In 2005, when a series of Commercial Appeal articles was published, the infant mortality rate (IMR) for Shelby County was 14.9 deaths per 1,000 live births. The county was ranked third-highest in the country and was similar to rates in developing countries.
Those newspaper articles spawned a Tennessee governor's summit in 2006, which aimed to tackle the issue head-on statewide. Now, 10 years of work by various agencies in Shelby County has resulted in the lowest reported infant mortality rate in 100 years: 9.2 deaths per 1,000 live births.
But it's still much higher than the national rate of 6.17 per 1,000 live births, according to the U.S. Central Intelligence Agency's 2014 World Fact Book data.
Dr. Michelle Taylor, a maternal and child physician for the Shelby County Health Department, said a range of possibilities — sudden infant death syndrome, lack of immunizations — contribute to the high IMR. The rate is usually a "general health and wellness indicator" for communities, Taylor said. As medical knowledge on how to take care of infants increases, infant mortality has decreased over time, particularly over the past 60 years.
"Even though we've had a 30 percent reduction in the mortality rate in the last 10 years, we still know there's a lot of work to do," Taylor said. "We know there's a gap between African-American and white infants. We're trying to change that as well."
Premature births also contribute to a high IMR. According to the Urban Child Institute, 13 percent of babies born in 2013 were preterm. Of those, 15 percent of black infants were born preterm, compared to 9 percent of white infants.
Low-income families also tend to have an effect on the IMR when there aren't enough resources in the community, either medically, nutritionally, or economically.
"We know that if you're under-resourced, your diet may not be as good," Taylor said. "You may not have as many opportunities for employment. You may struggle to take care of yourself during pregnancy, meaning that you may not get prenatal care as early as you would like."
On May 7th, during an Infant Mortality Reduction Summit in Memphis, agencies focused on measures that would further lower the rate. The Infant Mortality Reduction Initiative looks at prenatal care access, breastfeeding initiation, and teen birth rate, as well as appropriately spacing out pregnancies to 18 months apart and seeking care within the first 12 weeks of pregnancy.
"We found our rate was still higher than it needed to be," Taylor said. "There were several concerned citizen organizations, agencies, and nonprofits that weren't going to let that stand. With the summit we had a couple of weeks ago, we had people from all walks of life, people who have been engaged in this fight. They're ready to make that paradigm shift to the next level in working on this issue."
The health department has launched two technological initiatives: a blog, called the Shelby County Infant Mortality Reduction Initiative, centering on the issue and an iPhone and Android app. The free app, called B4Babylife, is designed to help people remain healthy before, during, and after pregnancy.
"The blog is going to continue the conversation we had on May 7th, and we'll have local experts, community leaders, and members blog about how to continue to reduce the rate in Shelby County," Taylor said.
The next step in terms of lowering the IMR isn't one step, she said, but a collection of steps needed to continue driving the number down. By organizations stepping up collectively, each issue can be tackled one at a time by various groups.
"We have to do it as a community," Taylor said. "You know, there are not a lot of initiatives that I know of in Shelby County that have lasted 10 years. [This has been] 10 years of work that different groups of people have been trying to maintain and make sure that we continue to pay attention to the issue. That's a long time for any locality, any group of people, to continue working on a problem."