Gov. Asa Hutchinson says he'll look into whether Arkansas provides enough funding and needed programs to reduce the state's high rate of infants who die in their sleep.
He'll talk to directors of the state Human Services and Health departments about what more can be done, Hutchinson said in an interview last week.
But he's under no illusions that Arkansas' infant sleep death rate -- second-highest in the nation -- will be quickly or easily reduced.
"This is a very difficult area," he said Friday. "I've looked at some of the things being done in other states, and I didn't see anything that was a 'Wow!' moment, or anything that might solve the problem in Arkansas.
"There are things we can look at. But we have to be careful. We have to move wisely in this direction."
In a series published Jan. 29-31 titled "Dead Asleep -- Babies at Risk," the Arkansas Democrat-Gazette studied coroners' reports on 102 cases of infant sleep deaths in Arkansas and found that in more than 90 percent of those cases, the babies were found in unsafe sleeping situations.
The series chronicled the death of a North Little Rock couple's infant, Avah Forrester, in December 2015. The baby died in bed with her parents after her mother fell asleep while breast-feeding her.
Between 1999 and 2015, Arkansas lost more than 1,000 infants between the ages of 1 month and 1 year to Sudden Unexplained Infant Death, once termed Sudden Infant Death Syndrome, or SIDS.
Scientists increasingly believe that unsafe sleep practices factor into such deaths. The practices include infants sleeping on their stomachs, with adults or other children, or with blankets, pillows and other soft bedding. Babies who aren't breast-fed or who live in households with smokers also are at higher risk.
Many infant sleep deaths are preventable, researchers believe.
Hutchinson said he plans to talk with Arkansas Department of Health Director Nathaniel Smith and Department of Human Services Director Cindy Gillespie about the problem. They could not be reached for comment Friday. Arkansas Surgeon General Greg Bledsoe also wasn't available last week.
Since publication of the newspaper's series, other public health experts have talked about what they think Arkansas could do next to address the problem, and why needed education and prevention efforts aren't easy to fund or deliver.
The state has programs to review infant deaths and ascertain the causes, and is working to educate parents, doctors, nurses and hospitals about safe sleep practices.
Hospitals, and sororities and fraternities offer safety baby showers in which safe cribs are given to parents who can't afford them, along with other infant safety information.
Community workers visit homes of expectant and new mothers under a few programs.
Arkansas' high rate of infant sleep deaths hasn't dropped since at least 1999, according to data from the U.S. Centers for Disease Control and Prevention.
For every 1,000 babies born in the state, 1.6 die sudden, unexpected deaths, the data show. Nationally, the rate is 0.8 babies per 1,000 births. If Arkansas' rate was the same as the nation's, about 500 babies would still be alive, data show.
Reducing infant sleep deaths "is a solvable issue, but will take a broad education effort," said Dr. Joe Thompson, president and chief executive officer of the Arkansas Center for Health Improvement at the University of Arkansas for Medical Sciences.
Finding people to press for more funding or lead the search for new programs is difficult, he said.
Often, "when people have a disease, they find others with similar diseases and band together in groups such as the cancer or heart association," said Thompson, who is a former Arkansas surgeon general.
"When there's a specific condition, people are fairly easily mobilized. When it's a risk factor, such as obesity or physical inactivity or unsafe conditions in sleep-related infant deaths, there's no organization to go to and say 'you're responsible.' We all have to take responsibility and make a contribution."
One area Thompson would like to explore is working with churches to help educate their members.
"That's where people gather. I don't know a minister who wants a preventable funeral for a child."
The national health system "badly underfunds prevention, education efforts in health," said Dr. Gary Wheeler, a pediatrician and chief medical officer for the Arkansas Department of Health. "You can get estimates of the parts of our health budget spent on prevention education. They range from 1 to 9 percent. Certainly it's no more than $1 in $10. Those are the kind of activities that would include SIDS education."
Wheeler, like several experts interviewed, mentioned a program announced last month in New Jersey that will offer every expectant or new mother baby boxes lined with firm mattresses as safe places for their babies to sleep.
The program is similar to a Finland effort in place since 1938. Infant mortality rates there are among the lowest in the world.
But public health leaders have to weigh costs versus benefits, Wheeler said
With 40,000 live births a year in Arkansas, the baby boxes, which start at about $70 each, could add up to millions. And research isn't clear on whether they lower the rate of sleep deaths in the U.S.
Wheeler would like to see a comprehensive plan for Arkansas health care that would include reducing infant sleep deaths.
"We'd sit down with our pot of money, go through a deliberative process and decide which ones do we want to fund."
Instead, most money for the state Health Department comes from federal sources and is set aside for specific goals. Also, sometimes health efforts are mandated but funding for them isn't provided, so the Health Department has to trim in other areas to meet them, Wheeler said.
Wheeler's recommendation: Sustain things that work.
One is to stop smoking around infants, he said. Smoking contributes to many health problems, including sleep deaths. Continue stop-smoking education. Raise the age for tobacco sales to 21.
"Hopefully that would have some impact," he said.
Dr. Anthony Johnson, a Little Rock pediatrician and a board member for the American Academy of Pediatrics, said, "We don't put the dollars behind what we know is good for kids" -- including access to high quality health care, early education opportunities, and safe and affordable housing and day care.
More than half of babies born in Arkansas are on Medicaid for low-income families, Johnson said.
Medicaid payment rates to doctors are barely half what Medicare pays doctors. So, doctors limit the number of Medicaid patients they serve, which ultimately limits poor people's access to health care, he said.
Johnson has heard about the New Jersey baby box program.
"As we think of families struggling financially," he said. "Would that be something positive in Arkansas? That might be a positive start."
"Every dollar we can put into improving the lives of babies and the moms carrying those babies, it's going to pay off," Johnson said. "Not in the short term, not in two years, but in 20 to 30 years from now, with healthier and more productive young adults."
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