This article by Judi Kanne and Haisten Willis is the first in a series of articles the Cobb County Courier will be publishing on health care in Cobb County.
While any preventable infant death is one too many, recent data indicate that one portion of Cobb County, in particular, has a strikingly high rate of deaths before age one — a problem community stakeholders and leaders are working hard to solve.
Infant mortality, or infant death, is one way of measuring how well society manages the health of its people, especially when it comes to women and children. Recent data indicate Cobb County has a problem.
During the four-year period of 2012 and 2016, Cobb County noted 260 infant deaths below one year of age — a high number for a county containing some of the best medical facilities in the state. In fact, according to a 2016 Cobb and Douglas Community Health Assessment, the infant mortality rate showed an increase of 30 percent from 2011 to 2015.
Information collected from that assessment and other community health needs influenced the development of a 2017-2021 Cobb & Douglas Community Health Improvement Plan. The reduction of infant death rates remains a high Cobb County priority.
But one census tract, in particular, No. 13067031311 near Six Flags Drive, saw a rate more than twice as high as anywhere else in the county. While no other Cobb census tract reported more than 10 infant deaths during the four-year period, this area reported 21. According to an email from District 4 Cobb County Commissioner Lisa Cupid the only residential neighborhood in that census tract is a mobile home community. So one mobile home park accounts for more than twice the infant deaths of those in any other census tract.
The nearest hospital, WellStar Cobb in Austell, is just eight miles away. However, there are several other factors that may contribute to alarming infant mortality rates in the area. The tract, located along the northern border of I-20, is significantly poorer than Cobb County as a whole, with a median household income of $34,503, just over half of the $63,920 county average.
Transiency may also be a contributing factor. Just 41 percent of residents in the Six Flags Drive-area census tract owned homes, compared to 66 for Cobb overall. Education levels also lag behind nearby areas. However, labor force participation is relatively high at 78 percent, fully 6 percent higher than the county average.
“There is a housing crisis in this area,” said Monica Delancy, a local community activist, and tutor. “If people don’t have a place to call home, that can distract from the need to be proactive regarding the health of babies. That’s is a population that’s constantly moving or facing eviction, so the health of their babies is at risk as well.”
Delancy pointed out several programs aimed at educating patients about infant safety, including programs at the South Cobb Recreation Center. Another group, Safe Kids, gives out books to parents about sleeping habits for infants.
“Safe Kids Cobb County had an event two months ago where they gave out car seats for infants and toddlers,” Delancy said. “That’s another potential way to help curb infant mortality rates.”
Cobb and Douglas Public Health (CDPH) leaders are also actively seeking causes and looking at solutions.
“Our strategy is to increase the proportion of at-risk pregnant women who receive early and adequate prenatal and, if needed, postnatal care,” said CDPH Director of Planning and Development Sabrina Mallett.
It’s widely accepted that some forms of infant mortality may be caused by a series of unavoidable factors, including genetics and birth defects. However, early and adequate pre- and postnatal care may improve these tragic outcomes.
“… But, you cannot access those services without some assistance,” said Laurie A. Ross, CDPH director of family health management. “The grants that we write in Cobb County help provide some funds for approximately 80 women a year.”
Ross explained that funding enables these pregnant women to receive a high standard of prenatal care and some perinatology services — if they are necessary. However, Ross said, “for everyone else, there just isn’t any help.”
“Our funding only goes so far,” she said.
The 260 Cobb County infant deaths between 2012 and 2016 were mostly attributed to conditions originating in the prenatal period (159) and to congenital malformations, deformations and abnormal chromosomes (52), according to the Online Analytical Statistical Information System (OASIS) — a tool of the Georgia Department of Public health.
Infant mortality rates include any infant’s death prior to reaching age one. According to Cobb and Douglas’ Community Health Improvement Plan II, disparities also exist within infant mortality numbers.
For example, between 2011 to 2015, Black, non-Hispanic infants had the highest rates of death during their first year of life with an overall infant mortality rate of 10.8, or 142 deaths total.
Sudden infant death syndrome, or SIDS, caused an added 60 deaths, while suffocation attributed to six more. Education and positive reinforcement for Cobb’s parents may have saved some of these tiny lives.
Experts remind parents that simple instructions like putting babies to sleep on their backs, keeping the crib clear of items that may cause suffocation and avoiding co-sleeping are critical.
According to the 2016 Cobb County Medical Examiner’s Report, all cases with an undetermined manner of death in the 17 and younger population were less than one year of age.
In addition, the report discusses the use of the terms SIDS and Sudden Unexplained Infant Death (SUID).
The terms are not synonymous. SIDS deaths meet specific criteria, which rule out the risk of an asphyxial component of the death; whereas SUID deaths have a risk of an asphyxial component found during investigation or examination that could have contributed to the death, as stated in the medical examiner’s report.
“An infant found dead or near death in an unsafe sleeping environment, which includes bed-sharing with an adult or inappropriate bedding, would not meet the criteria for SIDS and, as such, would be classified as SUID,” states the report. “The most common manner of death for infants under one year of age is undetermined.”
Ross and her colleagues want to implement maternal services available to all pregnant women — regardless of whether they have insurance coverage for full prenatal services and perinatology services.
Education is a critical part of any public health program.
“We know that if women have medical conditions like diabetes, or pregnancy-induced hypertension (high blood pressure) or maybe their baby isn’t growing as well as it should,” said Ross, “they need to have access to a perinatologist.”
Cobb and Douglas Public Health is part of Cobb 2020, A Partnership for a Healthier Cobb County.
According to the Partnership’s recent update, Kaiser Permanente and WellStar have helped to fund better access over the past five years, but the resources are simply overshadowed by the need.