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Black infant death rates down, but gap persists

Stefanie Lawrence and her 2-year-old daughter, Destiny, at their home in Dorchester on Friday.

Suzanne Kreiter/Globe Staff

Stefanie Lawrence and her 2-year-old daughter, Destiny, at their home in Dorchester on Friday.

The stairs to the attic were getting harder to climb for Stefanie Lawrence, then a 19-year-old pregnant with her first child. The air was always damp, aggravating her chronic asthma. She had moved there, into her relative’s home, because she and her mother could no longer afford a place of their own.

Worse still, Lawrence had no health insurance. She worried her unborn child would be affected by the turmoil buffeting her.

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But three months into her pregnancy, a cousin told her about city health department nurses who help mothers navigate pregnancy and the months that follow, part of a campaign to reduce the troubling infant mortality rate among black women. She signed up.

And on a summer day in 2012, Lawrence gave birth to Destiny, a healthy, 7-pound baby girl.

Today in Boston, black infants such as Destiny are more likely to celebrate their first birthdays than ever before.

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A report scheduled to be released Friday shows that infant mortality — the measure of how many babies die during the first year of life — has reached a historic low for black children.

And the study shows that the persistent gap in infant mortality rates between black and white infants has narrowed significantly over the past dozen years.

‘There’s no reason that at the start of life, that anybody should be at greater risk of dying because of the color of their skin.’

Barbara Ferrer, executive director of the Boston Public Health Commission 
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In 2000, black infants were nearly five times as likely to die as white infants; by 2012, a gap remained, but it had shrunk considerably.

In 2012, the most recent year for which data exists, there were 6.5 deaths among every 1,000 black infants born in Boston, the same rate as for Latino babies, according to the report. There were 3 deaths per 1,000 white babies.

Infant mortality is regarded as a bellwether of a community’s well-being, making such racial disparities particularly troubling in a city such as Boston, which hosts a range of world-renowned health centers, specialists say. Former mayor Thomas M. Menino once described infant mortality as the most pressing medical problem in Boston.

A Boston public health nurse visited Stephanie Lawrence twice a month when Lawrence was pregnant, helping her get food stamps, health insurance, and a two-bedroom apartment for her and daughter, Destiny.

Suzanne Kreiter/Globe Staff

A Boston public health nurse visited Stephanie Lawrence twice a month when Lawrence was pregnant, helping her get food stamps, health insurance, and a two-bedroom apartment for her and daughter, Destiny.

While the gap between black and white infants remains unsettling, the city has made significant strides in addressing infant morality, said Barbara Ferrer, executive director of the Boston Public Health Commission. There was also a reduction in premature and underweight births among black infants.

“We really targeted, for the first time, black women,” she said. The report “shows a persistent decline in infant deaths. This isn’t just chance; this is a real difference.”

Ferrer said these advances are the result of a new approach that started a few years ago encompassing more long-term and socially conscious efforts.

Instead of just focusing on prenatal care, public health care workers now work with women to help them lead healthy lifestyles before their first pregnancy, as well as between pregnancies. Nurses check up on children until the age of 5, following up to make sure they stay healthy.

Public health caseworkers, who serve about 2,000 women a year, try to address social stressors as well, referring women like Lawrence to resources that help with housing, food, and finances. Recent research shows that poverty, racism, and isolation may be deciding factors in an infant’s health, Ferrer said.

“There’s a new conceptual approach that says that rather than focus on prenatal care, our best opportunity is to discuss the time before pregnancies and [during] inter-pregnancies,” said Brent Ewig, director of policy at the Association of Maternal & Child Health Programs, a Washington, D.C., advocacy group.

The reduction in the mortality rate for black infants has occurred across the country, though Boston continues to eclipse the national average.

In 2011, there were 11.5 deaths per 1,000 live births among black babies in the United States, while the rate was 5.1 for white infants, according to the US Centers for Disease Control and Prevention. In 2000, the rate for black babies was just over 14.

But Boston’s infant mortality rate overall is slightly higher than the state average. In 2012, 4.3 babies died for every 1,000 live births statewide, according to the Massachusetts Department of Public Health, compared to 4.7 in Boston.

The statewide mortality rate for black babies — 8.2 per every 1,000 births — was higher than Boston’s.

Building social networks with other pregnant women is critical for mothers-to-be, said Elmer Freeman, a Northeastern University specialist in the study of health care disparities. The city has sought to nurture those networks with support groups known as “women’s circles.”

With scientific advances, the infant mortality rate fell dramatically in recent decades, dropping about 3 percent a year for both black and white babies since 1935. That year, there were 81.9 deaths per 1,000 live birth for black babies, while the rate for white babies was 51.9, according to the report.

“There’s no reason that at the start of life, that anybody should be at greater risk of dying because of the color of their skin,” Ferrer said. “Everyone needs to have the same opportunities to live a healthy life.”

For Destiny and her mother, Stefanie Lawrence, that opportunity came in the form of a public health nurse who visited twice a month when Lawrence was pregnant, climbing the attic steps behind Lawrence to check her vital signs and lay out her diet plan.

Her stress eased as the nurse helped her get food stamps, health insurance, and an apartment through a city housing program, with one bedroom for her and another for the baby, who is now a healthy 2-year-old.

“It wasn’t just good getting the home, but all of the resources, how my nurse came over,” said Lawrence, now 22. “I’m a young mom trying to get all the help that I need.”

Oliver Ortega can be reached at oliver.ortega@globe.com. Follow him on Twitter @ByOliverOrtega.
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