First Steps Credited With Lowering Infant Mortality State’s Infant Death Rate Dropped From 9.1 To 6.3 Per 1,000 Births

Health care for pregnant women and newborns has improved in the first six years of the state’s First Steps program, and child-health advocates said Thursday the effort likely has helped reduce Washington’s infant mortality rate.

The program was established in 1989 on the premise that investing more in prenatal care for low-income women would help reduce the infant mortality rate and produce healthier infants with lower lifetime health costs.

The state infant mortality rate - the number of deaths in the first year of life per thousand live births - had declined from 9.1 in 1989 to 6.3 by the end of 1993, according to state statistics. The 1993 figure is the most recent available.

For those receiving public assistance, the rate had dropped from 13.9 in 1989 to 10.7 by the end of 1992, the Department of Social and Health Services said. The 1992 figure is the most recent available.

In Spokane County, infant deaths dropped, but not as dramatically - from 9.4 per 1,000 babies in 1989 to 7.6 in 1993.

A news conference to call attention to the program’s success, coordinated by the Washington State Access to Maternity Care Committee, was held Thursday at Providence Hospital in Seattle.

“It appears the program is really making a big difference,” said Dr. Ed Marcuse, head of the Seattle Infant Mortality Steering Committee.

“It’s wonderful,” said Marilyn Walli, nursing supervisor for the First Steps program in Spokane.

“I think there was a fear with some of us the program would be disbanded before we could see these positive outcomes.”

The program made more pregnant women eligible for Medicaid and encouraged early prenatal care, as well as care after birth, through community clinics.

First Steps in Spokane County served about 500 pregnant, low-income women last year. About one-fifth of them were 17 and younger.

For every dollar spent on the program, $2.03 in future health care costs were avoided, according to a state cost-benefits analysis that considered lower rates of infant mortality and low birth weight along with associated reductions in disability rates.

“Substantial changes in the maternity-care system occurred after First Steps was implemented, especially for low-income women,” said Dr. Laurie Cawthon of DSHS, who conducted the analysis with Steve Hodgson of the agency’s Office of Research and Data Analysis.

“The timing of improvements in prenatal care access and birth outcomes provides strong evidence that First Steps has accomplished its goals.”

Asked about the program’s cost, Cawthon said $130 million was spent in 1992 ” to provide all the medical care that Medicaid funded for all the approximately 30,000 women who were part of First Steps in 1992.”

The Access to Maternity Care Committee is a multi-disciplinary organization formed in 1967 to promote improved health care for low-income mothers and children.