PULLMAN, Wash. — Sometimes the data doesn’t tell you what you want to know, like the meaning behind the causes of infant death that are reported on official death records. And that was what Kathryn Sowards, assistant professor of sociology at Washington State University at Vancouver, wanted to understand.
Sowards’ data covered the records of infant mortality in San Antonio, Texas, between 1935 and 1984. “I had lots of numbers and categories of deaths,” she says. “But I was frustrated with what I could understand from the data.” She felt she needed more. “I needed to talk with the people who made the statistics,” she says.
An interview at the University of Texas Nursing School resulted in a visit to a neonatal care unit. One thing led to another, and the numerical data she collected from the records led to a research project of a totally different type. During the two-year Robert Wood Johnson Foundation research project that followed, Sowards analyzed data in the form of in-depth interviews with health care professionals working in neonatal care units.
“What I found in the neonatal care units was an unusual environment. The highest levels of science, technology and bureaucracy interface with profoundly intense, personal and often tragic experiences,” says Sowards. It was a unique juxtaposition and she wanted to study it.
Sowards also became fascinated with the question of how these professionals do their work day in and day out, managing the intense environment without losing sensitivity. “They don’t learn it in medical school,” she says.
Sowards found that workers had a wide range of methods, for no single strategy works for all. Many draw strength from their work, while others find it intensely draining. Some compartmentalize their lives. Others find that talking with colleagues and sharing their burdens helps.
One part of Sowards’ study of infant mortality concerned the age of the mother at the time of her child’s birth. When statistics are incomplete, age at first birth appears more strongly associated with infant mortality than it might if the statistics were better. Poverty and disadvantage predispose young women to early motherhood, but they bring with them other factors that may affect pregnancy such as stress, nutrition and lifestyle habits. These factors must be accounted for in any statistical models that draw conclusions from the data.
While Sowards’ statistics did show that infants born of teen-age mothers died from poverty-related causes at a higher rate than those born of older mothers, she also found that ethnicity mattered. Infants of Mexican-American mothers died less frequently from birth weight related disorders than those of Anglo mothers. “This could be explained by cultural differences, biological differences, a combination of these two, or by something else entirely,” says Sowards.
Sowards’ work illustrates a problem that often confronts social scientists: the difficulty of using statistical methods to study human behavior. Statistics often fall short, and more interpretative methods such as interviews are needed. “If we want to understand human behavior and social systems, we need more than one set of tools,” says Sowards.
Sowards’ study of pregnancy, birth and survival will probably not end with these two projects. In the future, she’d like to talk with the mothers and others on the receiving end of the care. It’s clear from her experiences that these people would like to talk with someone outside of the health care profession.
“If we are to improve the quality of patient care and work to understand the statistics we use to make decisions about health status and policy, we need to talk with everyone who’s involved in the health care system,” Sowards says.