Black infants in St. Louis County are more than twice as likely to die as white infants, according to a new report.
The first Maternal and Child Health Profile, released today at Washington University’s Institute for Public Health conference, highlights troubling racial disparities in the health of moms and babies in St. Louis County. Health officials acknowledge these persistent issues, but also point to progress in other areas — including declines in teen pregnancy.
Spring Schmidt, acting director of the St. Louis County Department of Public Health, said there’s “no question” that poverty plays a major role in the health of moms and babies.
“There can be housing instability, food insecurity, instances of neighborhood violence and community trauma,” Schmidt said. “All of that impacts both mother and baby. We can't see our moms or our babies as disconnected from the environment in which they're living.”
Nearly 10% of infant deaths in 2018 occurred in areas of St. Louis County with high rates of poverty, down from 18% in 2014.
The death rate among black babies in St. Louis County has also declined steadily since 2014, while the rate among white babies has remained stable. Still, black infants die at more than twice the rate of white infants — 11.4 deaths per 1,000 black babies compared with 5.1 per 1,000 white babies.
Complications due to premature birth and low birth weight were among the most common causes of death, followed by birth defects and accidental injuries.
But high risk of death isn’t limited to black infants.
Black women in St. Louis County were also nearly twice as likely to die while pregnant or after giving birth compared to white women.
That frustrates Barnes Jewish Hospital obstetrician Ebony Carter.
It’s not a lack of prenatal care that’s putting mothers at risk, Carter said, but the fact that many low-income women in Missouri lose their insurance after giving birth.
“They come into pregnancy and we optimize everything extremely well. We make sure that their diabetes and their high blood pressure are well-controlled,” said Carter, an assistant professor in Washington University’s Division of Maternal Fetal Medicine. “Then after they have the baby, they lose their insurance.”
Under federal law, every state must offer Medicaid to low-income women while they’re pregnant. Nearly half of all births in the U.S. were covered through Medicaid in 2017.
In most cases, women lose coverage 60 days after giving birth. Missouri legislators passed a bipartisan law last March that extended Medicaid coverage for women struggling with addiction for an additional year — but the law has yet to be implemented.
Looking forward
The report is the county’s first comprehensive effort to document the health of mothers and babies in the St. Louis region, but the plan is to release it every year.
Based on current projections, the county won’t eliminate the racial gap in infant survival until 2085, said St. Louis County Chronic Disease Epidemiology Manager Nhial Tutlam.
“Sixty-five years from now. That’s a long time to wait,” Tutlam said. “Hopefully this [report] will be a call to action for people to devote more resources and targeted efforts to address this issue.”
Despite clear challenges ahead, county health officials point to signs of progress.
The number of teenage pregnancies in St. Louis County dropped by 33% from 2013 to 2017. The percentage of women who smoked during pregnancy also declined slightly, from about 8% in 2014 to 6.8% in 2018.
“It takes a really long time, and you can’t let your foot off of these issues,” Schmidt said. “But it’s not without hope that we tackle the reality of what we face now.”
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