Strategic Thoughts

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November 10, 2003

Health Officer on Infant Mortality

The defensive tone taken by Health Planning Minister Sindi Hawkins in her news release doesn't do justice to the excellent report by the Provincial Health Officer titled "A Review of Infant Mortality in British Columbia: Opportunities for Prevention".

Early in her news release Hawkins said "I am pleased to hear the report confirms that no significant change to the infant mortality rate has occurred." The report used a 95% confidence test of the difference in the rates in order to measure significance. Since a change in infant mortality, particularly an increase, is important, it would be legitimate to use a less stringent test. The higher rate in 2001 and 2002 was significant at a 75% confidence level. Dr. Kendall didn't get into that issue in his report but he did say "Infant mortality has been declining for decades in B.C., similar to the rest of Canada. This decline continued through the period of the mid 1980's to 2000. It reached an historic low of 3.7 deaths per 1,000 live births in the year 2000. The infant mortality rate rose in both 2001 and 2002 - to 4.0 deaths per 1,000 live births in 2001 and to 4.4 deaths per 1,000 live births in 2002. Over the last five years infant deaths have numbered 174 (1998), 158 (1999), 150 (2000), 162 (2001), and 177 (2002)." Kendall found that "The excess in infant mortality of 31 additional deaths in 2001 and 2002 can be attributed in large part to an additional 27 deaths amongst infants of <1,500 grams and <28 weeks gestation - a group of infants with a particularly high mortality risk."

Kendall made six recommendations in his report:

1. B.C. should establish a goal of attaining the lowest achievable infant mortality rates.

2. As a long-term tool to develop effective maternal and child health services, the Canadian Perinatal Surveillance System framework for preventable fetal-infant mortality should be assessed by Health Authorities, B.C. Children's and B.C. Women's Hospitals, the B.C. Reproductive Care Program, Aboriginal representatives, concerned professional groups, and appropriate other interested parties. The framework should be adapted for application in B.C., with a view to determining specific strategies for future improvement in our rates of low birth weight, stillbirths, and infant deaths. Issues include the selection of appropriate benchmarks, reproductive trends, the diversity of our population, and disparities based on social, ethnic, or regional factors.

3. The Ministries of Health, the Health Authorities, B.C. Children's and B.C. Women's Hospitals, the B.C. Reproductive Care Program, Aboriginal representatives, concerned professional groups, and appropriate other interested parties should collaborate in the monitoring of infant health outcomes and the evaluation of maternal and child health services in order to attain the best possible health outcomes for babies and mothers in B.C. Particular attention should be placed on disparities.

4. In the short-term, pending the availability and application of the results of that assessment, the role of Pregnancy Outreach Program (POP) services in B.C. should be reviewed, in order to determine how more women with at-risk pregnancies could benefit from these services. The value of these services is supported by a growing evidence base, suggesting that POP services can be regarded as an important complement to the core function of maternal and child health services as provided by community health nurses, physicians, and midwives.

5. In view of the disparities noted in this report, a major emphasis should be placed on improving maternal and infant health in Aboriginal communities.

6. The provincial and federal governments should give consideration to ways in which the income status of pregnant women can be improved (e.g., create a maternal nutrition benefit to start once pregnancy is confirmed, that becomes the Child Benefit once the birth is registered). Such a benefit would be cost-neutral if the Child Benefit program was terminated 6 months earlier than at present.

The news release issued by Hawkins mentioned recommendations 2, 4 and 6 before saying that the Ministry "has asked B.C. Children's and B.C. Women's Hospitals and the B.C. Reproductive Care Program to examine the detailed findings of the report and develop a plan to enhance infant and maternal health outcomes in the province." The release went on to say that "The ministry is looking at incorporating this plan into the performance agreements with the health authorities."

The strategic plan for the last government included infant mortality as a key measure of performance. It was also included in the performance plans for the Ministries of Health and for the Ministry of Children and Families. The Campbell government removed all references to infant mortality from its strategic plan and from its service plans except for one reference in Health Services where the plan calls for "Comparable health status between Aboriginal people and other residents of BC" measured by infant mortality and life expectancy.

Hawkins should pay attention to Kendall's first recommendation and reinstate infant mortality not only as a measure of government performance, but "B.C. should establish a goal of attaining the lowest achievable infant mortality rates."

 

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