Regional Insights: A poor outlook for babies in Pittsburgh

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There is no major region in the country that needs babies more than Pittsburgh. The region lost population for two straight decades and continues to have one of the slowest growth rates of any large region because it is the only major region in the country where there are more deaths than births.

While that's partly because our death rate is the highest of any major region in the country, it's also because we have the lowest birth rate among the largest 40 regions.

However, we don't just need more babies, we need healthy babies raised in households that can give them the support they need to succeed in life. Unfortunately, our region is performing poorly in that respect, too.

Babies are more likely to die in the Pittsburgh region than elsewhere. Data from the Pennsylvania Department of Health and the National Center for Health Statistics show that in 2010, the infant mortality rate (the proportion of infants born alive who die within the first year of life) was 7.2 deaths per 1,000 live births in the Pittsburgh metropolitan area, 17 percent higher than the national rate of 6.15.

The neonatal mortality rate (infant deaths that occurred during the first month of life) was 5 per 1,000 births in the Pittsburgh region, 25 percent higher than the national rate. The infant mortality rate in Allegheny County (7.6) was higher than both the regional and national averages, and the rate in Lawrence County (12.5) was double the national average.

African-American babies are much more likely to die here than in other regions. The mortality rate for infants born to African-American mothers in Allegheny County was 14.5 per 1000 in 2010, 25 percent higher than the national average of 11.6. (Eighty-five percent of the African-American births in the region occur in Allegheny County, so race-specific infant mortality rates are not statistically reliable in the other counties.) The infant mortality rate for African-American babies was more than double the rate for white babies (5.7), a bigger disparity than in other parts of the country.

Babies aren't dying because of a lack of prenatal care. Over 80 percent of mothers in the region get prenatal care in the first trimester, which is better than the national average. Although having every mother get early prenatal care would be ideal, it's more likely that our infant mortality rates are high because mothers aren't engaging in healthy behaviors during pregnancy and because many mothers don't have adequate resources to care for their babies after birth.

Too many babies in Pittsburgh are born to mothers who smoke during and after pregnancy. Research has shown that smoking during pregnancy doubles the likelihood of having a low birth-weight baby and increases the rate of infant mortality.

Pennsylvania Department of Health data indicate that 1 in 6 mothers in the Pittsburgh region smoked throughout their pregnancy, a 25 percent higher rate than the national average. Smoking during pregnancy is much more frequent in rural parts of the region; more than 1 in 4 mothers in Fayette County smoked throughout their pregnancy, and more than 1 in 5 pregnant women smoked in Armstrong, Greene and Lawrence counties.

Babies born to young mothers face the greatest health challenges. Teenage mothers (under age 20) and young mothers (ages 20-24) are more likely to engage in unhealthy behaviors such as smoking during and after pregnancy and to have low birthweight babies.

In the Pittsburgh region, 24 percent of mothers under age 20 smoke during pregnancy and 28 percent of pregnant women ages 20-24 smoke, compared to only 16 percent of pregnant women ages 25-29 and 10 percent of those age 30 and older.

Ten percent of the babies born to mothers under age 25 in Pittsburgh were low birthweight (under 5.5 pounds), compared to fewer than 7 percent of babies born to mothers ages 25-34. Low birthweight babies are more likely to die and, if they survive, to have serious health problems and learning disabilities that can make them less likely to succeed in school.

More African American babies are born to teen mothers in Pittsburgh than in any large region of the country. A major reason the infant mortality rate for African Americans is so much higher here is likely because an unusually high proportion of our African American babies are born to young mothers.

Fifty-five percent of African American babies in the region have mothers under age 25, compared to only 47 percent nationally. Nearly one-fifth of the black babies here (19 percent) have teenage mothers, the highest proportion among the top 40 regions in the country. In contrast, in regions such as Boston; Portland, Oregon; and San Diego, fewer than 10 percent of African American babies are born to teenagers, and teen birth rates in those regions are only half as high as they are in Pittsburgh.

Too many babies in the Pittsburgh region are growing up in poverty. Young mothers are far more likely to be single than older mothers, and that's particularly true here. Ninety-six percent of mothers under age 20 are single here compared to 88 percent nationally, and 74 percent of Pittsburgh mothers ages 20-24 are unmarried, compared to 63 percent nationally.

Single parenthood creates a vicious cycle of poverty for both the mother and baby, since it is very difficult for young, single mothers to finish their education and obtain employment while taking care of an infant.

In the Pittsburgh region, the majority (60 percent) of mothers under age 25 are on Medicaid, compared to fewer than 19 percent of older mothers. The problem is even more severe in the African American community, where 78 percent of the mothers ages 20-34 are unmarried, the third highest rate among the top 40 regions.

Likely as a result of the high rates of single motherhood in the African American community, over 50 percent of the African American children under age 5 in Pittsburgh are living in poverty, the 7th highest rate among the top 40 regions.

The inescapable conclusion is that the region needs to make a more concerted effort to reduce teen pregnancy rates and improve pregnancy outcomes, particularly in the African American community and rural parts of the region. At least three types of actions would be desirable:

• Encourage teenagers to avoid unplanned pregnancies and encourage young women to delay pregnancies until they have finished their education and have adequate financial resources to support raising a baby. This is something that parents, family and friends can encourage as well as physicians, schools and social service programs.

• Urge young women who are pregnant to stop smoking and obtain good prenatal care in order to have the healthiest baby possible. Encouraging this should also be a community role, not just the role of doctors and healthcare providers.

• Assist young women who have babies to obtain affordable childcare and to finish school and obtain employment.

Although there are a number of programs in the region designed to address these goals, particularly in Allegheny County, the data suggest that much more needs to be done. Programs that are effective should get the resources they need to expand, and those that are not effective should either improve or the resources supporting them should be shifted to higher-impact programs.

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Harold D. Miller is president of Future Strategies LLC and adjunct professor of public policy at Carnegie Mellon University.


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