Infant mortality measures the rate of infants born alive who die for any reason during the first year of life. In the 1990s, Maine’s infant mortality rate was the best in the nation. Since then, it has skyrocketed, led by a dramatic increase in the rate of infant mortality in rural Maine — and Aroostook County is driving the trend.
As an Aroostook County native, a mother of three, and a member of the Board of Directors of the Maine Children’s Alliance, I was shocked when I opened the latest KIDS COUNT data book and found that infant mortality rates in Aroostook are the state’s highest – in fact, the mortality rate of 9.7 deaths per 1,000 births is higher than the rate in Mississippi, historically one of the worst states in the nation for maternal and infant health outcomes. The rate of Aroostook babies who don’t see their first birthday is worse than the rate in Romania — a former Eastern Bloc nation where the annual income is around $3,000.
This is nothing less than a public health emergency. Every infant death is a tragedy. There are cases when babies die suddenly and there is nothing that could have been done any differently to change the outcome. But there are also signs in the public health data that indicate there are strategies we could adopt to protect more babies during their first year of life. One in ten Aroostook babies weighs less than 5 pounds, 8 ounces at birth. Over ten percent of births in Aroostook are pre-term — born before the 37th week of pregnancy. And 11.3 percent of babies born in 2017 were born drug-exposed.
The rate of Maine babies born drug-exposed has burgeoned along with the opioid epidemic. Babies born drug-exposed are much more likely to die within their first year. People with substance use disorders often struggle at work as their addiction tightens its grip, and are less likely to have employer-based health insurance to pay for the substance abuse treatment that could help them recover. States in the region that have expanded Medicaid to treat the uninsured made greater strides against the opioid epidemic and reduced overdose deaths far more successfully than has Maine, but the voter-approved Medicaid expansion that took place in January 2019 should ensure more low-income women will have access to substance abuse treatment — and hopefully reduce the rate of drug-exposed infants statewide and in Aroostook.
There are also strategies that can reduce the rate of pre-term births and low-birthweight babies. Poor pregnancy outcomes correlate with underlying health conditions in the mother — and reducing the rate of obesity in young women, as well as screening for and treating chronic conditions like high blood pressure and Type II diabetes, will improve babies’ odds at birth. Rates of both diabetes and high blood pressure are high in Aroostook, but detectable with inexpensive screening and often treatable when caught early in pregnancy.
Home visiting is another strategy that has helped reduce infant mortality in Mississippi. In Sharkey County, a nonprofit called Cary Christian Center sends social workers out to visit rural mothers-to-be and offer them support – and matching them with prenatal care, adequate food, and information about maintaining their health during pregnancy. Sharkey County has a significantly lower infant mortality rate than other regions of Mississippi, despite having a relatively high poverty rate. Data shows that 159 Aroostook children under two received a home visit in 2017. Calling on young women who often live in isolated areas, in poverty, and who are too often pregnant and parenting alone, could go a long way toward reducing poor birth outcomes and infant mortality.
I’m happy that I was born at the old Cary Memorial in the seventies, and grew up in Aroostook County, floating on my back in the lake in the endless-feeling, humid summers, walking the dusty midway of the fair with my friends, walking my dog down the muffled, snowy streets under a million stars. I’m happy that my kids are having the same experience. A lot of things about Aroostook County have stayed the same for generations. But this spike in infant mortality is a sudden and ominous change. Aroostook County is the best place in the world to be a kid. Let’s make sure that the little babies born here every year get a chance to be one.
