Infant mortality rises

MONTGOMERY - Alabama had an infant mortality rate of 9.1 deaths per 1,000 live births in 2016, the highest rate since 2008.

That's 537 infants who did not reach age 1, the Alabama Department of Public Health (ADPH) said last week.

The state rate had dropped for three consecutive years - 2013, 2014 and 2015 - before increasing nearly one full point in 2016.

And this year, the state's opioid epidemic was included as a factor in the rate.

"Our infant mortality rate is troubling and disheartening and trending in the wrong direction," Dr. Scott Harris, acting state health officer, said in a written statement.

In a telephone interview, Harris said deaths related to a mother's drug use are hard to track and as of now, there's no way to quantify how many infants die as a result of opioids.

"But we recognize that it's such a big problem in the state, and we're looking for ways to intervene on that issue," Harris said.

Even with adults, drug-related deaths are under-reported, Harris said.

"As bad as the numbers are, public health officials agree they're actually probably worse," he said.

About 100 Americans die from opioid overdoses daily, a rate that has more than quadrupled since 1999, according to the Centers for Disease Control and Prevention. According to a 2017 CDC report, Alabama has had the highest rates of opioids prescribed per capita for the past five years.

Harris is on a statewide task force charged with finding solutions to the state's opioid issue.

Babies born to addicted mothers are often underweight and premature. Some are addicted themselves. While withdrawal symptoms can be difficult for adult opioid users, they can be lethal for infants.

Harris said the department is studying the mortality rates in comparison to areas of the state with high opioid usage.

The infant mortality rate for black infants saw a slight decrease in 2016 to 15.1 per 1,000, compared to 15.3 in 2015. But that rate is still nearly double that of white infants.

Inequities in health care, housing, jobs, neighborhood safety, access to food and income are challenges faced by minority groups and have a negative impact on birth outcomes, the ADPH statement said.

The three leading causes of infant mortality remained the same in 2016 -- congenital malformation, premature births and Sudden Infant Death Syndrome.

Ongoing struggle

The state has struggled with high infant mortality rate for years. A decade ago, in 2007, the state's infant mortality rate was 10.0, and the state rate is consistently well above the national infant mortality rate.

According to the Centers for Disease Control, the national infant mortality rate was 5.9 births per 1,000 live births in 2015, the most recent available from the national public health care organization.

Karen Landers, Shoals-area district medical officer with the Alabama Department of Public Health, said struggles common in Alabama - poverty, low wages, unemployment, health care access - all factor into the state's fight with a high infant mortality rate.

"If we take some of the more rural counties in Alabama, those counties do not have any OB-GYNs and have no physicians that deliver babies, so there is no easy access for health care," Landers said. "It is really the attendant factors that go along with poverty that cause these problems that continue to exist in Alabama."

The state has a handful of strategies public health officials hope will move the infant mortality rate back in the right direction.

These include increasing the use of progesterone to women with a history of preterm birth; reducing tobacco use among women of childbearing age; encouraging women to wait at least 18 months between giving birth and becoming pregnant again; and continuing education about prenatal care, infant care and safe sleep efforts.

The state health department began distributing Baby Box sleeping kits to Alabama mothers this year. The program provides a box and mattress that is a safe sleeping environment for babies in an effort to curb infant deaths related to unsafe sleeping habits.

Landers said there also is a program that provides cribs to eligible mothers after the baby outgrows the Baby Box.

"There are many people including physicians, nurses, public health officials, hospital officials and community health providers that are trying to work together to reduce the infant mortality rate in our state." Landers said.

Good news

The teen pregnancy rate in Alabama dropped to its lowest level recorded. In 2016, teen pregnancies made up 7.7 percent of Alabama births. That rate is down from 8 percent in 2015.

There were 4,526 births to teen mothers in 2016.

The teen pregnancy rate in Alabama has dropped each year since 2009, when teen pregnancies made up 13.4 percent of all live births in Alabama.

Smoking during pregnancy also dropped in 2016 with 10.1 percent of mothers reporting they smoked during their pregnancy. That is the lowest rate ever recorded in Alabama, and is down from 10.4 percent in 2015.

"I think these efforts should be commended," Landers said. "A lot of the reduction in those areas is related to education provided through public health, health care providers and the education system in Alabama. We should applaud the decreases in smoking and teen pregnancies as those are two areas we have struggled with."