Academic journal article International Public Health Journal

Establishing Partnerships between Public Health and Academic Partners to Address Infant Mortality

Academic journal article International Public Health Journal

Establishing Partnerships between Public Health and Academic Partners to Address Infant Mortality

Article excerpt

Introduction

Infant mortality, in a public health sense, serves as a gauge of overall community health and is defined as the death of an infant before his or her first birthday. The national infant mortality rate per one thousand births in the United States is 6.06 - a rate much higher than that in other developed countries (1). Although infant mortality in the United States has declined in recent years (1), infant death in the Cincinnati-Hamilton County region of Ohio is nearly triple the Healthy People 2010 goal and double the national average (1, 2). Infant mortality has recently evolved to epidemic status in Cincinnati, although the issue has not affected all racial groups equally. At a rate of 17.8 deaths per 1000 births, African Americans have more than double the infant mortality rate of White residents (3-5). Considering the elevated overall infant mortality rate and the striking racial disparity in infant deaths, social and medical scientists are trying to untangle the web of factors that contribute to negative birth outcomes. Given the complexity of such disparities, interdisciplinary collaboration between public health and academic partners provides a unique way to dissect health concerns with greater rigor and objectivity.

Social determinants of infant mortality

The Cincinnati Health Department and its partnering social service agencies and community organizations have prioritized infant mortality as the key public health issue in our area and have started to investigate the unique social determinants of infant mortality in Cincinnati. Perhaps partially due to the fragmented landscape of health services for women in our area, understanding the perinatal risks for both women and their babies is multifaceted and therefore quite complicated. Unintended pregnancy, for instance, is documented as an indicator of poor birth outcomes (6). However, in a largely Catholic hospital delivery system, few post-partum women are discharged from the delivery hospital with contraception, thereby increasing the chances that these women might become pregnant before the recommended time of at least eighteen months post-delivery.

Pregnancy intention has been documented as a correlate of infant mortality, in that family planning can reduce infant mortality (7). Teen mothers are more likely to experience unintentional pregnancies, thereby increasing risks for adverse health outcomes. Proper prevention of unwanted pregnancy is also affected by the sociopolitical landscape. Research shows that young mothers with unwanted pregnancies are more likely to miss important prenatal visits (8), engage in risky behavior such as smoking or illicit drug use during pregnancy (9), and are more likely to suffer from postpartum depression than adult mothers who plan pregnancy (10). It has also been found that teen mothers often have poorer physical and mental health outcomes later in life than women who did not experience teen motherhood (11).

When attempting to promote optimal infant health and avoid mortality, social service agents and healthcare professionals tend to focus on those factors in which they have expertise. Primary care physicians may be more concerned with weight gain and hypertension as correlates of poor birth outcomes. Social workers may be more likely to contribute high infant mortality rates to domestic issues or access to social services. Obstetricians might focus on participation in prenatal healthcare as the primary target for intervention. In order to address the complex problem of infant mortality, collaboration among diverse stakeholders with varying skill sets and subjectivities is essential. Essentially, untangling the web of human behaviors that led to a pregnancy and ultimately a birth involves both social and medical perspectives.

University-public health department partnership

A truly successful partnership is considered to be a pooling of resources where each partner exercises power in decision-making (12). …

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