Unusually high rates of infant deaths among certain minority groups in Minnesota have state health officials searching for ways to better support mothers before, during and after their pregnancies.
A Minnesota Department of Health report released Thursday revealed that babies born to black mothers are more than twice as likely to die in infancy as babies born to white mothers — giving Minnesota one of the widest infant mortality gaps in the nation.
But it also found that the problem isn't just social disadvantage: The death rate is lower for infants of Hispanic or African-born black mothers than for those of U.S.-born black mothers, despite the fact that all of these minority groups suffer higher rates of poverty and other social ills associated with poor child health.
The key difference, state officials suspect, is the cohesion in the largely immigrant communities that provides new mothers with role models and support. Health officials said a key to addressing the disparity is finding ways to re-create that protective support for others.
"The baby gets a different kind of attention [in immigrant communities] than even in the white community," said Dr. Ed Ehlinger, state health commissioner. "So despite the economic risk factors, they have a lot of social support that helps keep their infants alive."
Roughly 380 infants die in Minnesota each year — with the leading cause being physical or neurological birth defects. The leading causes are different for blacks and American Indians, and those differences offer clues to the state's disparities.
One quarter of the African-American infant deaths were linked to prematurity, suggesting that many black women were getting pregnant with health conditions, such as hypertension, associated with early births.
One quarter of the Indian infant deaths were classified as sudden unexpected infant deaths, a broad category including suffocation due to unsafe sleeping positions. That indicates a need for better education in Minnesota's Indian communities about safe-sleep practices, Ehlinger said.
Sudden unexplained deaths also are linked with smoking, and tobacco use while pregnant remains more common among Indian women.
But these causes, too, can be traced to a lack of support — of advice from doctors and of family members or friends modeling safe practices for new mothers. "It's not your aunt anymore" who visits, said Dr. Lisa Saul, an Allina expert in high-risk pregnancies. "We don't live around our families as much."
United Family Medicine in St. Paul is one of nine clinics in Minnesota to try prenatal group appointments, where doctors spend an hour or so with parents together discussing pregnancy and infant care.
United's Dr. Micah Johnson has experienced group appointments as a father and physician. At one appointment, he recalled how expectant mothers wrote down one thing they hated about childbirth. "Breast-feeding is nasty," read one note.
Amid laughter, all eyes turned to the author, whose views were well known. The moms talked her through her fears, and a few weeks later she was breast-feeding regularly.
"It's a different type of reaction that patients have with their provider than with peers," Johnson said.
"Manufacturing" support for these mothers needs to start before women are pregnant, Ehlinger said, and should include improving access to exercise and healthier foods in low-income neighborhoods.
Not all the news is bad. Minnesota's overall rate is among the 10 lowest in the nation, and it has dropped in the past two decades. And despite the disparity, the infant mortality rate for non-Hispanic blacks in Minnesota from 2008 to 2010 was fifth lowest in the U.S.
The key to further progress, Ehlinger said, is dealing with disparities. Paid maternity leave, for example, is less common in low-wage jobs, which are more likely to be held by minorities. And infant mortality remained higher among blacks, even when the mothers were highly educated and when they started prenatal care early.