Scream ‘fowl’ over disparity in infant morality rates

Indigenous communities in the United States have the highest rate of Sudden Infant Death Syndrome [SIDS], according to information collected by the National Institute of Health in the U.S.

And in Canada the situation is the same.

The data, which was presented at the 4th International Meeting on Indigenous Child Health this March in Vancouver, states that in the US SIDS is two to four times more likely to occur in American Indian and Alaska Native [AI/AN] communities.

This makes it the leading cause of death in infants between one month and one year of age. The highest rates of SIDS was noted in the northernmost Indigenous communities of Alaska and those that border Canada.

SIDS workshop presenter, Jennifer Irving of the Oglala Lakota tribe in South Dakota, detailed findings from a report conducted through the Eunice Kennedy Shriver National Institute of Child Health and Human Development [NICHD]. Data collected for the report was gathered in collaboration with researchers, SIDS experts, and members of various US Indigenous communities.

“We’re trying to empower our communities,” said Irving.
While not all cases of SIDS are preventable, risks can be reduced. Babies who sleep on their stomachs are more likely to die of SIDS, so placing a baby on their back to sleep will reduce the risk significantly. Bed-sharing and the over-bundling of babies can cause infants to overheat and lead to higher risk of SIDS, research also suggests.
Crib mattresses should be firm and all toys and loose bedding should be out of baby’s sleep area. Smoking around an infant and consuming alcohol while pregnant or breastfeeding also raises the risk of SIDS.

Also, allowing babies arms to move freely rather than tightly wrapping and tucking them inside a blanket can minimize the risk of SIDS; although it can challenge certain cultural traditions, says Irving.

“It goes against the Indian wrapping of babies,” she admitted. But Irving says other culturally-specific methods, such as using a cradleboard for a sleeping baby, is encouraged because it allows for infants to sleep on their backs, significantly lowering the risk of SIDS.

Irving said it is also important to note that SIDS is not caused by immunizations and she urges Indigenous practitioners, community health representatives, new parents and family members to educate themselves on the risk factors associated with SIDS.

In British Columbia, the Vancouver Island Health Authority [VIHA] has formed an Infant Mortality Review Committee which goes into First Nations communities and studies the causes of the high infant mortality rates. They also provide education tools that community health representatives in various bands can share with their members.

“We have the highest infant mortality in the province,” said Charmaine Enns, VIHA Medical Health officer for North Vancouver Island. “We said something had to be done. We have to start looking at the babies that are dying on Vancouver Island to determine what we can do,” she said.

Enns said babies in First Nations communities have a disproportionately higher number of infant deaths than their non-Native counterparts.

She said that in the neo-natal phase of infancy—birth to 28 days—infant mortality rates among First Nations are two-and-a-half times higher than in the non-Native population.

In the post neo-natal phase—28 days to one year of age—death rates among Aboriginal infants are six times higher than those of non-Aboriginal infants.

It is the post-neo natal period that SIDS is most preventable, said Enns. She calls post neo-natal deaths “community deaths,” because it is a period when the babies are back in their communities and largely affected by the often poor social determinants.

“Those deaths [post neo-natal] bring in all the social determinants of health,” said Enns. “We cannot talk about Aboriginal Health until we get to the heart of the issue, which is the social determinants of health,” she explains.

Enns said socio-economic factors—poor housing, poverty, prenatal and second-hand exposure to tobacco smoke and teen pregnancy—all factor in to the high risk of infant deaths in Aboriginal communities.

However, since the Infant Mortality Review Committee was formed in 2008, Enns said the infant mortality rate has lowered a bit.

“I think it has improved,” she said, adding that the 2009 report showed there were less sleep-related infant deaths. The committee has yet to review the 2010 data.
Enns said sleep-related infant mortality is a huge concern when dealing with SIDS and SUDY (Sudden Unexplained Death in the Young). Bed-sharing is one of the biggest risk factors in regard to post neo-natal infant mortality, she said. “But we can’t just build homes,” she explained, adding why education is vital to lowering SIDS rates.
“There needs to be more education on safe sleep practices,” agreed Lucy Barney, Aboriginal Health consultant with the Perinatal Society of BC.

“We need to talk about the issues of why mothers and fathers are sharing their bed [with their baby],” she added. Barney also said more education is needed about Carnitine palmitoyl transferase-1 (CPT1). This is a hereditary, and treatable, deficiency and genetic marker in the number of infants on BC’s west coast and northern coastal communities.

She said research has been conducted determining that these coastal Aboriginal communities have high incidence of infant mortality linked to CPT1, but more research must be done.

Statistical evidence regarding SIDS and Aboriginal communities is sparse and the lack of information is an obstacle to lowering the infant mortality rate, said Dr. Evan Adams, the Province’s Aboriginal Health Physician Advisor.

“We don’t know what to do if we don’t know what the data says,” he explains, adding that one of the most important aspects of his work with the Ministry is to get a clear picture of the healthcare disparity between the province’s First Nation and non-Native communities. Gathering statistical data is difficult due to privacy laws around ethnic identification and health, he said.

Adams suggests that there needs to be a culturally sensitive way of gathering data so a balance between access to information and the provision of better healthcare can be achieved.

Currently in BC, statistical data regarding many Aboriginal people is gathered through a research process, said Adams. “We extrapolate data by matching a person’s numbers with their status cards,” he said.

“We know that SIDS deaths in Aboriginal communities is higher [than non-Aboriginal communities] And we know that that there is lots we can do to prevent these deaths but we have to make that actionable,” said Adams.

“As a society we should be screaming ‘fowl!’ as to why these rates are so different,” Enns said of the disparity between Native and non-Native infant mortality rates.
“We need a good and safe way to collect info,” she added. “We need to improve the health of Aboriginal people as they define it.”