PORT ANGELES — Clallam County had the highest infant death rate in Washington state from 2011-2015, according to the state Department of Health’s Infant Mortality Reduction report issued in early January.
The numbers are small, noted county Public Health Officer Dr. Christopher Frank.
“The numbers are still really small for a county like ours, so it’s really hard to break it down any further in an accurate way to be able to say anything more about the cause,” he told the Clallam County Board of Health on Jan. 16.
“Essentially we can say we have a statistically higher than the average rate for Washington state, and that we know we do have some deficiencies in areas that do cause increased rates of infant mortality, especially tobacco.”
The infant mortality rate is the number of infants who die before age 1 for every 1,000 live births.
Clallam County’s rate averaged 8.1 infant deaths per 1,000 live births compared to a 4.7 per 1,000 statewide rate. Stevens County had the lowest rate in the state at 3.2.
Washington state ranked eighth in the nation for the lowest infant deaths, according to the Centers for Disease Control.
“We are concerned that Clallam County has a higher rate, absolutely,” Lacy Fehrenbach, director of the state Office of Family and Community Health Improvement, said Thursday.
Native American and African American families “experience disproportionate rates of preterm birth, low birth weight and infant mortality,” the report said.
Fehrenbach said Jefferson County’s population, 30,466 in 2015, was too small and had too few births to determine a statistically reliable infant mortality rate.
In Clallam County, five infants younger than 1 year old died in 2011, three died in 2012, five in 2013, five in 2014 and nine in 2015 from among 3,338 births, Frank said Thursday in an interview.
In all, 27 infants died before their first birthday during the five-year period — enough to fill a school classroom.
“These are devastating deaths, devastating for families, absolutely,” Frank said.
Clallam was followed by Lewis, Walla Walla, Kitsap, Spokane, Pierce, Skagit, Cowlitz, Thurston and Benton counties.
King County stood at 17th among the state’s 39 counties.
Clallam County also had the highest infant mortality rate from 2009-2011.
The top three kinds of infant-mortality deaths statewide were congenital malformations followed by sudden unexpected infant death and short gestation-low birth weight, according to the report.
During the five-year period, 56 percent of infants who died were born before 37 weeks of gestation, and 57 percent of infants who died were born with low birth weight.
Infant-mortality risk factors for women included being overweight or obese, having diabetes, vaping, smoking marijuana and smoking cigarettes, according to the report.
It didn’t seem to help to stop smoking right before becoming pregnant.
“Washington women who reported cigarette smoking during the three months before pregnancy had an [infant mortality] rate approximately two times higher than the rate among women who didn’t smoke,” the report said.
Nearly one in five women in Clallam County — 17 percent — smoked cigarettes while they were pregnant in 2015, Frank said.
That’s more than double the state average of 7 percent.
Frank said Clallam County 10th- and eighth-graders also have reported smoking at rates more than double the state average — 13 percent of 10th-graders and 6 percent of eighth-graders.
While there was no Washington state-specific data on marijuana smoking, “nationally there is emerging evidence that maternal cannabis smoking negatively impacts lower birth weight of the infant,” the report said.
“We don’t know enough about ingestion of edible marijuana to really say whether it’s a significant risk factor for infant mortality or not,” Frank added.
The weight of the mother also can be an issue, according to the report.
In 2015, almost 54 percent of women in the state who had a live birth were overweight or obese before they became pregnant.
Frank said it’s hard to place the blame for high infant mortality on a specific cause or causes.
“We know the main factors, and they are tobacco use during pregnancy, poor access to health care, substance abuse — they all play a part,” he said.
“If you are poor and don’t graduate high school, you are much more likely to be poor, and you are more likely to smoke during pregnancy and be more likely to not have access to good prenatal care — all these things add up and are compressed into certain segments of our high-risk population,” he said.
He said evidence supporting universal home visiting programs is strong, citing the home visiting program run through First Step Family Support Center, known as Maternity Support Services.
But there is not enough funding to reach all the families that need those services, Frank added.
With a lack of money for government social programs, policy changes should be in order, such as the state lawmakers following through on a proposal to increase the smoking age to 21 in Washington state.
The Department of Health report suggests that women can take certain protective measures.
They include taking a multivitamin, prenatal vitamin or folic-acid supplement every day in the month before becoming pregnant, giving birth in a Level III medical facility, breastfeeding and, to reduce the level of sudden unexpected infant death, putting an infant to sleep on his or her back.
The measures are important even though infant mortality totals in Clallam County were so small for 2011-2015, Frank said.
That’s one thing that makes it difficult to draw hard, fast, concrete conclusions about the report, he said.
Frank said that in 2016, there were no infant-mortality deaths in Clallam County, although the statewide average was 4.3 per 1,000 live births.
“Since the numbers are so small, it makes five years look bad, then you have a year where there are no deaths,” Frank said.
“When you include them together, it brings them back close to what it really is, which is still higher than the state average.”
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Senior Staff Writer Paul Gottlieb can be reached at 360-452-2345, ext. 55650, or at pgottlieb@peninsuladailynews.com.
Reporter Rob Ollikainen contributed to this report.
