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    Infant Mortality in Tarrant County

    For many years, infant death rates in Tarrant County have ranked among the highest in the state. Fortunately, that has changed -- for the better!

    Recent data shows mortality rates for infants in the county have decreased to an historic low.

     

    Line of babies, Infant Mortality in Tarrant County Reaches Historic Low

    When the Texas Department of State Health Services released the most recent live birth and infant death data (from 2015) in 2017, Tarrant County Public Health (TCPH) staff began crunching the numbers immediately. They calculated the infant mortality rate for Tarrant County and saw something never seen before: an infant mortality rate of 6.17 infant deaths per 1,000 live births, the lowest rate in county history. Another discovery was quickly made – the infant mortality rate among non-Hispanic blacks was in the single-digits for the first time ever (9.59 infant deaths per 1,000 live births) and had decreased 42 percent since 2010.

    The progress seen in birth outcomes is possible due to community collaboration efforts that began almost 20 years ago.

    TCPH began looking at infant mortality data in 2001. At that time, little information was available although it was clear that too many infants born in Tarrant County did not have a healthy start and did not have a first birthday.

    Infant Mortality Rate, Tarrant County 1990-2015

    More data were collected and in 2002 the Infant Mortality Task Force (IMTF) began as an advisory group to Healthy Start. The first years were spent raising awareness about the poor pregnancy outcomes and the high infant mortality rate.

    TCPH continued to look at data, and with the help of City Match and National Association of County and City Health Officials, expanded their knowledge base with more tools to assess contributing factors to infant mortality.

    In 2006, TCPH published the first Perinatal Periods of Risk assessment. It found that many of the poor pregnancy outcomes were attributed to poor maternal health and premature birth. There were more factors that influenced the pregnancy outcome other than prenatal care.

    Through the years, TCPH, along with the IMTF, has worked to assure that community partners, leaders and program managers address infant mortality in all operations. As data analysis continued, the high infant mortality rate, especially for African American women, became the focus.

    Infant Mortality rate by race/ethnicity, Tarrant County 2006-2015
    black woman holding baby; These efforts have been enhanced by our partnerships with the Infant Health Network (formerly Infant Mortality Task Force), Tarrant County Medical Society, JPS Health Network, Cook Children's Hospital, Healthy Start and community organizations.

    The Fetal Infant Mortality Review (FIMR) began in 2008. Health professionals, community members and public health staff joined together to identify trends in circumstances surrounding infant deaths and develop recommendations to help reverse the trends. The Community Action Team (CAT), composed of community leaders, health professionals and other maternal and child advocates translates the FIMR recommendations into actionable strategies and participates in the implementation of interventions.

    photo of pregant woman's belly, with hands caressing; text: Counting kicks is usually implemented in high risk pregnancies, but the FIMR team recommended all pregnant women chart their kicks. "Kick counting" is discussed by Nurse-Family Partnership, Healthy Start, WIC, provider offices and clinics. Additionally, uncontrolled chronic diseases, untreated sexually transmitted diseases and obesity have been frequently tied to poor birth outcomes in the FIMR results.

    We utilized the TCPH Community Health Assessment (CHA), which included qualitative data from focus groups, listening sessions and community-wide meetings, as well as quantitative data from local, state and national indicators to inform discussions and determine health priority areas. The four priority areas that emerged were Education, Environment, Health Care Access and Partnerships.

    Many of these findings emphasized the social determinants of health that impact pregnancy outcomes and bolstered our education efforts. 

    baby's hand in larger hand; 17P; 15 million babies are born prematurely every year, #GiveThemTomorrow

    TCPH implemented a program to promote the evidence-based practice of the using of 17P medication to prevent the recurrence of preterm delivery. Pregnant women who have a history of preterm birth receive case management to help assure they receive the medicine on a regular basis. The injections help extend the pregnancy so the baby has more time to develop and is larger and stronger at birth.

    TCPH staff help train healthcare providers on the use of 17P as a best practice model in the prevention of preterm births. The women served are  Medicaid eligible and/or low income women, who have a history of spontaneous singleton preterm birth between 20-36 weeks.  

    "The Tarrant County WIC Program and our county hospital, John Peter Smith, help lead this initiative. Case management services are provided to these clients to increase compliance with treatment. TCPH is the only local health department that supplies 17P data to Texas Department of State Health Services for Title V block grant reporting," Marisol Berrios, TCPH Prematurity Prevention Coordinator

    Because unplanned pregnancies have a higher rate of poor outcomes, TCPH and the County Hospital District have instituted the best practice of asking the "One Key Question".

    All male and female patients are asked One Key Question, “Do you plan to add to your family in the next year?”

    If the patient says “no”, the provider discusses options for long term contraception. If the patient answers "yes", the provider discusses health concerns that may have a negative health impact on the pregnancy and how to address those issues. 

    Another effort to promote healthy infants began in 2016 with the Breastfeeding Boot Camp. Two hospitals reported lower rates of exclusive breastfeeding at time of discharge, citing limited staff competence at addressing routine breastfeeding barriers.

    The WIC program partnered with the County Hospital District and Medical Cities Arlington to host a four-hour, hands-on training with six stations to help raise the comfort level of hospital staff in teaching breastfeeding and increasing breastfeeding rates.

    The training modules, adopted from Dallas WIC, align with the Texas Ten Steps to Successful Breastfeeding and help partner hospitals meet related training requirements. Over 400 hospital staff completed training in the first year.    

    Two women handling breast pumps
    "We must continue to build a strong network to promote healthy outcomes for all mothers and babies -- and to ensure that the lower infant mortality rate is sustained for the future." Ann Salyer-Caldwell, Tarrant County Public Health

    We look forward to even more success in reducing the infant mortality rate, but TCPH can't do it alone. It takes a strong collaboration, like the Infant Health Network, to:

    1. base decisions on data,
    2. employ evidenced-based programs (including those that address the social determinants of health),
    3. partner with a strong community coalition,
    4. instill a culture of learning and
    5. welcome everyone to the table and look for shared goals.

    We are calling on our community to join the collaboration and make Tarrant County a place for babies to survive and thrive.

    To see more infant mortality data, please visit our extensive Live Stories dashboard for "Tarrant County Infant Mortality Figures".

    Other Tarrant County Public Health activities that help promote healthy pregnancy outcomes:

    Adult Health Services - this clinic provides treatment from sexually transmitted diseases. When a pregnant woman with an STD infection is untreated, her unborn infant is at risk for serious health problems, including premature birth.

    Health For Me - is a free self-management class for persons with diabetes, obesity, hypertension and other chronic conditions. Uncontrolled chronic diseases can have negative effects on pregnant mothers and their infants and are a leading cause of infant deaths in Tarrant County. 

    Immunizations for adults, including pregnant mothers and other family members help protect mothers and infants from vaccine preventable diseases like pertussis or whooping cough, which can be life threating for an infant.  When an infant is born, she begins her own vaccine schedule to help build immunity and fight other vaccine preventable diseases.

    Live Tobacco Free - is a free tobacco cessation class for adults. Tobacco use by pregnant mothers and family members of infants and young children not only compromise their health but can put the others in the home risk for asthma and other respiratory conditions.

    Nurse-Family Partnership - is a program for women who are having their first baby. A registered nurse visits expectant mothers in their homes throughout pregnancy and continues to visit until your baby is 2 years old.  These mothers have a good start to a healthy pregnancy and the babies thrive with the help of the nurse mentors.

    WIC Nutrition Program - helps families eat well, learn about nutrition and stay healthy. Services are  available for pregnant, postpartum and breastfeeding women, as well as infants and children under the age of 5, who meet financial requirements. All WIC services are free to those who qualify.  Pregnant mothers who participate in WIC have healthier pregnancy outcomes.