LOUISIANA PUBLIC HEALTH ASSOCIATION
Babies born in Central Louisiana have a better chance of surviving than babies born anywhere else in the state. The Bureau of Family Health recently released statistics concerning infant mortality rates around the state. As with most health statistics, these are often a couple of years old (2015), something true of most population based statistics. They nonetheless provide reason for rejoicing.
The Office of Public Health Region VI (Central Louisiana) achieved the lowest infant mortality rate in the state. The rate of 4.7 deaths/1,000 live births was below the national average of 5.9 deaths/live births and substantially lower than the Louisiana state rate of 7.7 deaths/1,000 live births. To be lowest in the state is remarkable, but to be lower than the national average is almost miraculous.
There have been numerous questions about how this feat was achieved and some other statistics need to be reviewed to attempt an answer. First, the Rapides Parish Health Unit is the busiest in the state by volume even though our region (Central Louisiana: Rapides, Grant, Vernon, Avoyelles, Winn, Catahoula, Concordia and LaSalle parishes) is eighth in regional population among the 9 Louisiana public health regions. Rapides parish contains about 120,000 of our total regional population of 300,000 and the Rapides Parish Health Unit sees over 25,000 clients a year.
Second, our other regional health units are busy as well, especially considering their very rural populations. Every parish health unit satisfies over 30% of the reproductive health needs of the women of child bearing age in that parish (with the exception of Vernon Parish with its significant military population). In fact, over half of our parish health units provide over 40% or higher of the women’s contraceptive health needs of the women in that parish.
Third, the Office of Public Health in Central Louisiana has been quick to implement same-day LARC insertions. LARCs are Long Acting Reversible Contraception and include intra-uterine devices (IUDs) and hormonal implants (Nexpanon®). OPH Region VI places more LARCs than any other region in absolute numbers (566 from 5/1/2016 to 4/30/2017), and more than double any other region in per capita insertions (97.6/1,000 women of reproductive age).
The high number of LARCs (which are highly effective compared with other forms of contraception) prevents unwanted pregnancies and allows women to put adequate time between desired pregnancies. Providing contraception of any kind helps prevents teenage pregnancies, a notable cause of low birth weight babies and resulting infant mortality.
The tragedy of infant deaths overwhelms everyone involved, especially if they are preventable, and its reduction should always be a primary public health goal. In addition, infant mortality occurs more often in African American babies, a sad testimony to our persistent health disparities, and a motivation to eliminate them.
Region VI (Central Louisiana) also boasts active Fetal Infant Mortality and Child Death Reviews. The Fetal Infant and Child Death Reviews, under the inspired leadership of Lisa Norman from the Bureau of Family Health, attract a large and varied group of stakeholders. These community centered groups discuss all infant (and child) deaths to determine if there were preventable causes. The individuals then make recommendations for changes to their respective organizations that might include anything from parental education to community service announcements.
Lastly, Region VI has a robust Nurse Family Partnership program, which follows first time Medicaid eligible pregnant women throughout their pregnancy and first year of motherhood. Their interventions reduces low birth weight babies and infant mortality as well.
In short, the Heart of Louisiana, has achieved a remarkable (and hopefully sustainable) improvement in their infant mortality statistics. Dropping from a high of 9.1 deaths/1,000 live births in 2007 (with a bump to 8.8/1,000 in 2013) to a low of 4.7/1,000 live births in 2015 should be celebrated. The hard work of the Office of Public Health and all providers of women’s health throughout the region surely played a role in such a favorable outcome. Congratulations to everyone involved!
David J. Holcombe, M.D., M.S.A.