Infant Mortality Funding Debate Lives On

Funding for an agency designed to reduce the number of babies who die in Tennessee survived the last round of budget cuts last month, but leading Republican lawmakers say it’ll have to do a better job proving its effectiveness to avoid being aborted in the future.

The Governor’s Office of Children’s Care Coordination oversees programs geared toward lowering infant mortality and improving health among pregnant women and children of limited economic means. The office’s budget totals $9 million, half of which is made up of federal matching funds.

The nine-employee agency, created by Gov. Phil Bredesen in 2004, was designed to distribute grant monies and, in general, “better coordinate the wide range of services available to children through state governments and the private sector, with an emphasis on delivery of health care,” according to the description of the office in the Tennessee Blue Book.

The office’s $4.5 million in state funding came under scrutiny this spring when GOP lawmakers began questioning whether duplication of efforts between the GOCCC and other agencies, like the Department of Children’s Services of the Department of Health.

Senate Republicans called for the office to demonstrate whatever real and measurable improvements it has achieved on the specific problems the GOCCC seeks to address. They were unsatisfied with anything presented.

“Of course everybody’s against infant mortality,” said Lt. Gov. Ron Ramsey, a Blountville Republican also angling to become governor. “But, if we’re putting $3 million into a program, please show me the results that are coming from that.”

The funding was ultimately left intact, but Republicans are resolving to reevaluate the office next year. In particular, they say they want to determine if the percentage of under-one-year-old babies who die annually in Tennessee is significantly lower now than when the office was created.

“This is going to be a very tough budget year next year in the same way it was this year, and we need to make sure that the the dollars that we’re spending are actually having a positive effect on this problem,” said Sen. Brian Kelsey, a Germantown Republican.

About 12 babies out of every 1,000 born died in Shelby County in 2008. Tennessee as a whole averaged about eight infant deaths per thousand births according to numbers released in June by the GOCCC.

That year, 185 babies died in Shelby County. Another 68 infant deaths were reported in Davidson County and 42 in Hamilton County. Statewide, 686 babies never reached their first birthday, according to the Children’s Care Coordination office.

As of 2007, Tennessee’s infant mortality ranked among the worst in the country.

Infant mortality is “not just a fad of the year,” said Memphis Mayor A C Wharton at the Family Re-Union 2010: Families and Healthy Beginnings day-long conference at Vanderbilt University last month.

Speakers said their biggest challenge in securing funding for infant mortality programs is convincing taxpayers and lawmakers to invest in policies that may not pay off quickly.

Advocates need to treat the issue like a political campaign, explained the Democratic mayor.

“We need to elect infant mortality,” Wharton said.

The GOCCC’s main task in regards to infant mortality is to issue federal and state grant money to local programs and evaluate each program’s progress, according to Susan Miller, the office’s Women’s Health Director. She said it also funds a series of local task forces that examine medical records of deceased babies and makes recommendations to community action teams.

Many outreach programs implemented with the state funds are have “been around the block,” tested and proven in other states, said Miller.

“These are things that have been tried elsewhere and have worked, so we’re going to try them, too,” she said.

Some GOCCC employees focus mainly on infant mortality while others zero in on other office projects like those under women’s health or at-risk children, but assist on infant mortality initiatives when those projects intersect, said Miller.

The Legislature needs to take a good look at this office, said Rep. Joe Towns, and figure out how to best focus infant mortality reduction efforts.

“Whether that program is working or not, it’s our responsibly to fix it,” said the Memphis Democrat. “If it’s not working, we need to figure out how to implement programs that will work. We’re talking about babies that need to be saved.”

The agency and the Maryland-based Anne E. Casey Foundation reported that statewide infant mortality rates dropped from 8.7 in 2006 to 8.3 a year later. Data for 2008 is not yet available.

Some lawmakers, like Debra Maggart, R-Hendersonville, question whether that reduction was entirely accurate, if it constitutes a trend, or whether the decrease was legitimately attributable to actions taken by the office.

Maggart chaired a committee assigned to examine the issue, but the members have yet to release a promised report, and missed an extended June 1 legislative deadline after asking for more time beyond the initially scheduled February report release date.

The six members of the bipartisan committee — including Republicans Dale Ford and Barrett Rich and Democrats Mark Stewart, JoAnne Favors and Jeanne Richardson — have yet to sign off on the report, said Maggart.

The committee’s unofficial findings, which were circulated behind the scenes, nevertheless fueled some legislators’ opposition to fully funding the GOCCC.

“The question is whether the almost $5 million spent annually was getting actually on the ground to the patients who need that kind of funding or whether it’s more administrative,” said Sen. Mark Norris, R-Collierville, who chairs the chamber’s GOP caucus.

Others in the Legislature say the agency isn’t doing enough to address the problem — or at least isn’t doing enough to prove its claims that what it is doing is successful.

Without that solid evidence, lawmakers may cut the program and brainstorm for different ways to address the problem, said legislators from both sides of the isle.

Infant mortality rates include any death of a child under 365 days old. Deaths can include everything from succumbing to extremely low birth weight to Sudden Infant Death Syndrome and accidental suffocation and strangulation in bed.

Underweight babies present the largest risk of infant mortality with a rate of 1.36 deaths per 1,000 births, according to the Tennessee Department of Health’s infant mortality data.

“When it comes to health, when it comes to education, a lot of it must be from yourself. You must want to be healthy. You must want to be educated. All the state can do is provide an opportunity and the success or failures is incumbent upon the individual,” said Rep. Glen Casada, R-Franklin.

An estimated $1.5 billion hole is expected in the state budget next year when federal stimulus dollars run out. Spending throughout the state will be tight and lawmakers from both sides of the isle generally agree programs across the board are going to be investigated for efficacy and those that can’t prove success or show results will likely be targeted for elimination.

“Whether that program is working or not, it’s our responsibly to fix it,” said Rep. Joe Towns, a Democrat from Memphis. “If it’s not working, we need to figure out how to implement programs that will work. We’re talking about babies that need to be saved.”