Indiana is one of the ten worst states for the incidence of sudden unexpected infant deaths, or SUIDs. And in its area of the state, Tippecanoe County fares the worst of all its neighbors. But why, when the county has several hospitals and a major research university?
Who tracks the numbers?
Tippecanoe County Coroner Donna Avolt opens a cooler at the county health office. Inside are four body bags on stretchers.
“Anything under 18 we are required by law to do an autopsy and that’s fine we’re also required to do x-rays,” she says.
Avolt is a member of the county’s Child Fatality Review Team, a panel which reviews the deaths of children whose cause is deemed uncertain or not immediately apparent by investigators.
“If a child does die, more often than not now it’s going to be a natural death," Avolt says. "Occasionally we will see a child die from positional-asphyxia but the co-sleeping deaths have drastically decreased.”
Some causes decrease, but rates flatten
Co-sleeping deaths, where an infant dies due to unsafe sleeping conditions, and deaths due to genetic disease, are down in Tippecanoe County in recent years. Still, the county and the state see the same 7.4 infant deaths per 100,000 live births – about 20 percent worse than the national average. And while the national rate has been cut nearly in half in the past 30 years, Tippecanoe County’s gains have, at best, plateaued.
“It’s very disturbing because we like to think places where we think we have concentrated medical care that we’re not going to see those types of numbers,” says Wendy Kline, a Purdue University history professor who also studies reproduction and its role in society. "These are alarming statistics and even if you factor in difference in differences in income and education, women of color are still facing by far worse outcomes.”
Racial disparities
In fact, African-American moms in Indiana – and in Tippecanoe County -- are more than three times as likely to see their child die suddenly in infancy. IU Health Arnett Intensive Care Unit Manager Jen Hittle has a theory why.
“They attribute that to stress levels," Hittle says. "So, stress levels and how that affects before your pregnant, your reproductive system, during pregnancy and after pregnancy.”
Kline agrees – sort of.
“It is really disturbing and it’s hard to pinpoint one particular factor, but I think we need to incorporate racism as a factor and the stress that that causes,” Kline says.
Kline has written books and presented lectures on the use of midwifery and home births in the U.S., which have been shown to help close the racial gap between white and minority birth outcomes. She says all moms need to feel capable with their newborn.
“Something is going on about the lack of support. I mean I think when it comes down to: when a woman receives good prenatal care feels empowered at the birth, and has a good support system she and her child are far more likely to have healthy experiences,” she says.
Lack of nearby specialty care
Johari Miller, an IU Health Arnett pediatrician who’s expecting a child later this year, admits she has access to more resources than other expectant African-American moms. But she says the poor outcomes are more likely because specialized care can be hard to find.
“Most of that’s not available here," Miller says. "But I mean it’s available but you gotta go to Indy for all of the sub-specialties.”
Infant deaths due to accidental suffocation, strangulation or asphyxiation are the most common – often due to co-sleeping. That’s a practice many doctors now advise against.
Yet, county corner Donna Avolt believes there’s only so much that can be done.
“If we see a concern, we’ll address it and hopefully prevent it from happening again," she says. "But there are some children who just aren’t going to make it.”
Between 2012 and 2016, more than a dozen of the 86 infant deaths in Tippecanoe County were termed “sudden.” That’s a rate of more than one sudden infant death per every one thousand births.