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Dallas and Tarrant Counties Battle Infant Mortality

Parkland Hospital Newborn Nursery

Dallas and Tarrant counties lead the state in infant deaths. They’ve been the highest of all urban areas in Texas for more than a decade. KERA’s BJ Austin reports county health officials don’t know why, and are working to figure it out.

Some fifteen thousand babies are born at Parkland Hospital in Dallas each year. Statistics show 110 of them will die before their first birthday.  The numbers are lower in Tarrant County, but both counties have infant death rates that are well above the state and national averages.  State health officials say the leading causes of infant deaths are premature birth, low birth weight and fetal malnutrition.

Salyer-Caldwell: We have battled a high infant mortality rate for many, many years. It is a measure of the community’s health.

Ann Salyer-Caldwell is with Tarrant County Public Health.  She directs the county’s Infant Mortality Network.

Salyer-Caldwell:  Everybody thought the answer was these ladies who are pregnant just need to go to the doctor when they’re pregnant.  Well, what we found out was that’s one part of the story, but it’s not the whole story.

Salyer-Caldwell says maternal health prior-to and during pregnancy is a major issue.  And she says there’s been an explosion 20-somethings that have chronic diseases; obesity, diabetes, high blood pressure and other ailments.

Salyer-Caldwell: If a woman isn’t in good shape to begin with, the woman suffers and the baby suffers.

Sladana Dekic is an example.  She fled the violence in Bosnia as a child, came to the U.S., was raised in foster care and on her own at 18.  She told Tarrant County Commissioners she did not know what to do when she discovered she was pregnant.  She found the county’s Family-Nurse Partnership.  Women whose pregnancies could be at-risk are teamed with a nurse who provides regular home-visits throughout the pregnancy and until the child is two.

Dekic:  I had issues with high blood pressure just dealing with the stress with the lack of employment, lack of being able to get any benefits.  I made too much money in one sense and I didn’t make enough in the other. She got me in touch with local churches where I was able to get fresh fruits and vegetables – things I was not able to afford on my own.

Dekic says her daughter is two and thriving, thanks to the program.

In Dallas, Parkland Hospital’s Gerilyn Laurence directs “Healthy Start”, which targets pregnant women in five high infant mortality zip codes.

Laurence: We work with them throughout their pregnancy providing education, care coordination, housing, jobs, school, child care, substance issues, smoking cessation, just all of those risk factors.  

The majority of the Dallas Healthy Start participants are teenagers.  Laurence says that adds to the stress factors.  In Tarrant County, Ann Salyer-Caldwell says they’ve just received a grant for mentoring teenage “dads” in their schools.

Salyer-Caldwell:  We’re actually starting in the Hurst-Euless-Bedford ISD and Fort Worth ISD those male mentoring programs, looking at them having financial literacy and a vocational plan.

She says they hope mentoring the dad will bring positive things to the family dynamic and lower the stress level of the teenage mom-to-be, resulting in a healthier baby.

The African American infant mortality numbers in Dallas and Tarrant are almost double that of Hispanics and whites.  Gerilyn Laurence says that’s true across the U.S., but why?

Laurence:  There really isn’t a clear answer.  Is it certain stressors?  There are things that people look at in terms of an African American woman with a certain level of education and access to care may still have poorer outcomes than a Caucasian.  It’s just alarming when you look at the statistics and not be able to understand why those differences are there.

In Tarrant County, they’re looking for those answers utilizing a Fetal Infant Mortality Review – the first such local program in the state.  It digs deep into a lot of different data.

Salyer-Caldwell:  Where did the mom get her prenatal care?  Was there any domestic violence? Were there any issues with lack of food?  And what kind of sociological factors surrounded things?  In our first report, our trend, our major trend was the frequency of sexually transmitted diseases.

Ann Salyer-Caldwell says that was surprising.  An untreated sexually transmitted disease can cause a woman to have premature labor.  Dallas County expects to start a Fetal Infant Mortality Review pilot program this spring. Even in a tough budget with cutbacks, state lawmakers last year appropriated four million dollars to launch the Texas Healthy Babies initiative, aimed at reducing premature births and infant deaths.  Ann Salyer-Caldwell and Gerilyn Laurence say they are encouraged the state is increasing its focus on the sad and serious issue.