‘Rock bottom’: Louisiana earns ‘F’ grade for infant health in new report

Louisiana is at “rock bottom” for infant health, according to March of Dimes. The state, which continues to see high preterm birth and infant mortality rates, earned an “F” grade for infant health in a new report from the nonprofit.

“There is a lot of work to do,” said Ashley Stoneburner, the director of applied research and analytics at March of Dimes.

The Pelican State had the second-highest rate of preterm births — defined as babies born before 37 weeks gestation — in the country, after the rate rose slightly in 2023 to 13.4% of live births, according to March of Dimes researchers. Preterm births are a leading cause of infant mortality and can lead to health problems throughout life.

Last year, Louisiana had the sixth highest infant mortality rate in the country, according to new provisional data from the Centers for Disease Control and Prevention. The figure dipped slightly by 3% from 2022 to 7.14 per 1,000 live births, a change the CDC deemed “not significant.”

The data show “not very much changed,” said Dr. Veronica Gillispie-Bell, a New Orleans OB-GYN and national expert on maternal and infant health.

Nationally, the preterm birth rate remained static last year, at 10.4% of live births. And infant mortality was similarly unchanged at 5.61 deaths per 1,000 live births, after spiking in 2022 — the first significant increase in a decade.

The reports reflect the first full year of infant health data with Louisiana’s abortion ban and similar bans across the country in effect. Researchers interviewed by WWNO/WRKF said the data does not indicate what impact the ban might be having on maternal and infant health, because it does not track whether the live births were pregnancies that might have been terminated in the absence of Louisiana’s ban.

“Because of the legal ramifications of that, we don’t want to identify those patients. So it’s really hard to know,” Gillispie-Bell said.

Kimberly Novod is an advocate for infant and maternal health and the executive director of Saul’s Light, an organization that supports families with babies in neonatal intensive care units, or NICUs. She said her organization has seen a spike in requests following Louisiana’s ban.

“We have definitely seen an increase in preterm birth, and we’ve seen a definite increase in infant mortality,” Novod said.

Black infants face worse health outcomes

Babies of Black parents were born prematurely and died at higher rates than any other racial group in Louisiana and in the U.S.

Nationally, Black babies were more than twice as likely to die as white babies in 2023. In Louisiana, Black babies were 1.5 times more likely to be born prematurely last year and 1.5 times more likely to die within a year of birth in 2022, according to March of Dimes data (the CDC only published national race data in its latest report).

Preterm birth is a leading cause of infant mortality across the country, and it was the leading cause of infant deaths in Louisiana from 2020 to 2022. Other top causes were accidents, birth defects and sudden infant death syndrome.

Chronic health conditions among mothers increase the likelihood of preterm births, including diabetes, smoking, hypertension and weight.

The March of Dimes recommends expanded policies to improve infant and maternal health, including policies that support midwives, doulas, and requiring Medicaid reimbursement for post-partum mental health screenings and paid family leave. Louisiana has made some efforts to improve doula access, but faces mixed results with improving access to midwives.

The role of abortion bans and birth rates

Two studies have shown increased infant mortality in the wake of state abortion bans. One analysis of CDC data found higher than expected infant mortality rates in the US in several months following the U.S. Supreme Court decision that overturned Roe v. Wade.

Co-author Parvati Singh, an assistant professor in the College of Public Health at Ohio State University, said it’s a question whether some of that increased mortality is due to reproductive health misinformation that spread post-Roe.

“Because if people start thinking that they can’t even access basic reproductive care, prenatal care, maternal health care, then that also would translate into adverse health outcomes for the infant, right?” she said.

The study’s results mirrored an earlier study that found an 8% increase in infant deaths and an increase in deaths from congenital anomalies, following Texas’s 6-week abortion ban, which took effect in 2021.

“The results suggest that restrictive abortion policies may have important unintended consequences in terms of trauma to families and medical cost as a result of increases in infant mortality,” the authors said.

The studies provide more evidence of the link between abortion bans and infant mortality, said Marie Thoma, an associate professor at the School of Public Health at the University of Maryland, who was not an author of either paper.

She noted that preventing unintended pregnancies by increasing access to family planning and encouraging immunizations are two other key public policy that can improve maternal and infant health. A bill to provide a state right to contraception failed in the Louisiana Legislature this year. An October legislative hearing on COVID-19 policies was rife with misinformation about vaccines.

Saul’s Light has seen the number of families it’s serving spike in the last two years. In 2022, it helped 113 families. In 2023, that number nearly doubled, to 217. Novod said they expect to help 230 families by the end of the year.

“The inaccessibility of comprehensive care for birthing people is going to lead to an exacerbation of this,” Novod said.

Gillispie-Bell said she thought Louisiana’s data was more likely tied to ongoing underlying health conditions and health policies, rather than the state’s abortion ban. But Stoneburner said abortion restrictions have negative impacts on maternal and infant health.

“Even if you can’t see it in the number of deaths, we know that it’s hurting moms and babies,” Stoneburner said.

Restrictive abortion policies are “going to cause providers to leave your state, or are going to cause really large inequities” between those who can access abortion and those who can’t, she said.

Despite Louisiana’s abortion ban, the number of births in Louisiana also fell in 2023, as it had in 2022, according to the CDC. That mirrors an overall trend in the state’s declining fertility rate, which Gillispie-Bell said could be a result more recently of more women using long-acting contraceptives.

“There’s data that shows that in [former President Donald] Trump’s first term, there was an increase in long-acting, reversible contraceptive requests and in permanent sterilization,” she said.