Causes of Infant Mortality
Learn how systemic issues impact St. Louis’ infant mortality crisis.
Birth defects, accidents and unsafe sleeping practices do play a role in our high infant death rate. But premature birth has led to a higher infant death rate in St. Louis than all other causes combined. That is why the health of Black babies begins with the health of Black moms.
All Black families should have the opportunity to make the choices that allow them to have a healthy pregnancy and healthy baby. But many face a variety of barriers in the community that block them from having access to the things they need to flourish.
Learn more about how FLOURISH is addressing these systemic causes of high infant death rates.
Access to Health Care
IMAGINE
You’re pregnant and already have a toddler, who happens to be sick. You’re trying to get to your prenatal doctor appointment, but you can’t afford a car and the nearest doctor who accepts Medicaid is miles away. There’ve been shootings in your neighborhood lately, so you’re worried about sitting at the bus stop for too long. You trudge with your uncooperative sick toddler to the bus stop that is 12 blocks away. The bus only comes by every 30 minutes, and it’s late or you’ve just missed it. You get to your appointment to find out they can’t fit you in. It will be weeks before another appointment slot opens up because not many doctors accept Medicaid.
The lack of prenatal care is associated with higher infant mortality. In St. Louis City and County, one in five women receives inadequate or late prenatal care. More than one third of Black women in the City of St. Louis receive inadequate care. Researchers found that increasing access to health care for women at all income levels has helped reduce infant mortality.[6]
Access to Living-Wage Jobs
IMAGINE
You’re pregnant and your low-income job doesn’t offer paid time off. You need both your and your husband’s income to pay rent and buy groceries, so you can’t afford to miss a day of work. You start to have serious headaches and a lot of swelling, but you push on and hope it just goes away because your bills are piling up. And, there isn’t a health care place that offers evening hours anywhere near you. Your health continues to deteriorate. You’re rushed to the hospital. The doctor says it’s preeclampsia, which threatens your life and the life of your baby.
Women with higher incomes are less likely to have an infant die.[8] But, our region has high levels of poverty, with one out of four people in St. Louis City and one out of ten people in St. Louis County living in poverty.[2] Additionally, only one in four jobs in the St. Louis region are reachable by a 90-minute public transit trip.
Stress Level
IMAGINE
You’re a single pregnant mom who’s been laid off, and you don’t have any family members living in town or anyone who can help you financially. You’re looking for a new job, but your limited education level doesn’t leave you a lot of options. You’re at risk of being evicted and have no idea where you will go. A shelter? A friend’s couch? The toxic stress of it all brings with it a lot of sleepless nights and hurts the health of you and your unborn child.
Individuals’ health and well-being is a product of their genetic make-up, as well as the environments in which they live and grow. It is well documented that exposure to toxic stress and trauma is associated with a large variety of problems in human health. Women who experience toxic stress during pregnancy have 25-60% higher risk for preterm delivery, compared to women with low levels of stress.[3]
Neighborhood & Housing Conditions
IMAGINE
You’re pregnant and you live in a poor area of St. Louis. The roads and sidewalks are deteriorated and a recent car break-in has you scrambling to put together this month’s rent. The apartment you live in has overdue repairs and a cockroach infestation, but the landlord won’t answer your calls. Your allergies and asthma have flared up due to the dirty interior and manufacturing plant down the road spewing dirty exhaust. You want to find a new place to live, but with a baby on the way, this is the most affordable place around town and so you stay.
Residential segregation and lack of affordable, safe housing options leads to stress, pollutant exposure, and a lack of access to community resources. All of these issues correlate with a high infant death rate.[4]
Access to Healthy Foods
IMAGINE
You’re pregnant and have gestational diabetes, so you need to eat healthy. You come home after working your minimum wage job to find your electricity was shut off because your family couldn’t afford to pay last month’s bill. The food in your refrigerator has gone bad. You’re starving, but you don’t have a car and the only places nearby to buy food are fast food restaurants or convenience stores. So, you buy the packaged doughnuts, fast food or chips that are available to keep your stomach from growling, so you can sleep that night.
Mothers with low energy as a result of not consuming healthy amounts of protein and key nutrients increase the likelihood of poor fetal growth.[5] According to the USDA, St. Louis has 15 neighborhoods that are considered food deserts – where it’s difficult to buy affordable or good-quality fresh food.[9]
Access to Education
IMAGINE
You tried to get ahead by earning a certificate from an online college, but they roped you into a loan with extremely high finance rates. And, they didn’t deliver on their promise of getting you the right certificate you needed to secure a medical office assistant job. Now, you’re pregnant and struggling to pay off the loan, buy groceries and pay rent. Without a real post-high school degree or training, your job prospects are slim. The thought of digging yourself out of this hole brings on a mountain of stress, which triggers you into premature labor. Your premature baby is born eight weeks early at just 3 pounds. Her life hangs in the balance as the NICU team does all they can to save her.
Women with access to education at higher levels are less likely to give birth to an infant who dies within the first year of life.[1] But, in St. Louis, students face challenges with education, with one out of four students in St. Louis City not completing high school.[7]
[1] Wanchaun Lin, “Why Has the Health Inequality Among Infants in the US Declined? Accounting for the Shrinking Gap,” Health Economics, vol. 18 (September 24, 2008), pp. 823-841
[2] The U.S. Infant Mortality Rate: International Comparisons, Underlying Factors, and Federal Programs Elayne J. Heisler Analyst in Health Services April 4, 2012
[3] See, for example, Brian Karl Finch, “Early Origins of the Gradient: The Relationship Between Socioeconomic Status and Infant Mortality in the United States,” Demography, vol. 40, no. 3 (November 2003), pp. 675-699.
[4] Cardwell MS. Stress: Pregnancy considerations. Obstet Gynecol Surv. 2013;68(2):119-29 4 Alio, A. P., Richman, A. R., Clayton, H. B., Jeffers, D. F., Wathington, D. J., & Salihu, H. M. (2010).
[5] An ecological approach to understanding black-white disparities in perinatal mortality. Maternal and child health journal, 14(4), 557–66. doi:10.1007/s10995-009-0495-9
[6] Abu-Saad, K., & Fraser, D. (2010). Maternal nutrition and birth outcomes. Epidemiologic reviews, 32(1), 5–25. doi:10.1093/epirev/mxq001
[7] https://www.stlouis-mo.gov/news-media/newsgram/Food-Deserts-in-St-Louis.cfm
[8] The U.S. Infant Mortality Rate: International Comparisons, Underlying Factors, and Federal Programs Elayne J. Heisler Analyst in Health Services April 4, 2012.
[9] Missouri Department of Elementary and Secondary Education