In 2017, Ohio tied Georgia for eighth highest infant mortality rate for all babies, according to the Center for Disease Control and Prevention.
DeWine said in his state of the state address that African American babies are dying at almost three times the rate of white babies, “leaving Ohio ranked 49th worst in the nation for deaths of African American infants.”
Former state senator Shannon Jones, executive director of Groundwork Ohio, said it’s
a complex issue that will take statewide leadership measuring evidence and then scaling the right programs, targeting the right areas and breaking down department silos.
“Most of this work has to happen at the local level. This is very community based work. Where the state can be helpful is setting policy and driving resources and measuring that against outcomes,” she said.
On Friday, DeWine announced plans to earmark $90 million in state funding over two years for home visits for at-risk pregnant women, new moms and their children up to age 3. Currently, the program gets $40 million over two years.
The governor also wants to create a public-private partnership, Pay for Success, to get more families to participate in the home visit program. Communities would receive incentive payments from Ohio Department of Health when participating families hit benchmarks.
Home visits are a crucial piece to lowering Ohio’s high infant mortality rate but only a small percentage of eligible Ohioans are participating, the governor has said.
Infant mortality is a stubborn problem that is intertwined with chronic poverty, medical care, racism, smoking and other issues. But public health experts say many of the deaths can be prevented with multiple early and ongoing outreach strategies.
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“Certainly, it is not a single approach that is going to solve the infant mortality crisis that we have here in Ohio,” said Sandy Oxley, chief of maternal, child and family health for the Ohio Department of Health.
Ohio has been focusing its efforts in the nine counties where nearly two-thirds of the infant deaths — and 90 percent of all black baby deaths — are occurring, including Montgomery and Butler.
In Montgomery County, the black infant mortality rate in 2017 was four times higher than for white infants, according to Public Health - Dayton & Montgomery County. From 2013 to 2016, the gap in Montgomery County had declined, with black babies dying at 2.5 times the rate of white babies that year.
The state recently re-tooled its strategies by sending “neighborhood navigators” — community health workers — to locate at-risk pregnant women and connect them to services proven to work, Oxley said.
Risk factors for infant mortality include poverty; previous preterm or low birth weight delivery; under age 25; tobacco use in the home; history of homelessness, child abuse or neglect; a need for substance abuse treatment; diagnosed mental health concerns.
Public health programs can advocate for mothers so all the weight isn’t on their shoulders when navigating the health care system, said Terra Williams, director of health promotion for Public Health – Dayton & Montgomery County.
Williams said it is good that there’s more funding planned for home visiting programs. Home visit workers establish a trusted relationship with the pregnant woman and help them develop a plan to get to prenatal care appointments, stop tobacco use, address other health issues, enroll in Medicaid and or WIC and find employment or education options.
“As home visitors, we make sure we address these issues so mom can have a healthy baby,” Williams said.
After the baby is born, the workers continue to meet with the family to help with well-child visits, breastfeeding, safe sleep practices and parenting skills.
Half of the infant deaths in 2017 were attributed to congenital abnormalities or premature birth. Nearly 12 percent of all Ohio babies are born premature – before 37 weeks gestation – and one in seven black babies are born premature. Prematurity and low birth weights increase the risk of disability, health issues and death.
Income is a factor but while black mothers are more likely to be poor than white mothers, the wealth gap can’t alone explain the difference in infant mortality rates. Even controlling for income, black women have worse birth outcomes than white women.
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“One of the root causes for the disparity would be racism … The system is not set up equally for African Americans versus whites,” said Sara Paton, an epidemiologist with Wright State University.
A 2004 study in the American Journal of Public Health found that experiencing racial discrimination was an independent risk factor for whether black women had a preterm delivery. The way women in the study answered questions about experiencing racial discrimination could be used to predict preterm births, and other studies have found similar results.
The number one cause of infant mortality is prematurity related conditions, Paton said. Stress is one of the causes of prematurity and black women experience high levels of stress.
“The African American woman experiences stressors different than other women in the community,” Paton said.
The infant mortality rate is a broad-based indicator of the health of a community, said Paton. It reflects everything from living conditions to violence in a community, she said.
“The problem is that infant mortality is a reflection of all those stressors on that woman in a community,” Paton said.
Related: Ohio’s overall infant mortality drops as black rate jumps
ODH is looking to address prematurity by encouraging women to space out births by at least 18 months and identifying more pregnant woman eligible for progesterone treatment, which can reduce the incidence of preterm birth.
The department is also relaunching a campaign to promote safe sleep practices, including ABC sleep for baby — Alone, on their Back and in a Crib. Tied into that is an effort to get pregnant women to quit smoking.
DeWine appointed Dr. Amy Acton to lead the Ohio Department of Health. Acton said she will consider low-cost, low-tech programs that are effective in other countries and communities at lowering the infant mortality rate. She noted that Rwanda has a lower infant mortality rate than some Ohio neighborhoods not far from the Statehouse.