In Philadelphia the same proportion of babies die on their first day of life as in Indonesia and Guatemala, according to new data released by Save the Children, an international charity.
Philadelphia County had the fifth highest rate of “first-day deaths” of counties included in the data set, behind Caddo Parish, La., Baltimore, Washington, D.C. and Guilford County, N.C. In Philadelphia an average 5.43 babies died on their first day of life for every 1,000 live births between 2007 and 2009. The national rate is 2.6.
Infant mortality is often used as an indicator of maternal and child health care, and the countries with the worst infant mortality are often countries with the worst health care.
The report focused on first-day deaths, stressing that 1 million babies die every year on the day of their birth. The major causes are birth complications, prematurity and infection.
The vast majority of infant deaths take place in developing countries, at 98 percent. But the United States, despite spending the most on healthcare, has the highest rates of infant mortality of any industrialized country.
Part of the reason for the high numbers is that the U.S. has advanced medical care, so doctors try to save high-risk babies and sometimes fail. But inequality is also a major factor.
“The doctors in Philadelphia in maternal and fetal medicine have worked very hard so that every woman in Philadelphia gets access to really good medical care,” explained Joan Bloch, a nursing professor at Drexel University in an interview in March, “but having a baby is not a medical event, it’s a social event.”
Most of the first-day deaths in the U.S. are babies born pre-term, and the U.S. has among the highest rates of pre-term births. Women living in poverty and minority women have higher rates of prematurity and are also less likely to access the advanced care they need.
“It’s not a random event,” said Bloch, who has done studies mapping pre-term births in Philadelphia. “It’s clustered predominantly in black neighborhoods and that’s because there’s disproportionate numbers of black women living in the worst neighborhoods, with poverty, exposure to violence, lack of resources.”
The report emphasized, “Within countries, often the more prosperous segments of society have seen the greatest reductions in preventable newborn deaths. Not surprisingly, the better-off families everywhere tend to have better nutrition, better sanitation and better access to lifesaving health care. The babies who are still dying tend to be from families with the lowest incomes in the most remote areas. They live in communities where there are few health clinics and few health personnel, or where such services do exist but are out of reach due to financial barriers and pervasive poverty.”
This is true in the developing world — and in Philadelphia.
Philadelphia has faced a maternal health crisis over the last decade and a half. Maternity wards have closed in record numbers. While there were 19 maternity wards in 1997 in the city, there now are six. Most closed because maternity care loses money; the remaining maternity wards are all in teaching hospitals, and are subsidized by residency programs and educational grants. They mostly hug the center of the city, with only two maternity wards in North Philadelphia, the area with the highest poverty levels and highest infant mortality.
All of the remaining maternity wards are in tertiary care hospitals, which have advanced medical capabilities and neo-natal intensive care units. When the hospital closures accelerated, the heads of the remaining maternity wards started collaborating to address the crisis. They meet monthly to share strategies and discuss challenges. Yet infant mortality stays stubbornly stuck near the worst in the country.
“The maternal mortality and the peri-natal morbidity that you hear about I think is not related to the quality of the OB care or even the accessibility of the obstetrical care,” said Dr. Arnold Cohen, program director in obstetrics at Einstein Medical Center in North Philadelphia. “I think it has to do with the social problems that people are facing in their daily lives.”
Philadelphia has the highest poverty level of any major U.S. city at 28 percent, and is one of the most segregated. In an upcoming Forefront story I dive deeper into how Philadelphia mothers are living through this disparity, and what the maternal health crisis means for Philadelphia’s future.
Allyn Gaestel is currently a Philadelphia Fellow for Next City. Much of her work centers on human rights, inequality and gender. She has worked in Haiti, India, Nepal, Mali, Senegal, Democratic Republic of Congo and the Bahamas for outlets including the Philadelphia Inquirer, the Los Angeles Times, Reuters, CNN and Al Jazeera. She tweets @allyngaestel.