The number of children who die each year in the District has decreased significantly over the past decade, even as the city’s population has increased. Between 2008 and 2015, fatalities dropped by 32 percent, from 182 to 124.
The decline was stark for teens, with deaths among 15- to 19-year-olds falling by 53 percent. The number of infant deaths also decreased by 28 percent, from 100 to 72 between 2008 and 2014.
Despite the declines overall, there was an uptick in child deaths between 2014 and 2015. And child fatalities remain far more prevalent in the District than nationwide. The death rate for every 100,000 children in the city was 88.7 in 2015, compared with 52.4 nationwide. It was 56.7 in Maryland and 52 in Virginia.
The numbers were highlighted in a report by the D.C. auditor, published Friday, that analyzed annual reports by the city’s Child Fatality Review Committee, which investigates deaths and makes recommendations for improving systems to prevent future deaths.
“We have made progress with child deaths in the District, and we want to keep going in this direction,” said D.C. Auditor Kathleen Patterson in an interview.
Improved medical technologies for premature babies and a reduction in gun-related deaths are factors in improvements, she said. Demographic changes are also a likely factor, as the city’s population is growing more affluent.
But Patterson emphasized that the review committee is well-positioned to play “a more powerful role in the trend” by identifying ways city agencies can work together to protect infants and children.
Children continue to die from homicide at far higher rates in the District. Racial disparities are stark, with African American children dying at much higher rates.
The infant mortality rate in the District was 27 percent higher than the national rate in 2014, with 7.6 deaths per 1,000 live births, compared with 6 per 1,000. The death rate for African American infants was nearly three times as high as the rate of non-Hispanic whites, 10.5 compared with 3.7.
Disparities reflect inequities in access to health care, the report said. In 2014, black mothers were less likely to begin prenatal care in their first trimester — 57 percent compared with 83 percent of white mothers — and more than twice as likely to have low-birth-weight babies as white mothers, the report said.
Infant deaths largely occurred in the first weeks of life and were tied to chromosomal abnormalities or deformations or complications related to pregnancy.
Unsafe sleep environments were a major factor among infant deaths that did not have natural causes. In 2014 alone, the committee reviewed six infant deaths that were attributed to sudden infant death syndrome associated with unsafe sleeping conditions.
The Child Fatality Review Committee, established by a mayor’s order in 1992, includes members from 13 D.C. government agencies. They are tasked with looking for ways they can work together to prevent future deaths.
Similar child death review teams in other cities and states have been credited with spurring system-level reforms, the report said. A death review team in Virginia prompted a public awareness campaign about shaken baby syndrome; A Massachusetts team inspired a broad campaign to educate new parents about safe sleeping practices; and a Tennessee team pushed for a new law requiring helmet use on all-terrain vehicles.
The panel in the District has made scores of recommendations over the years, but few have yielded concrete changes, Patterson said.
The report quoted people involved with the committee describing a pattern in which agency officials would respond to recommendations by saying, “We’re already doing that,” or “Thanks, but no thanks.”
The auditor’s report recommends that the D.C. Council hold a public hearing on each annual report, as required by law, and that the city administrator ensure that city agencies incorporate the committee’s recommendations into annual performance plans.
The report also recommends that the city fund more staff members to conduct investigations. The District has had as many as eight employees in the Office of the Chief Medical Examiner to investigate child deaths, but that number dwindled to less than half that in recent years. As a result, the number of child fatalities being reviewed dropped from 122 in 2010 to 35 in 2015.
Patterson, who served three terms on the D.C. Council earlier in her career, said the reports are a valuable and underused resource. As a policymaker, she said she has often turned to the child death reports to help her understand trends affecting some of the city’s most vulnerable residents.
“I found them an extraordinary source of very tough information on things not working in DC government,” she said in an email.