The latest infant mortality numbers from the Centers for Disease Control show a regression in how Texas is caring for its most vulnerable. The Lone Star State is one of four states in the country with where infant mortality is increasing, but it isn’t all bad news. The Parkland Center for Clinical Innovation’s Preterm Birth Intervention Program is helping high-risk mothers have healthier babies.
Texas joined Georgia, Iowa, and Missouri with statistically significant increases in infant mortality between 2021 and 2022, according to the CDC. Out of nearly 373,594 births in Texas in 2021, 1,977 infants died. In 2022, 389,741 births resulted in 2,228 infant deaths in Texas. The number of infant deaths per 1,000 births increased from 5.29 to 5.72 during that period, an 8 percent increase. Many of these deaths are the result of low birth weight, congenital disabilities, and complications, according to the report.
Racial disparity continues to be a factor, as most of the deaths are children of poor, uninsured or underinsured women of color. While infant mortality rates increased for most demographic groups, the Black infant mortality rate (10.86 per 1,000 births) is more than twice as high as the White(4.52 per 1,000 births) and Hispanic (4.88 per 1,000 births) rates. Infant mortality decreased in the Asian population, from 3.69 to 3.50 deaths per 1,000 births between 2021 and 2022.
Texas’ infant mortality rate increase was more than twice that of the United States, which grew 3 percent from 5.44 to 5.60 per 1,000 births between 2021 and 2022. The neonatal mortality rate also increased by 3 percent, and the postneonatal rate increased by 4 percent. According to The World Factbook, the United States has the 173rd worst infant mortality in the world, behind countries like Cuba and Serbia.
Texas and Georgia are two of the 11 states that have not implemented the Medicaid expansion, meaning 18 percent of the states without Medicaid expansion experienced increases in infant mortality. Conversely, only 5 percent of the states that have expanded Medicaid experienced increases in infant mortality. Texas leads the nation in uninsured rate and number uninsured people.
Lack of health insurance and access to prenatal care is a significant factor for infant mortality, says Dr. Yolande Pengetnze, a pediatrician at the Parkland Center for Clinical Innovation. Other factors that increase infant mortality are social determinants of health, like transportation, healthy food, and childcare.
“When we see the data on infant mortality, an increase in mortality is driven by preterm delivery,” Pengetnze says. “It is mostly babies born at a gestational age of less than 24 weeks.”
PCCI has long been operating a program to target high-risk pregnant women to help them avoid preterm birth, the primary driver of infant mortality. The program helps them connect to prenatal care and overcome other barriers to seeing a provider. The Preterm Birth Intervention Program uses several factors to identify high-risk women signed up through the Parkland Community Health Program, a Medicaid managed care program. These women can sign up to receive text reminders to attend upcoming appointments and other educational interventions to prevent preterm births.
The program identifies 13,000 at-risk women yearly, and 1,500 have opted in. Compared to those not in the program, enrollees are 20 percent less likely to have a preterm birth and visit a doctor 8-15 percent more than their peers. The initiative connects future mothers with case managers, a nurse line, and other opportunities for care. Once enrolled, PCCI enacts an intensive campaign to connect them to a provider, schedule an appointment, and stay connected to the health system.
PCCI has been in contact with other health systems to implement a similar program and is also changing to an opt-out rather than an opt-in program to increase its impact locally. The program is also looking to expand beyond PCHP enrollees and work with Parkland’s network of federally qualified health centers.
Even with the program’s success, the numbers are unlikely to move much without improved access to care. “Under insurance and lack of insurance are driving these numbers,” Pengetnze says. “Once they are insured, the social barriers to care can be addressed. We need to be striving to give these low-income women access to care.”
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