, mothers with high-risk conditions, sitting on blankets on the floor waiting to get seen," Ham-Ying said. "Some had brought their lunches and were eating them on the floor while they waited. They said it could take hours, sometimes all day. The two of us, after we left the clinic, sat in the car talking about what we could do, both of us in tears about what we had seen.”

Ham-Ying said he could not criticize the perinatal intensive care center's staff; they were overwhelmed by the large number of patients coming in from surrounding counties. In 2016, shortly after Ham-Ying visited the center, it restricted its geographic reach to Hillsborough County, further limiting the options for low-income Polk County residents.

With the conditions so dire, Ham-Ying said he and Jackson, who as head of the Polk County Health Department is also responsible for delivering services to a large number of low-income patients, decided to approach private-practice neonatologists asking them to start accepting Medicaid and uninsured moms as patients.

It worked; two specialists in maternal and fetal care who were in the process of expanding their practices into Polk County agreed in early 2017 to also see Central Florida Health Care and Health Department clients, Ham-Ying said.

 

In early 2017, Lakeland Regional Health System partnered with Nemours Children's Health System to offer maternal fetal care for women with high-risk pregnancies, Arand said. The hospital's center for fetal care opened in July with the opening of the eight-story Carol Jenkins Barnett Pavilion for Women and Children.

“We hope to have an impact on the infant death rate by providing one-stop care, starting before the baby is born,” said Dr. Daniel Haight, Lakeland Regional's vice president of community health.

Women with high-risk pregnancies no longer have to travel in heavy traffic to Orlando or Tampa for specialized care.

Fuentes, of Nemours, said that recent improvements arising from several Nemours partnerships in Polk County include the diagnosis of very mild heart defects that previously would not have been seen until after the baby is born. Instead of a three-week delay before an infant is seen by a pediatric cardiologist, the specialist can be on hand at the birth to start immediate treatment, he said.

And with fetal monitoring care available locally, “we can manage diabetic hypertension locally,” Fuentes said.

Uncontrolled diabetes can affect the growth of the fetus, Haight said, and uncontrolled high blood pressure can force early delivery to protect the health of the mother. Early delivery means low birth weight babies, who are more prone to health issues.

 

Although it is fairly rare for women to receive no prenatal care, in Polk County black women are nearly twice as likely as white women to give birth with never having visited a doctor — 3.4 percent of black women compared with 1.8 percent of white women.

And, black women are more likely than white women in Polk County to delay going to their doctor until after the first trimester at 12 weeks.

It may take six to eight weeks for a woman to realize she is pregnant — a period when cells are multiplying rapidly and there are many opportunities for miscarriage or issues to develop. By the end of 12 weeks, the cells have combined into a fetus with bones, muscles and all the organs formed.

Educational efforts need to reach not only the moms but also to health care providers about when they talk to women about pregnancy, Akwetey said.

“I am 33 years old and have one child,” she said. “When I go to my family doctor they don't talk to me about whether I am going to have another baby. That period between babies, inter-conception, and before conception is important. Ideally, women should start taking vitamins and preparing before becoming pregnant.”

Jackson said that if women are planning before they become pregnant they would have stopped smoking and using alcohol and drugs, and would have worked on bringing under control any blood pressure or diabetes issues. In their first trimester, they would be taking folic acid to help in fetal development and would be being monitored for changes in blood pressure and signs of pregnancy-related diabetes.

“Maybe we need to flip the question of preventing infant deaths and say, 'What can we do to increase healthy outcomes?',” Jackson said.

“We want moms to plan the pregnancy — to use folic acid, avoid tobacco, alcohol and drugs, be at a healthy weight and be at a good stage in life when they are ready to take on the responsibility of parenting an infant, which is very physically and emotionally stressful and is expensive.”

 

NEXT: "I did not speak about it for a while, even to my own husband."

 

 

WORDS: Marilyn Meyer

PHOTOS: Pierre DuCharme, Ernst Peters, Scott Wheeler

EDITS: Allison Guinn, Bob Heist

DATA: Allison Guinn

WEB: Laura L. Davis

 

The author of this story, Marilyn Meyer, has retired from The Ledger. Comments, questions and news tips regarding this story can be directed to Editor Bob Heist. Email him at bheist@theledger.com or use the contact form at left.