This man is on the trail of a mystery killer taking the lives of babies, particularly black babies.
The killer isn’t a person. And the crime isn’t murder.
Rather, the mystery has to do with fetal and infant mortality. After years of hard-won progress, New Haven has experienced a disturbing rise in that rate. Now the city is working with an expert in the field, Brian Karsif (pictured), to get to the bottom of how New Haven’s public-health success story hit a bump.
(Click here for a previous Independent story on the issue.)
Through the 1990s, the city slashed infant and fetal death rates through a community-wide effort led by the Community Foundation for Greater New Haven (then called the New Haven Foundation) and the city’s Health Department. New Haven became the Connecticut city with the lowest infant mortality rates. In particular, infant deaths among African-Americans — the highest at-risk group—plunged. The overall rate went from a high of 31 per 1,000 live births to 15.
But that rate has inched back up since 2001. According to the most recent statistics, New Haven has had the highest rates of premature baby deaths of any Connecticut city.
And no one’s quite sure why.
“This is a big deal,” said Mayor John DeStefano. “It’s a major concern. It’s hard to speculate” at this point about the cause.
“We’ve been looking at this recent spike. We haven’t been able to get under the numbers yet,” said James Rawlings, president of the Greater New Haven NAACP and chairman of the NAACP’s statewide Health Committee.
Three-Year Trend
Even spotting a trend is tricky: The number of infant deaths each year is small enough that, in the words of state Department of health point person Lloyd Mueller, any one year can produce “erratic fluctuations.” Around 1,900 to 2,000 babies are born a year in New Haven.
But now the city has three years of what appears to be a trend. It cuts across both categories of statistics relevant to this discussion: fetal deaths (stillbirths) and infant deaths (babies dying within 12 months of birth).
The combined rate was 14.9 deaths per 1,000 live births in 2001, 16.9 percent in 2002, 21.6 in 2003, 26.9 in 2004, 22.4 in 2005, according to the most recently available state figures. (For more state figures, click here.)
New Haven consistently posted the lowest or among the lowest rates among Connecticut cities in the 1990s. But from 2001 – 4 it posted the highest. (Figures for 2005 weren’t available from the other cities.) Hartford’s combined rates were 20.1 deaths per 1,000 live births in 2001, 16.0 in 2002, 15.9 in 2003, 18.1 in 2004. In Bridgeport the rates reported were 18.8, 17.2., 20.3 and 14.9; in Waterbury, 14.0, 20.4, 19.1. and 13.9.
“I wouldn’t want to hang my hat on any of the numbers yet,” Brian Karsif said. “But I think there was a bonafide increase.”
Karsif is researching the last few years’ cases throughout the region under a state-funded program. Karsif and other members of the local the local chapter of a group called FIMR (for Fetal and Infant Mortality Review) successfully enlisted State Rep. Pat Dillon to rescue funding for the program this year in the face of a proposed budget cut.
While he’s still analyzing data, Karsif reported that the clear majority of fetal and infant deaths involved African-American babies.
Part of the reason, he said, appears to be a greater incidence of “bed-sharing”; moms sometimes inadvertently roll over onto their babies. Also, he said, African-American mothers breast-feed in smaller numbers. Breast-feeding moms sleep lighter and are more attuned to babies’ calls, he said.
The NAACP’s Rawlings said that Yale-New Haven Hospital and other health-care groups have recently succeeded in convincing more black moms to breast-feed. “Everybody has pushed,” he said. “People are getting the message.”
One change from 20 years ago, according to Karsif: Access to care doesn’t appear to be a problem, thanks to programs initiated by local hospitals, clinics and government.
Other factors contributing to infant mortality can include poor nutrition and low birthweight, as well as substance abuse.
The rate of infant mortality in Latino families is no higher than among whites because of what’s known as the “immigrant effect,” according to Karsif: Mothers new to this country bring healthier habits with them. They eat better. They smoke less. They have lower rates of hypertension. They have more family support, because they live with more people. By the time immigrant families have second or third children, the families have adopted more American habits and the infant mortality rate starts rising, Karsif observed.
The biggest rise in infant mortality and fetal deaths occurred in 2003 in New Haven. That extraordinary spike can be attributed to multiple births, according to Mueller, a senior epidemiologist with State Health Department. In general, giving births to twins is riskier than giving birth to “singletons,” he said; the risks continue to rise with triplets and quadruplets,
The increased use of fertility treatments is also a factor, Mueller theorized. He can’t know for sure yet: Birth certificates don’t include information on whether a mother had such treatments. In Connecticut that information will start appearing on certificates in a year or two, Mueller said.
The NAACP’s Rawlings has used the issuance of a recent report on racial disparities in health care to push the state for the creation of an Office of Minority Health. (Click here to read about that.) Other New England states have such offices, he said. They also have lower rates of infant mortality.