New moms and dads are consumed with so many questions during those first few sleepless months.
Why isn't the baby sleeping? Is she growing? Did we install the car seat correctly? When will he start crawling? When should she stop breastfeeding? Why does he keep crying? Should we call the doctor?
Meanwhile, scientists and public health experts are largely focused on a single question: How many of these babies will survive their first year?
That answer is expressed in the "infant mortality rate," an important metric that is considered a benchmark for a community's health. In Charleston, for example, the infant mortality rate in 2015 was five, meaning that, on average, five infants for every 1,000 born died before their first birthday. In real numbers, 25 infants died in Charleston that year, approximately 0.5 percent of the 4,991 babies born. The national infant mortality rate is about 5.8.
Those numbers are much better than they were a decade ago, when the infant mortality rate in Charleston approached 12. Likewise, a new paper in the Journal of the American Medical Association found that the overall infant mortality rate across the United States dropped 15 percent in the past 10 years but that the improvement masks a wide gap between black and white infant mortality rates.
The same trend holds true in South Carolina. In Charleston, where the black infant mortality rate is 11.7 and the white infant mortality rate is 1.8, black babies were 6.5 times more likely to die during their first year in 2015 than white babies.
"The sustained progress in reducing infant mortality among black infants since 2005 has stalled in the past few years," the JAMA report's authors wrote. "Interventions to further reduce the rate of preterm birth among black infants appear the most promising option for reducing black infant mortality and the absolute inequality between black and white infants."
Dr. Rick Foster, the senior adviser for population health improvement with the S.C. Hospital Association and a member of the S.C. Birth Outcomes Initiative, agreed the problem demands a targeted strategy.
But the issue is complex, he said, and risk factors for infant death include medical conditions, as well as social and environmental factors. Some of those include lack of transportation, domestic violence, unstable housing, exposure to smoke and limited access to prenatal care.
Unfortunately, Foster said, these contributing factors more often impact black women in this state.
The JAMA report's authors also found that "(n)o single cause appears solely responsible for the recent increase in black infant mortality" but that black babies are more likely to be born too early and die due to short gestation and low birthweight.
Closing the gap between black and white infant mortality becomes even harder to tackle, Foster said, considering many of black women suffer from pre-existing conditions, such as diabetes and obesity, that could cause their babies to be born too early or too small. Many of them remain uninsured until they qualify for Medicaid when they become pregnant.
"We’re not doing a great job managing their health care before they get pregnant," Foster said. "It’s even worse in the rural areas."
A program called Centering Pregnancy shows promise, he said. The model offers pregnant women one-on-one prenatal care, coupled with group sessions designed to help women navigate their pregnancies. The moms learn from each other and hold each other accountable.
Studies have shown that Centering Pregnancy participants are less likely to deliver their babies too early, Foster said. These babies tend to be born at a healthy weight and their moms will more likely breastfeed them.
The program is available in some of South Carolina's larger cities, including Charleston and Greenville, but Foster would like to see Centering Pregnancy offered in smaller, rural areas, where black infants face particularly high mortality rates.
"If we don’t close the gap, we’ll reach a plateau," he said.