NIH-DC Initiative to Reduce Infant Mortality in Minority Populations in Washington, DC: History and Lessons Learned

Abstract

In the years leading up to implementation of the NIH-DC Initiative, the infant mortality rate among blacks was at least twice as high as among whites. National data (Table 1) demonstrate that while infant mortality rates were decreasing for both white and black infants, the discrepancy between the rates increased. Table 2 provides the infant mortality rate among white and black infants In Washington, DC, as well as the rate ratio. During this period, the rate for blacks in Washington, DC was higher than observed nationally for blacks and the discrepancy in rates between whites and blacks was also higher [1–3]. Similar disparities existed between the rates for blacks and whites for other birth outcomes related to infant mortality, such as low birth weight [4] (Tables 3, 4) and preterm delivery. Data on low and very low birth weight showed a similar pattern: the actual rates and the discrepancy in rates comparing whites and blacks were higher in Washington, DC than nationally. In response to this problem, the United States Senate and House [5] urged the National Institutes of Health to close the health gap between minority and majority Americans by addressing issues such as infant mortality and health behaviors in adolescent and young adult minorities. To address these issues in Washington, DC, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and what is now the National Institute on Minority Health and Health Disparities (formerly the NIH Office of Research on Minority Health) established the NIH-DC Initiative to Reduce Infant Mortality. This was a collaborative research network between the NICHD, a data coordinating center, and various primary collaborating sites in the District of Columbia. There are multiple known risk factors for poor perinatal outcome, including perceived racial discrimination, young maternal age, low level of maternal education, poverty, inadequate housing, lack of social support, being unmarried, late or no prenatal care, unintended childbearing, adverse health behaviors during pregnancy like smoking, drinking and drug abuse. Additionally there are a number of medical risk factors, including preeclampsia, premature rupture of the membranes, urinary tract and vaginal infections. To address these health discrepancies, the overarching goals of the NIH-DC Initiative were to develop projects with the objectives of understanding the determinants of risk factors for the high rates of infant mortality, understanding risk factors for low birth weight among minorities in DC, and developing interventions that help reduce those risk factors. Phase I began in 1992 and included diverse projects that: evaluated an educational program for new mothers who had inadequate or no prenatal care; studied the characteristics of neonatal intensive care units within Washington DC; addressed immunization rates for DC children; evaluated a program to prevent adolescent pregnancy; described the barriers, motivators and facilitators of prenatal care utilization; surveyed childhood injuries; and assessed alcohol consumption during pregnancy. These studies produced many relevant results. Three key results: First, that mothers randomized to an intervention for women with M. Kiely (&) M. Davis Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development/NIH/DHHS, 6100 Executive Blvd, Rockville, MD 20852-7510, USA e-mail: kielym@nih.gov