The miracle of the dramatic drop in Dane County’s black infant mortality rate has become more of a mystery, as the rate shot up last year after years of surprising declines that received national attention.
Health officials learned last month that the county’s rate of black babies who die before their first birthdays, which dropped nearly 70 percent from 1990-2001 to 2002-2007, increased last year to slightly above the previous level.
Researchers, who have been studying what seemed to be going right, also are looking at what apparently went wrong last year. The recession could be to blame, said Dr. Thomas Schlenker, director of the Madison-Dane County Health Department.
"We’re very concerned, but we don’t believe the system has fallen apart," he said. "The environment has gotten a lot more hostile, mostly from the economy collapsing."
Statewide, however, the black infant morality rate went down slightly last year, while the rate among whites went up a bit, according to the Wisconsin Department of Health Services.
Still, the South Madison Health and Family Center-Harambee, a non-profit agency that serves many pregnant black women, has been hit by the recession in ways that may have contributed to the county’s increase in black baby deaths, said David Smith, interim executive director.
Budget cuts forced the agency, on South Park Street, to scale back on cab rides to medical appointments last year and stop the rides this year, Smith said. The agency is supported by city, state and federal money, local foundations and its own fundraising.
"What is an expectant mother going to do if she can’t get transportation? She’s not going to go to her prenatal appointment," Smith said.
Harambee has received some of the credit for the previous, stunning reversal of the county’s high rate of black infant mortality, one of the most entrenched public health problems in Wisconsin and around the country.
The county’s turnaround, revealed by Schlenker in early 2008, was featured in The New York Times last month and the online version of Newsweek in October. The Atlanta-based Centers for Disease Control and Prevention highlighted the development in its weekly bulletin in May.
Now that the 2008 data is in, health officials are trying to solve two puzzles, one good and one bad. Data for 2009 won’t be available for many months, Schlenker said.
The 2008 data "is very real and very tragic," he said. "But one bad year does not negate the previous six good years. That was a real, positive trend ... even though it has been obscured by the horrible year of 2008."
Added Betty Banks, former director of Family Enhancement’s Early Childhood Center, who has been active in issues affecting black children: "We need to see if this is a fluke or a trend."
Before 2001, the county’s black infant mortality rate was about 19 deaths per 1,000 births. That was more than three times the rate for whites, mirroring the racial gap in the state.
From 2002 to 2007, the black infant mortality rate in the county was about 6 deaths per 1,000 births. The rate for white babies was about 4 deaths per 1,000 births.
Last year, the rate went up for all major racial groups — but especially among blacks, for whom the rate soared to 20 deaths per 1,000 births, four times the new rate for whites.
The number of deaths is relatively small; 41 babies died in the county last year out of 6,217 births.
Of 506 black babies, 10 died. If the previous trend had continued, there would have been three such deaths, Schlenker said. So there were seven "excess" deaths of black babies, he said.
The percentage of black babies born prematurely, or before 29 weeks gestation, went up only slightly last year. There were nine such births, five of which were among the 10 deaths. Schlenker and others have cited the decrease in premature births among blacks in recent years as one of the main reasons for the drop in infant mortality.
Researchers in a three-year study, led by Dr. Gloria Sarto of UW-Madison’s Center for Women’s Health Research, are interviewing black and white mothers, examining medical records and assessing community resources in Dane County and in Racine County, where the black infant mortality rate has remained high.
The original purpose of the study was to identify what was working well in Dane County and share lessons with other health departments. The city-county health department’s emphasis on home visits to low-income women, along with programs by other agencies to provide care to uninsured women and find insurance for them, are considered possible reasons for the positive trend here.
The bad news in 2008 doesn’t make the study any less valid, Sarto said.
"It adds to the mystery of it," she said. "I think we can learn even more about what influences the black infant mortality rate."