After nearly a decade of work to reduce infant deaths in Tarrant County, Fort Worth and Arlington still have among the highest rates of infant mortality in Texas.
The reason remains a mystery, according to presenters at an Infant Mortality Summit in Fort Worth on Thursday.
"The casualty of not having the answers is death," said Micky Moerbe, biostatistician for Tarrant County Public Health.
Social service workers used to believe that a lack of prenatal care was to blame, Moerbe said.
Now, many in the field seem to agree that too many women are unhealthy before they become pregnant, Moerbe said.
If pregnant women in North Texas never got sick and maintained good health habits, the odds would tilt in favor of infants living past their first birthday, but there would be no guarantees.
Many Tarrant County programs focus on African-Americans because that community's infant mortality rate is historically two to three times as high as that of Hispanics and Anglos.
"We have a lot of low-birth-weight babies in the African-American community, and we don't know why that is," Moerbe said. "African-American women do not seem to be able to carry their babies to term. This is a nationwide issue.
"Unfortunately, it's something that has always happened. No one at this summit is going to be able to tell you why."
The mortality rate does not seem to be affected by the mother's education level.
"African-American mothers with college degrees have an infant mortality rate more than 50 percent higher than white or Hispanic mothers who dropped out of high school," Moerbe said.
In 2010, the latest year with statistics available, Fort Worth posted the worst infant mortality rate in Texas among cities with 5,000 or more live births, according to Tarrant County Public Health. Arlington was second and Dallas third.
Dallas County had the highest infant mortality rate among Texas counties, and Tarrant County had the second-highest.
Efforts to reduce Tarrant County's rate have grown more intensive.
The Nurse Family Partnership has begun using a holistic approach.
The partnership's current caseload is 169, meaning that each nurse counsels and visits about 25 families, said Ann Salyer-Caldwell, Tarrant County's associate director of community health promotions.
Less than 10 percent of the women enrolled in the partnership had low-birth-weight babies, and no deaths were recorded, records show.
Mothers in the program have an easier time finding jobs and fewer run-ins with the justice system, and their children fare better, Salyer-Caldwell said.
The state recently took a greater interest in the number of infant deaths, and more resources might be directed at reducing the rate, Salyer-Caldwell said.
But that may not be the biggest benefit of the state's involvement.
The increased attention should make it easier to employ a holistic approach in the region, Salyer-Caldwell said.
"We cannot put everything in a nice little box and say, 'If we fix everything in this box, we will lower infant mortality,'" Salyer-Caldwell said.
"We have to make sure we have healthy girls who will grow into healthy women who will have healthy children."
At Catholic Charities Fort Worth, 43 programs serve expectant families, said Misty Wilder, who manages the Healthy Start program.
The health of the mother, stress, and access to healthful food and to transportation all contribute to whether a woman has a healthy pregnancy.
How a community treats its most vulnerable residents is a good way to gauge its viability, Moerbe said.
"There have been a number of programs that have been initiated, hospital systems have gotten together to help out, and women in the neighborhoods have gotten together to help a mother who needs it," Moerbe said. "We hope to see that reflected in the numbers. I think because that hasn't happened, it has been more frustrating for us.
"But there is no one number that will ever tell us the whole story."
Mitch Mitchell, 817-390-7752