The District recorded its lowest infant mortality rate in history in 2003, reversing a one-year increase and putting the critical health statistic on the brink of single digits, officials said yesterday.
The 76 children who died before they turned 1 -- down from 86 the previous year -- equate to an infant mortality rate of 10 per 1,000 live births. A decade earlier, the rate was 18.2.
Although the latest measure remains higher than the nation's infant mortality rate of 6.9, it is significantly below that of such cities as Baltimore, at 13.2, and Detroit, at 16.3. And for a fourth year, the mortality rate for black infants in the District fell below the national rate for blacks.
"Absolutely, it is progress," District Health Director Gregg A. Pane said.
The improving outlook for the city's youngest residents reflects headway on numerous related fronts. The percentage of births to teenagers continues to fall, as does the percentage of births to unmarried women of all ages, many of them poor, less educated and with less support and stability.
"It's been a widespread effort throughout the community," said Kate Jesberg of the D.C. Department of Human Services, referring in particular to education and assistance programs targeting youth and single mothers.
The District has been richly rewarded for its success in reducing out-of-wedlock births, with the federal government awarding it more than $150 million in the past seven years. The award program requires an accompanying drop in abortions, and the number of District residents terminating pregnancies through abortion plummeted to 2,442 in 2003 from 5,143 in 1997. (In the late 1980s, the number exceeded 10,000 abortions a year.)
"It's a big deal," Jesberg said of the latest $25 million award, which was announced this month and marked the seventh consecutive bonus for the city. No state, she noted, can boast such a record. The District has used the money to promote a "safe sex or no sex" campaign for teenagers, provide job training and education programs, subsidize child care and launch numerous initiatives, although some community advocates fault officials for a scattershot approach.
The city had 7,616 newborns in 2003, up from 7,494 the previous year. Slightly more than 11 percent were born to teenage mothers, compared with nearly 13 percent a year earlier. About 55 percent of the 2003 total were born to unmarried mothers, with the percentages sharply higher in wards on the eastern side of the city.
Of the 76 infant deaths in 2003, 10 were blamed on congenital defects or chromosomal abnormalities and 8 on sudden infant death syndrome. But one-fourth were attributed to maternal complications during pregnancy and nearly all of the rest to a variety of issues that largely relate to maternal health, including smoking, substance abuse and poverty -- issues that explain why infant mortality is considered such an important indicator of a community's general well-being.
"The factors get back to the mothers," Pane said. "They're young, they've got medical problems, they're probably not getting the care they need."
Race continued to play a major role, with black infants more than six times as likely to die before their first birthday as white infants and nearly twice as likely to die as Hispanic infants. At 7.2, the mortality rate for Hispanic infants in the District remains above the national Hispanic rate of 5.9.
One surprise in the data released yesterday was a slight drop in the number of women getting adequate prenatal care, from 68.7 percent in 2002 to 67.6 percent in 2003. Pane had no explanation. "We need to try to understand why it went down," he said.
The city's top health officer also wants to better discern the demographic shifts that may affect the overall picture. A 2004 study by a New York economist concluded that a smaller population of black women under 35 was the central reason for the District's decrease in out-of-wedlock births, and Pane acknowledged that such changes also could be variables within the infant mortality rate.