For the last two decades, the number of American babies that die before their first birthday has been dropping. However, in Maine, once a model state for infant survival, the mortality rate has been trending upward.

Just why that is the case is unclear. Infant mortality, with its many complex factors, is not well-understood, and Maine doesn’t appear to have the tools to properly understand it, or even to implement specific initiatives that could make a difference.

Because of its small population — and subsequent small number of infant deaths — Maine’s infant mortality rate can rise or drop from year to year. But as an analysis by the Bangor Daily News found, the rate has trended upward since 1996, when Maine had the lowest rate of any state — 4.4 per 1,000 births.

The rate for 2014 — 6.7 per 1,000 births — places Maine as 37th in the country. In fact, we are the only state with a worse rate in the last decade than in the previous one.

Most infant deaths are the result of sudden infant death syndrome, birth defects, assaults and unsafe sleeping. Substance abuse and access to prenatal and neonatal care and support are considered contributing factors, but the greatest appears to be demographic — infant mortality rates are much higher among disadvantaged groups, particularly poor and black Americans.

But none of these factors alone explain Maine’s departure from the national trend, and deaths from SIDS, birth defects, maternal complications and premature or low birth weight have all increased since the 1990s. No silver bullet is likely to reverse the course.

More information on individual deaths would shine more light on the situation, but officials in Maine have been stymied in their attempt to collect it.

Following the recommendation of a national program aimed at infant mortality, legislators in 2005 created a panel to collect such information from parents who have lost a child.

However, worried about infringing on parents’ privacy while mourning, legislators said parents must consent to passing over the information, and officials cannot even ask parents until four months after an infant’s death. As a result, the panel has had a hard time getting a response — it has completed only six interviews since the program started, and did not meet at all in 2015.

The Department of Health and Human Services says it is funneling more resources into its home-visiting program, in order to educate new parents how to avoid unsafe sleeping, a known major factor in infant mortality.

But a former state health director told legislators last month that the shortage of public health nurses — there are only 25-30 positions filled out of 40 — is hampering that effort.

That’s the same shortage that is hindering Maine’s ability to react to a whole host of health issues, and led health experts to call the state’s public health infrastructure “incredibly fragmented” and “poorly prepared.

That’s a situation that must be addressed, not only for the sake of Maine’s newborns but also for so many of the state’s most vulnerable residents.

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