Infant Mortality in Tarrant CountyReaches Historic Low
When the Texas Department of State Health Services released the most recent live birth and infant death data (from 2015) in 2017, Tarrant County Public Health (TCPH) staff began crunching the numbers immediately. They calculated the infant mortality rate for Tarrant County and saw something never seen before: an infant mortality rate of 6.17 infant deaths per 1,000 live births, the lowest rate in county history. Another discovery was quickly made – the infant mortality rate among non-Hispanic blacks was in the single-digits for the first time ever (9.59 infant deaths per 1,000 live births) and had decreased 42 percent since 2010.
The progress seen in birth outcomes is possible due to community collaboration efforts that began almost 20 years ago.
TCPH began looking at infant mortality data in 2001. At that time, little information was available although it was clear that too many infants born in Tarrant County did not have a healthy start and did not have a first birthday.
More data were collected and in 2002 the Infant Mortality Task Force (IMTF) began as an advisory group to Healthy Start. The first years were spent raising awareness about the poor pregnancy outcomes and the high infant mortality rate.
TCPH continued to look at data, and with the help of City Match and National Association of County and City Health Officials, expanded their knowledge base with more tools to assess contributing factors to infant mortality.
In 2006, TCPH published the first Perinatal Periods of Risk assessment. It found that many of the poor pregnancy outcomes were attributed to poor maternal health and premature birth. There were more factors that influenced the pregnancy outcome other than prenatal care.
Through the years, TCPH, along with the IMTF, has worked to assure that community partners, leaders and program managers address infant mortality in all operations. As data analysis continued, the high infant mortality rate, especially for African American women, became the focus.
The Fetal Infant Mortality Review (FIMR) began in 2008. Health professionals, community members and public health staff joined together to identify trends in circumstances surrounding infant deaths and develop recommendations to help reverse the trends. The Community Action Team (CAT), composed of community leaders, health professionals and other maternal and child advocates translates the FIMR recommendations into actionable strategies and participates in the implementation of interventions.
We utilized the TCPH Community Health Assessment (CHA), which included qualitative data from focus groups, listening sessions and community-wide meetings, as well as quantitative data from local, state and national indicators to inform discussions and determine health priority areas. The four priority areas that emerged were Education, Environment, Health Care Access and Partnerships.
Many of these findings emphasized the social determinants of health that impact pregnancy outcomes and bolstered our education efforts.
TCPH implemented a program to promote the evidence-based practice of the using of 17P medication to prevent the recurrence of preterm delivery. Pregnant women who have a history of preterm birth receive case management to help assure they receive the medicine on a regular basis. The injections help extend the pregnancy so the baby has more time to develop and is larger and stronger at birth.
TCPH staff help train healthcare providers on the use of 17P as a best practice model in the prevention of preterm births. The women served are Medicaid eligible and/or low income women, who have a history of spontaneous singleton preterm birth between 20-36 weeks.
Because unplanned pregnancies have a higher rate of poor outcomes, TCPH and the County Hospital District have instituted the best practice of asking the "One Key Question".
All male and female patients are asked One Key Question, “Do you plan to add to your family in the next year?”
If the patient says “no”, the provider discusses options for long term contraception. If the patient answers "yes", the provider discusses health concerns that may have a negative health impact on the pregnancy and how to address those issues.
Another effort to promote healthy infants began in 2016 with the Breastfeeding Boot Camp. Two hospitals reported lower rates of exclusive breastfeeding at time of discharge, citing limited staff competence at addressing routine breastfeeding barriers.
The WIC program partnered with the County Hospital District and Medical Cities Arlington to host a four-hour, hands-on training with six stations to help raise the comfort level of hospital staff in teaching breastfeeding and increasing breastfeeding rates.
The training modules, adopted from Dallas WIC, align with the Texas Ten Steps to Successful Breastfeeding and help partner hospitals meet related training requirements. Over 400 hospital staff completed training in the first year.
We look forward to even more success in reducing the infant mortality rate, but TCPH can't do it alone. It takes a strong collaboration, like the Infant Health Network, to:
1. base decisions on data,
2. employ evidenced-based programs (including those that address the social determinants of health),
3. partner with a strong community coalition,
4. instill a culture of learning and
5. welcome everyone to the table and look for shared goals.
We are calling on our community to join the collaboration and make Tarrant County a place for babies to survive and thrive.