In Hong Kong, the infant mortality rate is 4.1 per 1,000 births. In Western Europe, 4.7 infants die for every 1,000 births. In Australia, New Zealand and Canada, the rate is 5.4. Even in Cuba, the infant mortality rate is only 7.3. But in Mahoning County, Ohio, the death rate for babies in their first year of life is greater than 12.9. And the tragedy is that many of those deaths and the sorrow they brought to local families might have been prevented.
In 1998 -- the last year for which the state has released data, Mahoning County ranked 82nd out of the state's 88 counties for infant mortality, at a time when Ohio ranked 34th out of the 50 states. And Mahoning County Health Commissioner Matthew Stefanak believes the local data will be worse when the statistics for 1999, 2000 and 2001 are reported, considering that the county birth rate is trending downward while infant deaths have increased over those years.
And it's not just babies who are dying. Too many adolescents have died as well. And many of those deaths could also have been prevented, too.
Highest death rate in a decade
The child death rate in Mahoning County is the highest it's been in a decade as the number of infants and teens who have died point to problems in, among other areas, prenatal care and lifestyle choices.
That Mahoning County residents are less well educated and in poorer health than much of the rest of Ohio has long been a concern of this newspaper. Those who are less well educated tend to be in poorer health and are also more likely to be smokers -- in the Youngstown-Warren area, that means 30 percent of men and 27 percent of women. Women who smoke during pregnancy are putting their children at risk as smoking increases the chance of low birth weight, miscarriage, stillbirth and infant death.
Alcohol use during pregnancy is another leading preventable cause of birth defects -- such as abnormal features of the face and head, growth and mental retardation, and abnormalities of the central nervous system -- and resultant infant death.
What is particularly tragic about the high rate in the region -- Youngstown's is even higher than the county rate -- is that better prenatal care and healthier lifestyle choices could prevent many infant deaths.
Women who smoke during pregnancy or who are exposed to second-hand smoke tend to have babies with low birth weights, and low birth weights -- less than 51/2 pounds -- are responsible for a host of problems. Further, infants born to blacks are twice as likely to have low birth weights than babies born to whites, which helps explain why black infants continue to die at twice the rate of white infants, according to a report from the National Center for Health Statistics.
Mahoning County's Child Fatality Review Board, which was established under Ohio House Bill 488 to decrease the incidence of preventable fetal and child deaths, has identified the most serious risk factors for infant death in this area: inadequate prenatal care, cigarette use during pregnancy, unmarried mother, teen-age mother, non-white mother.
Black teens at greatest risk
Thus, unmarried black teen-age girls who smoke or are exposed to second-hand smoke are the most likely to have babies that doesn't survive their first year. Teens are less likely to be well educated before becoming pregnant, less likely to obtain early prenatal care and less able to get the nutrition they need for themselves and their developing babies.
And to make matters worse, teens have greater difficulty bonding with babies who are sick or whose prematurity or low birthweight requires the infants to remain in the hospital after the mothers can go home.
The biggest challenge, then, for public health officials is to persuade teens in Mahoning County to make the right choices for a healthy lifestyle. But when so many adults either don't understand the risks of unhealthy living or choose to ignore them, it's not easy to ask their children to behave otherwise. What's more, if pregnancy is condoned or even encouraged by a girl's circle of friends or family members, why should she believe the warnings of authority figures?
We would urge those in a position to influence teen-age boys and girls to actively advise them of the need to avoid pregnancy and failing that, to encourage teen-age girls to seek prenatal care as soon as they learn they are pregnant. Ignorance is not bliss. Denial, for whatever reason, imperils the life of the child.
Adolescents often need to be protected from themselves and from the high-risk behaviors in which many indulge, such as drug and alcohol abuse, reckless driving, sex and tobacco use, even when death is not the immediate result of their dangerous decisions.
Although they pretend not to, kids really do listen to their parents. Messages that can mean the difference between life and death cannot be sent too often.