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Infant Mortality and Los Angeles County

Infant Mortality and Los Angeles County
Reducing and eliminating racial and ethnic disparities in infant mortality in Los Angeles County (LAC) is a significant priority for both LAC and California State public health departments. In 1989 LAC was among the first health jurisdictions to receive funding from the State to create the Black Infant Health Program to provide a culturally specific perinatal intervention to African American mothers and infants in LAC. In 1994, LAC Fetal Infant Mortality Review (FIMR) Project, one of the 12 California county programs, was implemented to address the problem of fetal and infant death in areas with high rates of perinatal mortality.

The Healthy People 2010 objective is to reduce the infant mortality rate to no more than 4.5 per 1,000 live births.1 The infant mortality rate for LAC has had a downward trend for the past ten years (See Figure 1), going from 5.9 deaths per 1,000 live births in 1997 to 4.8 deaths per 1,000 live births in 2006.2 Nevertheless, racial and geographic disparities in infant mortality and adverse birth outcomes persist. Compared to the overall LAC infant mortality rate, the 2006 rate for African Americans was significantly higher, at 11.6 deaths per 1,000 live births in 2006. In other words, the infant mortality rate for African Americans was more than two times the rate for Los Angeles County overall. African Americans comprised 7.6% of all births in LAC in 2006, and 18.2% (134 cases) of all infant deaths within the same period.3 More specifically, nationally, Black infants are 2.4 times as likely to die in the first year of life as White babies.4 In comparison, African American babies in LAC are approximately three times (2.97) as likely to die as White babies in LAC.3 With such a large disparity ratio, LAC provides an ideal target population.



Among the eight geographic regions within LAC, both the Antelope Valley and South regions had the highest infant mortality rates in 2006 (7.6 and 5.5 infant deaths per 1,000 live births, respectively). The infant death rates for African Americans in Antelope Valley and South regions were as high as 18.3 per 1,000, while other racial/ethnic groups had rates close to 5 per 1,000 live births.

As indicated by a needs assessment completed by LAC Maternal, Child, and Adolescent (LACMCAH) programs in 2004, LAC lacked comprehensive information with which to explore the association between racism and adverse birth outcomes until the advent of the Los Angeles Mommy and Baby (LAMB) project in late 2004 and Los Angeles Health Overview of a Pregnancy Event (LA HOPE) in 2005.5,6,7 Using information collected for these projects, LACMCAH has started to assess the prevalence of experiences of racism by mothers of different racial backgrounds.

Findings from LAMB and LA HOPE show that half of the African American mothers who recently gave birth, experienced discrimination, compared to other racial or ethnic groups. The disparity in experience of discrimination was most apparent when mothers sought jobs and assistance from police or courts. With respect to school campuses, however, Asian/Pacific Islanders reported the most discrimination (Figure 2).3



Such experiences with discrimination could directly and indirectly contribute to infant mortality in LAC. LACMCAH has the ability to examine the above hypothesis using data collected as part of the LAMB and LA HOPE projects. Although data collection has continued since 2004 despite scarce resources, data analysis has largely been delayed. It is critical now for LACALC to conduct an in-depth analysis to explore the association between racism and adverse birth outcomes in LAC. This information will be extremely useful for community stakeholders to design effective prevention and intervention strategies to address racism in the field of maternal and infant health.

References
1. Healthy People 2010. Maternal, Child, and Infant Health. Retrieved on September 3, 2008: http://www.healthypeople.gov/document/HTML/Volume2/16MICH.htm#_Toc494699659
2. Los Angeles County Department of Public Health. Maternal, Child, and Adolescent Programs. Unpublished data 2008a.
3. Los Angeles County Department of Public Health. Maternal, Child, and Adolescent Programs. Unpublished data 2008b.
4. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2005 period linked birth/infant death data set. National vital statistics reports; vol 57 no2. Hyattsville, MD: National Center for Health Statistics. 2008.
5. Los Angeles County Department of Public Health. Five-Year Plan, 2005. Unpublished.
6. Los Angeles County Department of Public Health. Maternal, Child, and Adolescent Programs. Retrieved on September 3, 2008: http://publichealth.lacounty.gov/mch/lamb/LAMB.html
7. Los Angeles County Department of Public Health. Maternal, Child, and Adolescent Programs. Retrieved on September 3, 2008: http://publichealth.lacounty.gov/mch/LAHOPE/LAHOPE.html

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