Babies hostage in city budget dealmaking

New York City’s improving public health extends down to its very youngest residents: its infant mortality rate has been trending downward for years, reaching a historic low in 2011, the most recently available data shows.

Yet in the city’s poorest neighborhoods, rates remain nearly double the citywide average, with levels more comparable to those in third-world countries like Costa Rica than nearby communities in the city.

East New York’s 8.4 deaths for every 1,000 live births echo the odds of survival in Kuwait more than in the neighboring Queens neighborhood of Ridgewood. And Central Harlem’s rates, at 8.5 for every 1,000 live births, far more closely resemble those of Montenegro than the nearby Upper West Side.

infant_mortality_promoAs Mayor Michael Bloomberg and the New York City Council enter their final weeks of negotiations on the city budget, figures like these loom over the numbers on the negotiating table. In their annual so-called budget dance — in which the mayor proposes sharp cuts to programs and then the council restores them — funds for programs to reduce infant mortality have been consistently targeted.

Unlike firehouses, programs to improve chances of live births have actually seen cuts as a result. The Infant Mortality Reduction Initiative, a Department of Health and Mental Hygiene project started in 2002, depends heavily on city funds. But for years, Mayor Michael Bloomberg has left the program completely out of his proposed budget, forcing the Council to step in.

In 2009, for example, the City Council restored $3.5 million to the infant mortality program after the mayor’s budget eliminated funding. But last year, the program received only $2.5 million, following a reduction of funds available to the Council. Providers and advocates plan to make their way back to City Hall today, pleading their case with a rally on the front steps.

“The mayor removes it from his budget and the City Council has to restore it, and we have to restore it with limited resources,” said Letitia James, a City Council member who represents Fort Greene and parts of Crown Heights.

“Every year it gets cut. The administration questions its effectiveness and efficacy, so we consistently have to defend the program. This is just another year. It really should be baselined and expanded.”

The Mayor’s office was unable to respond to requests for comment before deadline.

The infant mortality program funds caseworkers to perform outreach in particularly vulnerable communities and coordinate care for new and expecting mothers.

“When babies can’t make it to their first birthday, it’s because families and mothers are having a hard time staying healthy to delivery and having a hard time prioritizing their health needs during pregnancy,” said Ngozi Moses, director of the Brooklyn Perinatal Network, the lead organization for the Brooklyn Infant Mortality Reduction Initiative funded through the city program.

Social stresses like poverty and violence, as well as limited access to care are prime factors in the high rates.

According to a recent report by the New York Women’s Foundation, infant mortality rates in New York City are highest for black women living in impoverished neighborhoods. While white women in the city have a rate of 2.8 infant deaths per 1,000 live births, black women experience a rate of 8.6 deaths per 1,000.

These disparities are not unique to New York City, according to public health experts.

“Whether it’s Minneapolis or Los Angeles, very low income zip codes will have higher infant mortality rates,” said Irwin Redlener, clinical professor of population and family health at the Mailman School of Public Health at Columbia University.

At the same time, at least four hospitals serving high-risk mothers across central and eastern Brooklyn are teetering on the edge of financial collapse. Brookdale Hospital Medical Center, Interfaith Medical Center, SUNY Downstate Medical Center and the embattled Long Island College Hospital were among six cited by the state’s Medicaid Redesign Team in late 2011 as needing to reorganize to stay open.

SUNY recently announced a sustainability plan, calling for the dumping of LICH. Some networks have shown an interest in acquiring the ailing hospital, but it’s unclear what the final results will be. And if any close, experts warn, infant mortality rates would be negatively affected.

A study published in the April edition of Health Services Research showed that the likelihood of neonatal mortality — newborns who die before leaving the hospital — spiked by 49 percent in Philadelphia in the years following the closing of large obstetric units before leveling off.

Said Kathleen Powderly, PhD, director of the John Conley Division of Medical Ethics and Humanities at SUNY Downstate, “I think unless you consolidate and possibly expand the services here towards prevention to improve the health status of the community, then any decrease in available, accessible healthcare can only send those numbers in the wrong direction.”

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