Infant Mortality Rates: MN disparities for African immigrants and communities of color

Minnesota, the healthiest state in the country, also has the lowest infant mortality rates, but health disparities between minorities and the larger white population still exist, and infant mortality is one example of these disparities.

Infant mortality refers to the death of an infant during its first year of life, and the rate is calculated per one thousand infants. The Minnesota Department of Health reports that “out of 70,000 births to Minnesotan mothers about 380 die each year.”

While the state’s average infant mortality rate for white infants born in Minnesota during 2002-2006 (these are the latest available numbers from MDH) was 4.4 per 1,000 infants, the rates for African American and Native American infants were more than twice as high at 10.6 and 10.3, while that for black infants born of African mothers was 7.1. Asian and Hispanic communities show little disparity, with infant mortality rates of 4.8 and 4.9 respectively.

In 1990, 4.7% of black women who gave birth in Minnesota were born in African countries. This percentage has increased tremendously; by 2006 almost half of the Black mothers who gave birth in Minnesota were African born. In 1990, a total of 118 African women gave birth in Minnesota. The majority of these women were born in Nigeria or Ethiopia. In 2006, 2,894 African women gave birth in Minnesota with nearly half (1,433) of these women born in Somalia. In 2007, the number of births by country of mother’s birith was: Somalia (1463), Ethiopia (498), Liberia (388), Kenya (140) and Nigeria (125).

According to the Minnesota Department of Health, the leading causes of infant deaths are Leading birth defects, complications from premature birth, Sudden Infant Death Syndrome and other sleep related infant deaths, and obstetric conditions, such as multiple gestations, premature rupture of membranes, incompetent cervix.

In 2001, the Minnesota legislature established the Eliminating Health Disparities Initiative (EHDI) by allocating $13.9 million to address infant mortality disparities and halve these disparities by 2010.  This year the Twin Cities Healthy Start, a community-based project will receive a $4.6 million dollar federal grant over five years to reduce the infant mortality rates in African American and Native American populations in St. Paul and Minneapolis. 

Because of the “healthy immigrant effect,” infants born to foreign-born mothers tend to have lower infant mortality rates than infants born to U.S.-born mothers of the same ethnicity. This phenomenon has generally been attributed to healthier lifestyles (education, food and exercise) by immigrants, even those from poorer countries, before settling in the United States. However, in collecting data on infant mortality in Minnesota’s black [African American] population, the MDH found that, while the infant mortality rate in African immigrants was lower than that of African Americans, it was still higher than that of the general population. 

Cheryl Fogarty, an infant mortality consultant with MDH speculates that the general lifestyles of the two groups could explain the difference. 

“Generally, we have found that these [African] women have a healthy diet and do not smoke nor drink. Somali women, for instance, particularly have a network of support from other women in their community,” she says. 

Fogarty also attributes the higher infant mortality rate in infants born of African mothers compared to the general population to limited access to pre-natal care, post traumatic stress in refugee mothers and the strain of living in a new culture. 

MDH statistics also show that in 2007 African women are increasingly receiving adequate prenatal care; 67.9% of expectant African-born mothers received pre-natal care. While these numbers are higher than those of African American women at 63.7%, they are lot lower than the state average which is at 79.3%. 

Professor Katherine Fennelly, of the University of Minnesota, offers another explanation for the reason that infants born to African mothers have higher mortality rates than those born to U.S.-born mothers.

“While we can only speculate, refugees present a special case because many of them are fleeing their homes from some traumatic experience,” she said. The healthy immigrant effect, she explains, has typically shown the health trends in immigrants who have “self-selected: “These are immigrants who were better off economically than their country mates in their home countries and have made a deliberate choice to immigrate. 

David Stroud (Center for Health Statistics) explains that data on infant mortality is gathered from birth records and death certificates of infants born in Minnesota, but added that there is much information that is simply unknown.  

Because the mother of the child indicates her place of birth it is possible to know the number of children born to women born outside the US. However, the ethnic information on the mother’s identification is limited. Stroud cites Somali Americans, who he says, while they may be American-born, have distinct cultural characteristics and habits that are distinct from African Americans. In many instances, it is these characteristics that would determine the health of infant at birth.

Julia Nekessa Opoti (nekessa@kenyaimagine.com) is a freelance writer and the publisher of kenyaimagine.com, a Kenyan online magazine and newspaper.