Above Average, But Why?

Newborn infants in New Mexico should be experiencing healthier births. Teen pregnancy rates are declining, and more pregnant women are receiving early prenatal care. But babies are dying more often, according to

.

The state's infant mortality rate, which reflects the number of babies who die before they reach their first birthdays, jumped above the national average in 2012 for the first time in nearly 20 years. Though the actual numbers are still arguably small—186 infant deaths in 2012 compared to 143 infant deaths the year before— that spike alone accounts for an increase in the state average to 6.9 deaths per 1,000 births, topping the national average of 6.1 per 1,000.

The DOH hasn't yet determined what exactly caused the rise in infant deaths in 2012 identified in statistics released last week, but a look into demographic data from the new report and previous trends provides some insight.

Most of the rise between 2011 and 2012 occurred among Anglos first and Hispanics next, while Native Americans saw a decline. Infant deaths also increased primarily in rural New Mexico, where health access oftentimes is lacking.

"In the rural areas, there is a shortage of health care workers," says Mary Shepherd, an epidemiologist with DOH who's working on the issue. "That's just a fact of life."

Jessica Frechette-Gutfreund, a midwife who delivers babies in the rural Española region, says many pregnant women in that area report trouble getting prenatal care.

"There's not a relationship between that person and care provider because there's not time for that relationship," Frechette-Gutfreund says.

A state pregnancy risk assessment conducted in 2011 found that one in four pregnant women does not receive prenatal care during her first trimester.

The biggest reasons women in New Mexico don't get prenatal care, according to the survey, is that they can't get appointments, they don't know they're pregnant, they don't have enough money or they don't receive a Medicaid card to pay for the services in time.

And babies that don't receive prenatal care during the first trimester—or the first three months of pregnancy—are three times more likely to be born with a low birth weight and five times more likely to die than those who do get early care, according to the US Department of Health and Human Services' Office on Women's Health.

Incidentally, infant deaths caused by low birth weights and premature births jumped in New Mexico from 24 in 2011 to 36 in 2012.

"On a percentage basis, that's a big increase," Martha Payne, a program manager at Coop Consulting, Inc. tells SFR.

The state also showed a sharp increase in "extreme immaturity"—or births of infants in less than six months of pregnancy.

But Payne, who is working on research in four New Mexico communities with high early childhood development risks, says that drawing conclusions on why more low-weight births and premature births are happening across the state isn't such an easy task. She says that a lack of prenatal care for pregnant women during the first trimester is "definitely related" to low birth weight problems.

Another possibility is the high amount of tobacco and alcohol use among pregnant women here, which Shepherd describes as "concerning."

"We've seen an increase over time in smoking, both before conception and around the time of conception," Shepherd says.

The 2011 survey points out that substance use is most harmful during the first trimester, "often before women even know that they are pregnant." More than 20 percent of respondents reported binge drinking (or drinking four or more drinks in a two-hour period) at least once and smoking daily during the three months before they found out about their pregnancy.

And while the state's teen pregnancy rate declined by 30 percent in the past five years, according to DOH, it's still among the highest in the nation. Payne says that pregnant teen women are often in denial about their pregnancies, which causes many of them to wait until the second or third trimester to seek out prenatal care.

Soon, DOH should have more explanations. Shepherd says the agency will link death certificates with birth certificates within the next month.

"We'll probably put out an epidemiology report on it," she says.

"Then it's [up to] the Legislature on how to follow up on it."

Santa Fe Reporter