Mortality rate shows disparity

By Mary Garrigan, Journal staff | Tuesday, February 06, 2007

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For American Indian babies born in sparsely populated areas of western South Dakota, the first year of life comes with a certain amount of risk.

Of the state’s 66 counties, 13 have dishearteningly high infant mortality rates of more than 10 deaths per 1,000 live births, health officials say, and each of those is on, near or next to one of the nine Indian reservations in the state. Ten of the 13 counties with the highest infant mortality rates are on or west of the Missouri River.

When broken down by race, South Dakota’s infant mortality rate shows a large disparity between whites and Indians. From 2000 to 2005, 65,346 babies were born in the state, and 453 did not live to see their first birthday. But the death rate for American Indian babies was 12.9 per 1,000; more than double the 5.5 death rate for white babies in South Dakota.

“The disparities are great, and they are persistent,” Christine Rinki of the Northern Plains Tribal Epidemiology Center said.

In 2005, South Dakota’s overall infant death rate was 7.2. Nationally, the United States has an infant mortality rate of 6.8.

But a baby born in the most sparsely populated counties in South Dakota — called “frontier” counties because they have six or fewer people per square mile — has an even higher risk of dying before its first birthday — 8.8 deaths per 1,000 live births.

Mellette County, in southwestern South Dakota, had the sad distinction of having the highest infant mortality rate — 23.7 per 1,000 — in the state. That means that of the 211 babies born in Mellette County between 2000 and 2005, five of them died before 1 year of age. Mellette borders the Pine Ridge and Rosebud Indian reservations.

Five of the 21 West River counties either had no infant deaths from 2000 to 2005, or too few to create a statistically significant infant mortality rate. Counties with fewer than three infant deaths in the six-year reporting period were listed as “low number of events” counties.

Of the 16 West River counties rated in the state Health Department report, only one, Butte County, had an infant death rate lower than the national average of 6.8 deaths per 1,000 live births. Butte’s infant mortality rate was 4.1

In South Dakota, only two counties — Minnehaha and Pennington — qualify as urban, defined as having a population center above 50,000. Pennington County has an infant mortality rate of 8.1, which compares unfavorably to Minnehaha County’s rate of 5.4.

A health study group was appointed by the state Department of Health in response to high infant death rates in 2004. It wants to target specific behaviors among pregnant women as ways to reduce the state’s infant mortality rates.

Getting pregnant women to stop smoking and to seek prenatal care throughout their pregnancies are keys to reducing infant mortality, state officials said.

An educational media campaign, “I Didn’t Know,” will run through April 30 in South Dakota to help educate people about the early signs of pregnancy and about the importance of getting prenatal care.

The campaign’s goal is to reduce the state’s infant mortality rate, which hit a high of 8.2 in 2004, to 6.0 by the year 2010.

“We found the infant mortality rate was six times higher for moms who received no prenatal care than for those mothers who got prenatal care in the first trimester,” said Doneen Hollingsworth, state secretary of health. The death rate in the neonatal period, which is from birth to 27 days of age, was even higher for those infants whose mothers received no prenatal care. “The numbers clearly show that early and regular prenatal care improves pregnancy and health outcomes for both the mother and child,” she said.

The leading cause of infant death in South Dakota is complications from premature birth and low birth weight. Birth defects and congenital anomalies is the second leading cause, followed by sudden infant death syndrome and accidents.

Rinki said public health policymakers see high infant mortality rates as a problem that has both specific causes and broad causes.

The global view of infant mortality rates is that they reflect much larger processes going on in the world, Rinki said. The socio-economic well-being of a society, as measured by educational levels, infrastructure, development and the health of families and communities all correlate to infant mortality rates.

Lack of reliable transportation, winter weather, bad roads and long distances often conspire to prevent prenatal care in isolated Indian reservation communities. Northern Plains tribes suffer the highest rates of infant mortality of any American Indian population, Rinki said.

“You can’t ignore any of it,” she said, noting that solutions will have to target both individuals and the larger society. “I think if there were simple answers, we wouldn’t still have these problems.”

As the project coordinator for South Dakota Tribal Pregnancy Risk Assessment Monitoring System, Rinki is collecting information about maternal and infant health that she hopes will improve tribal health and lower infant mortality rates here.

All nine tribes in the state are participating in the three-year, $375,000 grant that was awarded to the Yankton Sioux Tribe by the U.S. Centers for Disease Control and Prevention in 2006.

It will try to survey 1,000 mothers of American Indian babies born between February and July of 2007 to better understand their prenatal care experiences and any barriers to it. The information gathered will be shared among all the health programs — state, tribal and federal — to collaborate on what works and to support funding applications for those programs.

The state PRAMS project is the first CDC grant of its kind to be awarded to a tribe anywhere. Previously, only state health departments were eligible.

At the CDC’s national PRAMS meeting in December, the Yankton Sioux tribe and its project were recognized for their “outstanding collaboration and capacity building to improve maternal and infant health.”

It is, Rinki said, important to keep in mind that great strides have been made in lowering infant mortality rates in Indian country over time. Those rates have trended downward for decades, just not as fast or as far as she would like.

“Tribes have struggled, but they have also survived and thrived, despite all those obstacles that cause high infant mortality rates,” Rinki said. “Still, it’s morally egregious that these disparities exist, and they should be unacceptable.”

Contact Mary Garrigan at 394-8410 or mary.garrigan@rapidcityjournal.com