New York City’s infant mortality rate – widely regarded as a barometer of a population’s general health – fell slightly in 2006, the Health Department reported today. The rate in 2006 was 5.9 infant deaths for every 1,000 births, down from 6.0 the previous year. The City has made major progress in reducing infant deaths since the early 1990s, when the rate was double what it is today, but the decline has leveled off in recent years. The Health Department also reported that in poorer sectors of the city, infant mortality rates are still double the citywide rate.

In 2006, there were 740 infant deaths (defined as deaths of infants less than a year old) out of 125,506 New York City births. The city’s infant mortality rate is still lower than the national rate, which was 6.8 per 1,000 births in 2004, the most recent year on record. The leading causes of infant death both in New York City and nationally are birth defects, premature birth, and low birth weight.

“We are making progress, but not enough, and not everywhere,” said Dr. Thomas R. Frieden, Health Commissioner for New York City. “There is no single solution to high rates of infant death we see in poor neighborhoods. We need targeted efforts to improve the health of women and children, but we also need to reduce poverty and improve women’s access to health care, healthy food, smoke-free environments, and opportunities for physical activity before, during, and after pregnancy.”

A woman’s health before she becomes pregnant is critically important. Infant illness and death is more common in babies whose mothers smoke, use alcohol or drugs, or are obese, have diabetes, or have high blood pressure before they become pregnant. New data from the New York City Pregnancy Risk Assessment Monitoring System suggest that all of these risk factors are common among NYC women. Among those who gave birth in 2004 and 2005:

• About 40% were overweight or obese before they became pregnant.
• One in eight women reported smoking during the three months before pregnancy; only half of these women stopped smoking while pregnant. According to a separate survey, 16% of New York City women aged 18 – 44 smoke. Many women may smoke or use alcohol during the first trimester of pregnancy, before they know they are pregnant but during the most critical time for fetal development.
• Nearly 8% reported having high blood pressure before or during pregnancy.
• About one in 40 (2.4%) had diabetes before becoming pregnant, and one in 10 developed diabetes during pregnancy – a condition known as gestational diabetes.

Disparities in Infant Mortality

In 2006, the infant mortality rates for black and Puerto Rican New Yorkers were more than double those for whites and Asians – a pattern that has persisted for more than a decade. The race gap persists even when poverty is taken out of the equation. Infants born to higher-income black women died at nearly three times the rate of those born to higher-income white women. While the reasons are not well understood, some experts believe the stress of experiencing of racial discrimination may affect the health of black women.

Infant mortality also varies greatly from one part of the city to another, with low-income areas suffering the highest rates. The highest rate was in the Bronx (7.1 deaths for every 1,000 births). Brooklyn’s rate was on par with the city average, while Queens, Manhattan and Staten Island fared better than the city as a whole. Over the past three years, Brownsville and Bedford-Stuyvesant in Brooklyn, along with eastern Jamaica in Queens, have had higher infant death rates than any other neighborhood. A complete list of rates by neighborhood is available online at www.nyc.gov/html/doh/downloads/pdf/vs/vs-imr-neighborhood-2007.pdf.

Infants who are multiples (twins, triplets, etc.) die at five times the rate of single infants because they are often born preterm. Multiples accounted for 3.8% of New York City births in 2006, up from 3.0% a decade earlier – reflecting a rise in maternal age and an increase in the use of fertility treatments.

Driving Down the Infant Mortality Rate

While working to improve everyone’s access to healthy food and physical activity, the Health Department is also taking direct steps to reduce infant mortality and address its disparate impact:

• Expanding the Nurse-Family Partnership, with the aim of serving more than 2,000 families by July 2008. NFP is a nurse home-visiting program for low-income, first-time mothers. Nurses interact regularly with women from the time they are pregnant through their child’s second birthday to help them take the steps needed to keep themselves and their babies healthy.
• Offering a single home visit to all families with new babies in parts of Harlem, Brooklyn, and the Bronx. Through this Newborn Home Visiting Program, Health Department workers assess the safety of the home environment, educate new parents about breastfeeding and safe sleep, and help families access medical care and social services.
• Promoting breastfeeding through the Breastfeeding Initiative. Most recently, the Health Department and the Health and Hospitals Corporation launched a comprehensive breastfeeding-promotion program to encourage breastfeeding and eliminate formula giveaways in public hospitals.
• Providing portable cribs and safe-sleep education through the New York City Safe Sleep Initiative.
• Working with 40 community-based organizations, with funding from the City Council, to reduce infant mortality through health education workshops, outreach, referral services, case management, peer education and other activities.

What Women Can Do To Stay Healthy and Have a Healthy Baby:

• Plan your pregnancy. Unplanned pregnancies are more likely to result low birth weight, infant death, and poor development.
• Have a regular doctor or health care provider to help you stay healthy.
• If you smoke or use alcohol or drugs, get help to stop.
• Maintain a healthy weight and eat a healthy diet.
• Keep chronic illnesses like diabetes and high blood pressure under control.
• Get help if you are depressed, overly stressed, or abused.
• Take folic acid, which helps prevent serious birth defects.
• Breastfeed your baby. Breastfeeding lowers the risk of acquiring infectious diseases that put a new baby at risk of death. Breastfeeding also lowers the risk of SIDS.

About the Data

Annual infant mortality data are derived from birth certificates and death certificates. Data on preconception health come from the Health Department’s Pregnancy Risk Assessment Monitoring System (PRAMS), a mail and telephone survey of over 2,000 births (about 1.5% of all NYC births). PRAMS is conducted annually among New York City residents randomly selected from recent birth certificates. For more information, visit www.nyc.gov/html/doh/html/ms/ms-prams.shtml.

Source: New York City Health Department