Infant mortality rate has risen in South Dakota

[UpInArms]

http://www.siouxcityjournal.com/articles/2006/01/17/news/south_dakota/c5bc250ac710fe50862570f90013d002.txt

PIERRE, S.D. (AP) -- South Dakota's infant mortality rate is rising, according to state Health Secretary Doneen Hollingsworth, who gave an update to a legislative committee last week.

South Dakota's infant mortality rate rose in 2004 to 8.2 deaths per 1,000 live births. In 2003, the rate was 6.5 per 1,000 live births.

"We've got some further work that we need to do," Hollingsworth said.

"Unfortunately, we're heading in the wrong direction."

<snip>

According to the Health Department, the main cause is inadequate prenatal care. The state medical association, Indian Health Services and the University of South Dakota medical school have formed a team to look into the issue further, Hollingsworth said.

...more...

[xchrom]

1. the aritcle didn't say if they thought

the problem rested mostly on the reservations.

it does state that they the 6th highest rate for inncoculations -- not bad -- so what else is contributing?

[Ilsa]

3. Considerations:

Inadequate prenatal care;
Higher rates of multiple pregnancies resulting in more premature births with inadequate NICU care or simply too early to survive;
Change in criteria;
Pregnancies lasting a little longer so what used to be a miscarriage is classified as a birth that doesn't survive;
Environmental problems causing fetal death after birth.

Just a few ideas. A dramatic change in rate like that needs to be examined very carefully so appropriate changes can be made.

[xchrom]

4. indeed.

i know the dakotas have a bad problem with fetal alcohol syndrome -- particularly among first nations people -- but i'm guessing there is considerable spill over -- it's hard life in the dakotas -- even in the cities you cannot escape the dreadful winters.

i was surprised to see that they do fairly well with their innoculations -- pregnancies lasting longer is actually news to me.

[CAcyclist]

7. Also teenagers having babies

instead of abortions. Teenagers have more low birth weight babies and low birth weight babies are less likely to survive, as well as the fact that these babies may be less well-cared for if they aren't really wanted.

This is just a guess on my part, but I know South Dakota only has one abortion facility for the entire state and condoms are still a foreign concept to a lot of guys there.

I have noticed that where-ever the abortion rate goes down when births are going up, the mortality rate goes up.

[SharonAnn]

14. But, but, but it's a strong "Right To Life" state.

[hadrons]

2. "Unfortunately, we're heading in the wrong direction." ....

thank you Red state South Dakota

[donsu]

5. the polluted envrionment can cause early labor and underweight

infants. and more and more infants are born degraded by the pollutents

male sperm count is down worldwide, same reasons

we can ignore pollution but pollution will never ignore us.

[AnneD]

6. We are seeing more of this nationwide.....

The Native Americans have access to health care, more so than an indigent non native.
In rural areas, hospitals are closing due to cuts in funding and the Medicare Medicaid underpayment for procedures in rural areas as opposed to same procedure done in an urban area.
So you no longer have a local hospital or clinic. You can have a 2-3 hr drive just to get to a doc (if you can find one-most go to the larger cities). Now factor in gas costs (cause there are no bus lines) which on a low income can be prohibitive.
The quality of health care in American cities is abysmal and even worse in rural America. Our overall mortality rates are also going up and it has a direct link to socioeconomic factors.

[Mabus]

10. Have you ever been to IHS?

Indian Health Services isn't always accessible. The local IHS doesn't do pre-natal care anymore. They give two choices - pay for it yourself or try to qualify for state/federal assistance. Some people have trouble qualifying for assistance and end up not getting proper pre-natal care as a result.

[AnneD]

12. Yes, and I even applied for a position as a nurse.

They expanded the facility at the Mescalaro Apache (to include dialysis center among other things). They are able to get care at the clinic or through local docs. The deliveries are at the local hospital and it is covered by the IHS as that is the only facility around. I don't know how other services are organized, but it is not to bad at that Rez. Of course they don't have the gee whiz stuff, but the rural hospitals aren't that much better either. I have sat in on many a Mescalaro birth. Most we delivered were good births (healthy good weight). We did have some with FAS but it was a low number.

[Mabus]

15. It feels like a crap shoot locally

Anymore it seems to depend on who you get in to see. It is kind of scary. Back in the '80's I went in for some abdominal cramping. I got tested for STDs and started anti-biotic, as did my very confused partner. Both my long time partner and I were tested for every STD imaginable. It caused a big strain in our relationship since we both believed that it was a monogamous one but one of us had to have contracted an STD somewhere. Every time a test came back negative the doctor ordered more tests. While waiting for yet another test to come back I doubled over at work and rushed to the hospital. Guess what? I didn't have an STD. I had cankers in my bowel lining. I was losing weight (vomiting, etc.) because of irritable bowel syndrome not because I had an STD. After that experience I became really leery of the care I was getting.

A few years ago there was this one doctor that was great. She actually took the time to listen to me and review my chart. I had felt run down for years. Before she got there I was put on anti-depressants for a while but it didn't seem to help. This doctor ran blood tests and found I was low on some vitamins. She suggested I take some B supplement and it worked. She tested my thyroid because she read in my chart that my grandmother was on some thyroid medication. Mine was fine. I had been going to IHS for close to fifteen years and no one had ever did simple blood test like that. She's gone now. Right now there's one doctor that is pretty good (he listens - I don't like to take pills so he suggested yoga for my arthritis), I don't care for the other one (I asked for a mammogram and she complained about the paperwork).

Anyway, a friend of mine went into IHS and was pregnant. They told her they didn't do those anymore and referred her to the state for assistance.

[AnneD]

18. There is a large variation.....

IHS doesn't pay much, but it has much to offer in the way of intangible rewards. The application process is ridiculously long.
Your experiences point out many of the problems I saw in some places. I am glad you are assertive. I think IHS should have more quality assurance and customer friendly service, but that is just me.
Part of the problem is the lack of accountability at IHS. I think tribes should start demanding better care, not just accept leftovers. It is the squeaky wheel that gets the grease.
People in rural areas suffer in the same way. Docs work there just long enough to pay off the loans then leave. Care can be spotty or poor and sometimes there is none at all. Communities and tribes need to organize around this issue.

[LostinVA]

8. Pine Ridge Reservation -- poorest county in the US

Literally sub-human living for most people. Broken Ft. Laramie Treaty, selling of mineral rights, etc. Hey, outsource some jobs over there.

Some stats:

The Pine Ridge Reservation covers roughly two million acres of land. Population is approximately 40,000 Lakota Sioux and Whites combined. The reservation has one of the highest unemployment percentages (86%) in the nation. The average yearly income per household is $6000 where the nations average is $21,000.

Life expectancy on the reservation is 45 year of age. Almost half of the homes do not have electricity and 60% of the homes do not have a telephone. Often is the case where homes are over crowded and they live in substandard conditions (no or very little insulation). Grandmothers raising grandchildren, relations all living in one home and single mothers trying to raise children, are a norm here. Many of the homes do not have running water, stoves for cooking or refrigerators. Some are sleeping on floors




Check online for even worse Shannon County stats. Appalling.

[AnneD]

13. The Pine Ridge and the Rosebud Res's

have always been vexing. They were the most resistant to go to the reservation and have a sad history of neglect and corrupt administration of resources. Other tribes have done better.

[LostinVA]

16. Blaming the victims? Oh my...

I know people who live in abject poverty on PR rez. They would blame the US Gov't lying and reneging and throwing them into the garbage can. They are aware of the corruption, but fault the system, not themselves. Forsooth.

Can't do better if you have nothing to do anything with.

[AnneD]

17. I am a bit confused by the post...

My family comes from Oklahoma. Some of our family lives on a Rez, some live off (Blackfoot Cherokee). My father made a choice to leave and make his life our side. Our only regret is the loss of culture. But culture can only go so far.
I have been to several different Rez's and they vary greatly in their quality of life. And some of that seems to be due to local leaders and the governance, but some of it stems from the cultural attitudes. What I am saying is that those two tribes did not go in willingly (more so than others) and have suffered. There is a defeated attitude that permeates everything. The depression is not only in wealth but in spirit too. When you go to the Pueblo's the attitude is more like 'OK, here we are let's make the best of it', and they do.
The difference in attitudes from tribes to tribes is amazing. I am not being a Pollyanna, but guilt and blame only go so far for so long. There comes a point where you have to stand up and take some personal responsibility.

[depakid]

9. Poor prenatal care

Due to a number of factors-

Here's a summary report:

http://www.state.sd.us/doh/Stats/Documents/PrenatalSummary05.pdf

[Mabus]

11. Here's part of the press release - tobacco use and delayed prenatal care

FOR IMMEDIATE RELEASE: January 3, 2006
CONTACT: Doneen Hollingsworth, [phone]

South Dakota infant mortality rate up, SIDS deaths down

***
Hollingsworth said there was a significant disparity by race with the infant mortality rate for American Indians double that of whites, 13.3 per 1,000 live births compared to 6.9.

The data points to tobacco use and lack of early prenatal care as major risk factors for low birth weight and pregnancy complications which can result in infant death. The infant mortality rate of babies born to mothers who used tobacco during pregnancy was much higher than for non-users, 12.8 deaths per 1,000 compared to 7.2 for infants whose mother did not use tobacco.

There was also a strong link between early prenatal care and a lower infant mortality rate. The lowest infant mortality rate was among mothers who started prenatal care in their first trimester, 6.9 per 1,000 live births. The highest rate, 59.4, was among mothers who had no prenatal care.

There were 93 infant deaths in South Dakota in 2004, or a rate of 8.2 per 1,000 live births. That’s well above the United States rate of 6.6 infant deaths per 1,000 live births for the same year (provisional data).

http://www.state.sd.us/doh/News/2006/infantmortality.htm