This week, the Centers for Disease Control and Prevention (CDC) released new data on a tragic trend: more than 3,700 cases of congenital syphilis were reported in 2022, nearly ten times the number recorded 10 years ago.
If left untreated, congenital syphilis can lead to stillbirth or infant death. Infants who survive may have severe developmental delays, become blind or deaf. In 2022, the disease caused 51 infant deaths and 231 stillbirths. Congenital syphilis can be prevented, but it requires testing a pregnant woman for syphilis right away. The CDC said nearly 90 percent of the new cases in 2022 could have been prevented with timely testing and treatment. In 40 percent of the cases, there was no evidence that the pregnant woman had received prenatal care.
The news comes nearly a week after another startling statistic was released from the CDC — that the infant death rate in the country increased by 3 percent in 2022. It marks the first significant increase in about two decades.
Dr. Marie E. Thoma, an associate professor in the department of family science at the University of Maryland, told Salon that in general, the U.S. ranks very poorly compared to other high-income countries. While she cautioned to call it a “crisis,” the news “definitely set off some alarm bells,” and emphasizes the need for improvement. Overall, there have been declines in infant mortality rates over the past 20 years due to a number of public health and medical advances in the U.S.
Thoma said what we’re seeing is likely a consequence of another crisis that is inextricably linked to infant health: the maternal health crisis. Women in the U.S. are dying from pregnancy-related causes before, during and after childbirth at a higher rate than any other developed nation. When the healthcare system fails mothers, it fails infants, too, as recent data has shown.
“Several of the recent initiatives to address infant health were specific to infants and haven't done as much for mothers,” Thoma told Salon. “Whereas, advances in maternal health can continue to address both maternal and infant health combined.”
The drive behind the infant mortality rates appears to be due to a rise in maternal complications, and bacterial sepsis, which is often correlated with issues that come up during pregnancy and around birth. Joy Baker, an OBGYN based in Georgia told Salon the mother and fetus are a unit and should be treated as so.
“Whenever you have a mom that is not at her best health, you're going to always see that infants aren’t going to do as well,” Baker said. “And that’s mainly because the baby is completely dependent on the mom.”
For example, Baker said, if a mother doesn't have great cardiovascular health, it makes it harder to send good blood flow oxygen and nutrients to the fetus. If she's dealing with diabetes and has really high blood sugar, that could lead to preterm birth, increasing the risk for complications. Historically, public health policies have approached infant health and maternal health as separate entities. But as Thoma pointed out, since at least the 1980s, there have been calls to think of them combined. As researchers posited in 1985: “Where is the M in MCH [maternal and child health]?”
“We're asking that same question, and I do see a lot of momentum now,” Thoma said. “I think there's a lot more attention to the issues, a lot more policy investment, but we need to pass the policy.”
Thoma said she thinks the White House has a comprehensive blueprint for what can be done to address the maternal health crisis, which first suggests expanding healthcare access and coverage. Currently, Medicaid, which finances 4 in 10 births and only covers a woman 60 days postpartum. However, more states are offering coverage to women postpartum up to 12 months, with specific qualifications.
Experts agree that access to healthcare for mothers seems to be one of the drivers behind the rise in infant mortality rates — both in terms of general deaths and a large contributor to the rise in congenital syphilis. But it’s not just health insurance coverage. Regarding congenital syphilis, the CDC has previously said data suggests there are multiple issues at play, such as reduced access to STD prevention due to drug use, poverty, stigma and cuts to STD programs at the state and local levels. Defunding public programs could have hindered access to treatment for all moms.
Since the 2008 recession, local health department workforces have shrunk and the pandemic likely exacerbated the issue leading to fewer options for pregnant women. More than 5.6 million women live in counties with no or limited access to maternity care, areas that are commonly called “maternity care deserts.”
“Access to care is a major issue, we know that we're probably about 9,000 OBGYNs short in this country,” Baker said. “That's a major issue, women having access to good prenatal care, being able to get into a clinic to see a doctor or midwife, a nurse practitioner, who can help guide the pregnancy — that can be a real issue for folks who are living in maternal care deserts.”
An investment in women’s health services needs to be prioritized, the White House’s initiative said, particularly to address maternity care deserts. In a statement, Sandy Ching, president of the American Academy of Pediatrics (AAP) said the increase in infant mortality rates is “disturbing and disappointing.”
“Racial and ethnic disparities related to accessible healthcare — including prenatal health services — are just one of the many possible reasons for lower birth weights of babies and sometimes, infant deaths,” Ching said.
Jennifer Smilowitz, a professor of nutrition and health equity at the University of California-Davis, said in order to solve infant mortality in the U.S., the entire system needs to embrace both maternal and infant health as one.
“The problem is the current medical system is set up where the mother and the infant are not treated as a dyad,” Smilowitz said. “They are a dyad.”
