Officer on Infant Mortality
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
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."
made six recommendations in his report:
should establish a goal of attaining the lowest achievable
infant mortality rates.
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.
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.
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
view of the disparities noted in this report, a major emphasis
should be placed on improving maternal and infant health
in Aboriginal communities.
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.
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."
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.
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."