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Despite gains in reducing infant mortality, many countries lag behind

Leading the news this week on Harvard’s World Health News (WHN) website is the dire infant mortality crisis facing Milwaukee, Wisconsin. The article is available here and more information on confronting the infant mortality crisis are available here. The headline reminded me of a similar story in the New York Times more than a year ago. (After a little digging, I realized the NYT article also addressed infant mortality in the same community, as well as the many interventions to decrease the rates.)

The article from Harvard’s WHN, available at Milwaukee’s Journal Sentinel, drew comparisons to the infant mortality crisis globally and noted that:

“In Milwaukee, the infant mortality rate for all children, regardless of race, exceeds that of Uruguay, Bosnia or Kuwait.”

And again, like many other aspects of health across the United States, there is great disparity between Blacks and Whites. The article goes on to say that:

“In 2008, the infant mortality rate for whites was 5.9 per 1,000 births. It was 13.8 for blacks. That means that in Wisconsin, black infants die during their first year of life at more than twice the rate of white infants. It is worse than Romania. It is among the worst in the nation.“

This article led me to seek out infant mortality rates for the Caribbean region, seeing that Target 4A for the Mellenium Development Goals is to reduce under-5 mortality rates by 2015.

According to UNICEF, many regional countries have met or exceeded their goals, including Dominica, Grenada and St. Kitts and Nevis. The full report is available here. Countries such as Barbados, Trinidad and Tobago, St. Vincent and the Grenadines and St. Lucia are on pace to meet their goals. However, the reported cited Jamaica and Haiti as two countries lagging behind. In fact, the report said that Haiti is the only country in the region with infant mortality greater than 1 in 10; while Jamaica was the only country in the region to not report a drop in under five mortality rate during the 1990’s.

Now, I understand that much has changed since the compiling of the data, and where possible I will attempt to get updated data. As of 2004, the last year available for the UNICEF Child Survival Report Card, the annual rate of reduction slowed in the 1990’s after increasing sharply from the 1960’s through the 1980’s.

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We as a region face many challenges. And there are varying social, economic, historical,  cultural, biological and possibly political reasons for high and or/low infant mortality rates. My attempt is not draw conclusions on why one country experienced a drop and another did not. I also do not attempt to draw comparison between Milwaukee and the Caribbean, but instead, I wanted to use it as a starting point for further discussion. My hope is that someone who wants to study child mortality rates in the Caribbean or elsewhere can build on what I’ve given here. Even though many countries in the Caribbean experience a decline in infant mortality rates, I am interested in knowing whether any disparities exist between majority and minority populations in certain countries, for example, between people of African decent and Indigenous groups in Dominica or St. Vincent; between those of African decent and of South-Asian decent in Guyana and Trinidad. Data such as this will help us as a region better understand the complexities of the health of the public and to target limited resources to groups who need them most.

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The public and private side of Breastfeeding

Recently, President Obama made news for asking for appropriate workplace accommodations for nursing mothers. The news was of course mixed. Breastfeeding seems to be a very political issue across the U.S., with many people saying seeing a nursing mother’s breasts amounts to too much public displays of affection to other not wanting screaming babies near them.

Of course, for working moms, their is a lot at stake to have to breastfeed a child according to the recommended guidelines here and here–exclusively for six months and continuing until the first year of life. The new U.S. recommendations are suppose to assist mothers during this process.

Both the CDC and the WHO have long been recommending breastfeeding for infants since breastmilk contains antibodies and other nutrients pertinent to early growth. In fact, the CDC has been actively trying to raise the rates of breastfeeding across the U.S. And, like many other health issues across the country, disparities exist between non-hispanic Blacks and non-hispanic Whites.

Across the U.S., Blacks are substantially less likely to breasfteed than other groups, according to the CDC. The full report is available here. Now, one of my issues with any reports like is that the Black population is often counted as a monolithic groups. Having been in the U.S. for half my life now, I’ve seen many African American parents (and I’m not saying this is exclusive to African Americans) who refuse to breastfeed their kids. I’ve always seen it as their decision and although I rarely questioned them on it, I do often wonder why one would choose not to breasfeed their child. Growing up on Dominica, it wasn’t unusually to see mothers nursing their children at Saturday Market or at the bus stop. In fact, my mother would often say that she breastfed her kids for as long as they want it. Knowing this, I am interested in data that stratifies foreign-born and U.S.-born Blacks and their breastfeeding habits.

I know that women in the Caribbean are still encouraged to breastfeed. And at times, it can seem odd to find someone who does not. So it does interest me to see what impact, if any, acculturation has on the breastfeeding habits of people of Caribbean decent living in the U.S. If anyone knows of any studies, do alert me to it.

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Cheryl Burke admits being molested. What does that have to do with us?

In a new book, Cheryl Burke of Dancing with the Stars fame reveals she was molested as a child. As reported on People.com, Burke said the molestation began at age 5 by a person close to her family. She also talks about having to testify at his trial, which led to a 20-year sentence.

It seems that many more celebrities are coming out with cases of molestation or other forms of child abuse. In the past few years, we’ve heard from Monique, Raz-B from B2K, and Teri Hatcher from Housewives. Many celebrities who admit to such a devastating time in their lives mention doing so because of the platform they’ve been give. They all mention telling their storis in hope of encouraging others to do so.

Across the Eastern Caribbean, child molestation and sexual abuse is one of the most difficult topics to discuss. As a society, we know it happens. As a society, we keep saying we are doing everything to address it. Yet as a society, there is little public discourse on the topic. I posit that one of the reasons is the lack of published data on the child abuse across the region. So we are left with governments spewing numbers and rarely putting them in context.

Exhibit one is two recent articles on Dominica News Online from the Minister for Social Services, Community Development and Gender Affairs and Chief Welfare Officer. (To read them, visit here and here.) Both address child sexual abuse as one of the leading forms of abuse committed against children on the island. The Minister for Social Services attributes the increase in reporting of abuses to increased public sensitization and awareness without really discussing what the public knows.

Also, published reports sometimes do not get the media attention that other topics receive. For example, the article from the Chief Welfare Officer references a 2009 UNICEF study on child abuse in six OECS countries. The only thing the article said about that report was it’s confirmation that child abuse is an issue on Dominica.

In fact, the article is about “Perceptions of, Attitudes to, and Opinions on Child Sexual Abuse in the Eastern Caribbean” and begins by saying that “Although there is extensive international research, few empirical studies of child sexual abuse have been carried out in the Caribbean and there are no reliable data on the prevalence of child sexual abuse, or indeed on attitudes and perceptions of abuse across the region.”

I did search on previous articles from DNO to see what they’d written at the time of the report release in June 2010. Several articles appear here, here, here and here. And, as I suspected, the ‘articles’ are more in line with press releases. There is very little in-depth reporting on what the study says, what the study means, and implications for interventions towards addressing child sexual abuse in our society as well as the impact of such abuse on future health and welfare of our kids.

I’ve decided to go through the report and write another positing on it at a later date.

P.S. After writing this post, I was listening to Stardom Tent in Dominica and one of the songs addressed child molesters. This reminded me how this issue is at once pervasive in our music yet hidden in so many ways. This is not the first song dealing with child abuse and child molesters. It won’t be the last. I’ll try to get the lyrics or maybe the song and put it on here.

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Need for better reporting on health issues

Earlier this month, an article on Dominica News Online lead with the headline “Timothy Blames Social Problems on Marijuana”. I wrote earlier on the the Minister’s seemingly lack of qualifications for the job.

However, I also wanted to write about the newspaper’s shortcomings.

Many articles appearing on the website read more like press releases than actual reporting. First, there rarely are any bylines with most attributed simply to Dominica News Online. Second, in instances such as the one noted above, I want to see more than the Minister’s words. Where are the counter arguments? Why couldn’t a DNO reporter get a quote or two from a public health or medical official on the island? And, if not a rebuttal from a health official, indeed follow-up questions to the Minister himself regarding how he came to those conclusions. Any of these approaches would greatly increase the value of information gleamed from the article as well as educate the public on what might indeed be a growing problem as well as give others an opportunity to design interventions to address those problems.

I am writing this now because another article appeared this week–this time on child abuse and from the Minister of Social Services, Community Development and Gender Affairs. Again, there are quotes from the Minister and nothing else. (I will address the issue of child abuse in a later post as well as how newspapers can educate the public on reported cases vs actual cases.) There are no quotes from the police department; nothing from the Minister if Health for indeed, child abuse is a public health issue. It is also a law enforcement issues.

I will say that I did not address this directly with the newspaper. I will attempt to do this in the future if this pattern continues. We need to educate those who bring us the news on how best to present them. It is particularly important for media and communications professionals to understand the best practices when reporting on health issues across the region.

 

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An HIV/AIDS course in every school

For the past three weeks, I’ve been attending AIDS: Principles, Practices and Policies. Tonight’s class saw about six people living with HIV and one living with AIDS address a group of more than 350 members if the UNC community: The oldest member of the group had been living with HIV for more than 22 years;  the newest HIV diagnosis among the panel was in 2008; and the person with AIDS was diagnosed in the mid-1990’s.

The group’s stories were inspiring in that they reminded us that HIV, and indeed AIDS, is now a chronic disease. Because of access to medication, day-to-day life is now about managing the disease. It is also about managing the myriad of other illnesses associated with HIV. Topics discussed included stigma and discrimination and  access to healthcare–one person being having medical disability from a job while others said they had no insurance and depended on ADAP.

This course is also inspiring because is shows the progression of the disease from the beginning of the epidemic to now. The panel included gay, heterosexual and transgender individual. Writing this now made me realize a missing demographic from the panel: young Black women. Although the panel was diverse in terms of race and gender, young African American women (18-34) are increasingly at risk for contracting the disease. And, cases are rising in the Southern U.S.

Nevertheless, this is a course that can be adapted for other universities. Particularly, I would like to see this course at the University of the Virgin Islands because it educates not only students from across the V.I. but also many of the next leaders across the Caribbean. It’s about time the university lives up to its “globally interactive” slogan. What’s more global than AIDS and HIV?

This video is an example of one of the lessons. It’s on Global AIDS. And, as one can see, HIV and AIDS is at once global and local.