Infant Mortality Problems in Columbus Indicate a Poor Quality of Life for Low-Income Women and Women of Color
It’s taken resilience for the impoverished urban core of Columbus to get to this moment. Many didn’t make it. Many more are struggling to. The obstacles are dense and stifling. In a way, they’re a distraction from themselves. People are too busy navigating each minute to be able to look around and ask why and wait for answers. It’s called survival mode, and a good percentage of our neighbors are stuck in it.
Every year Franklin County adds more to their headcount of homeless people. Affordable housing is ripped away to make room for apartments with price tags well outside the budget of a single mom making $10 an hour, a subpopulation that makes up almost a third of all households in Linden.
The Linden community and seven others around Columbus make up the highest-risk neighborhoods for infant mortality, a problem that for years has only been mounting, statewide and locally.
Three babies die every week in Franklin County; black babies die at more than twice the rate of white babies; and those are not stand-alone statistics. They’re indicative of a poor quality of life for low-income women and women of color, and they’re dependent on the social determinants of health — factors that contribute to the wellbeing of an individual. These are the essentials, like built environment, financial stability, healthcare, education, and social/community context.
It’s no surprise that babies are best off when their moms are fat and happy. Food insecurity and stress from financial instability or a dangerous living environment lead to underweight, underdeveloped babies. Juggling these chronic stressors during and after pregnancy is often an unchangeable reality for low-income women in Columbus.
Linden resident De Lena Scales, who gave birth to her first child as a teenager, said the process demands every moment, every ounce of effort, and more.
“From that point on it was about work, school, mom. Work, school, mom,” she said. “I was working hard at trying to maintain my GPA so that I could, I guess, beat the odds, or not be who everyone expected me to be because I became a teenage mom. I think that’s where that weight of the world kind of started.”
At that point until very recently, Scales felt like she was carrying that weight alone. She was fixated. She was busy. Busy striving, sacrificing. She earned a degree in radiology from Columbus State and committed to providing her growing family with every want and need.
But in 2013, when her third child died within an hour after birth, her life’s trajectory would be permanently changed. In fact it would intersect with those of other women who share her loss and her passion to keep women in her community from living the same tragedy.
“For so long, when you’re in a community where you witness violence all the time, where your house is getting broken into, your neighbors are known crack addicts so there’s always strange activity going over there, you feel like your movie is being written for you, and you’re an extra in your own movie,” Scales said. “I kept telling myself, ’I have to be in charge of my own happiness. I can’t let the things that have happened in the past dictate where I can go.”
It hasn’t dictated, but no doubt there’s been influence. Scales has involved herself in the growing effort to reduce Franklin County’s infant mortality rate. As two of the many boots on the ground in the fight, Scales serves as a community health worker in her neighborhood.
She received her training at the OSU College of Nursing through a partnership of CelebrateOne, the United Health Foundation, Columbus Public Health, and eight other community-based organizations. She and 16 other women are in the first class of the program, and they come from each of the eight highest risk neighborhoods for infant mortality: Northeast, Southeast, Morse Road & 161, Franklinton, Hilltop, Near East, Near South and Linden.
Their job once the course is completed is to reach out to women of childbearing age in their communities and talk to them about their family plan. Some have already started. Through their respective community organizations, they work to educate women on contraceptive methods, connect them to physicians for prenatal or perinatal care if necessary, and fill in the gaps wherever they might be.
This could mean connecting them with services that provide diapers, formula, clothes, food and other essentials. It could mean assisting in grocery shopping and educating people on healthy food choices and how to cook healthful meals.
For Connector Corps student and community health worker Cissy Watkins, a lot of it entails comprehensive sex education. She and fellow staff members at the United Methodist Church for All People, on Parsons Avenue, frequently need to set straight the misconceptions about sex that women in her community have.
“We had a girl who thought that — someone told her that as long as at some point you had a condom on, it’ll keep you from getting pregnant,” Watkins said. “I think that’s an issue also with people out here. To you and I that doesn’t make any sense, but to someone who’s never had that conversation and has never had that education, they have no idea.”
With each support visit they hold with clients, Scales, Watkins, and their fellow community health workers go into the field with a defined purpose: work to reduce the county’s infant mortality rate by 40 percent, and cut the racial disparity in half by 2020.
These ambitious goals were established in 2014 by CIMT after a report uncovered the severity of the epidemic and eight ways to address it. To follow through on the recommendations, the taskforce created CelebrateOne, a mass partnership of public and private organizations.
Erika Clark Jones, Community Strategies Director for CelebrateOne, said the initial struggle in many communities is finding out what members of those communities need first and connecting those needs with resources. It takes raising awareness, building a coalition and bringing stakeholders in to start putting resources where they’re needed.
“Stakeholder is live, work, worship, study, pray, recreate,” Jones said. “If you have any affiliation to any one of these areas you’re invited to the conversation. Share your perceptions, share your thoughts, share your experiences, share stories about what’s happening in the neighborhood – where it was, where it should go.”
Each neighborhood has its own immediate needs. That might mean dealing with abandoned houses in the Near South or working to combat the high rates of domestic violence in the Near East.
But policy and bureaucrats can take these communities only so far, said Scales.
“Everybody has to get involved,” she said. “In Upper Arlington, they’re self-contained. That community is taking care of the Upper Arlington community. Worthington is doing the same. That village is taking care of the people in that village. The Linden area – we have to start doing the same. We have to start taking care of the people in our village.”
It’s also not as simple as that, she said. People are in survival mode, and with that comes a kind of tunnel vision, living day to day, paycheck to paycheck. And when there’s only one person bringing a paycheck home, the struggle gets steeper.
“All the chronic stressors, you focus in on them and then you can’t, you don’t find time to focus on the people in your community,” Scales said. “And our health depends on our community.”
The ideal community is a system of support in which everyone is involved. It would bring together medical professionals, community leaders, community organizations, and all other stakeholders to provide low income individuals with reliable healthcare.
A microcosm of this already exists in the form of Moms2B, a program launched by partners Patricia Gabbe, M.D. of Ohio State University and Twinkle Schottke, infant mental health specialist.
Gabbe previously worked with Nurses for Newborns at Vanderbilt University in Tennessee. The program’s purpose was to address infant mortality in the state, and Gabbe’s role was to care for infants in their first weeks and months of life.
“Then I came up here and was shocked that Ohio had one of the worst infant mortality rates in the United States,” Gabbe said. “I could not believe it.”
Gabbe came to Ohio in 2008 and joined the infant mortality taskforce created by then governor Ted Strickland. The end result was a report investigating the reasons behind the state’s embarrassing infant mortality rate.
“We finished the report in early 2009, and I said, ‘You know, you can’t just do a report and put it on the shelf. You’ve gotta do something,’” Gabbe said.
With the help of partners in the infant mortality circle, like Columbus Health Commissioner Teresa Long and Rep. Joyce Beatty, Moms2B was established in Weinland Park in 2010. There were two women at the first meeting; now they have roughly thirty women every week at each of their four locations.
The program grew through word of mouth and is sustained through its reliability. Women can count on a Moms2B meeting every Wednesday from 11 to 1. And when they’re there, they can count on a hot, healthy meal and usually leftovers to take home. If a mom is particularly food insecure, she’s sent home with a tote bag of food.
Sarah Posten, public health worker for Moms2B, said the program is designed to address any issue that might endanger moms in the community and prevent them from having healthy, successful pregnancies. On site at Grace Memorial Church in Weinland Park they have a staff of public health workers, nurses, nutritionists, lactation specialists and a legal aid, and anyone with a transportation conflict can get a ride to and from meetings.
“We take away a lot of those barriers — the transportation, all of these things that kind of build that wall up, that cause us to have a high mortality rate,” Posten said. “We are doing something about it.”
Posten, from Franklinton, is from the same Connector Corps class as Scales and Watkins. The organizations they represent house programs to ease the stressors that impact the county’s high infant mortality rate.
Moms2B is one of the only programs that is as all-encompassing, and it is the only one that connects and collaborates with groups like Father 2 Father out of the Columbus Urban League, which Director David Fluellen simply describes as a program designed to help dads be better dads.
“Fatherhood is a movement, and it has been since they wrote this out seven or eight years ago at the Columbus Urban League,” Fluellen said. “I feel the partnership we created with Moms2B is going to grow because no one is doing what we’re doing, and it’s having such a huge impact.”
Through the 10-week Father 2 Father program, men learn how to navigate fatherhood and how to communicate with the mother of their children when the relationship has been broken. Fluellen said many of the men grew up with absent fathers and, as a result, looked for heroes in the wrong places. Now, as fathers not having known or felt fatherhood, they’re unsure how it works, or how to break the cycle of the absentee dad.
“I’ll use me for example,” Fluellen said. “I’m a product of the inner city. My role model was my big cousin who sold drugs, and I didn’t have a father. And so I wanted to be like him — he had a nice car, had girls. And so that’s what I wanted to be like, because that’s what I’d seen. I think a lot of dads in our communities experienced the same thing.”
Father 2 Father helps dads get jobs, if they don’t already have one. That and access to Franklin County Child Support helps resolve some financial hardship. Dads who’ve lost their jobs, or who’ve had to change to a lower paying job, can get their child support payments adjusted to fit their new income.
Franklin County Courts also comes in to help mediate conflict between parents. The goal is to establish a relationship where mom and dad can communicate and coexist for the child’s benefit.
“What we have found out is that dads do want to be involved with their children,” Fluellen said. “Sometimes they just don’t know how to go about doing it.”
Fluellen and several fathers who’ve graduated from the program attend Moms2B meetings once a month, reaching out to the dads-to-be to educate them and facilitate conversations.
Meetings start with a big group, then split off into those with infants, those who are pregnant, and fathers. Each group’s lesson is tied together by a common theme, so that partners can return and educate each other.
“We go over a lot of emotional wellness stuff too, especially since pregnancy is such a stressful time,” said Kalia Bond, Moms2B participant. “Today we’re learning about unhealthy relationships, which is definitely important.”
Bond and her husband have been going every week since she was six weeks pregnant. Their son is due in August, and thanks to family and the staff at Moms2B, Bond has had the support she needs throughout her pregnancy.
“I was kind of like, not like totally high risk, but I have a history of epilepsy, and I also have a low PAPP-A,” Bond said. “So they’re just watching me more, doing more ultrasounds and stuff, and so far everything’s been good. But it’s also good to come here because you have a lot of medical professionals. If I ever have questions I don’t have to be at the doctor’s office every day.”
Having medical professionals on-site at the meetings eased her apprehension about dealing with physicians, Bond said. Between micro aggressions and stigmatization as “Welfare queens,” being a single black mom can be its own stressor. Physicians with prejudices or biases may treat patients differently based on what kind of insurance is used, how many children the patient has or which neighborhood she’s from.
Bond said she’s being empowered simply by knowing more about her own pregnancy.
“Knowing more makes you a better patient, because you’re not just going to go with the flow and let them do whatever and treat you any type of way,” she said. “Because you’re like, ‘At Moms2B this is what I learned!’”
Plus, the physicians and community health workers at Moms2B get it. They’re in the fight; they understand infant mortality. They understand the community. Scales, Watkins, Posten, and the rest of their class shop at the same stores and drive the same streets as the women they’re helping.
“It’s great that we have people stationed in that area,” Scales said. “We understand some of the plights going on in the other areas because we have representatives coming from that community educating us.”
Still, Scales said, it needs to get bigger. The Connector Corps program is an asset to the taskforce, but there aren’t enough people in each neighborhood.
“I see what they’re trying to do with the CelebrateOne, which is why I’m involved,” she said. “But it has to be bigger than this. This is really only gonna be a drop in the bucket. There’s only two community health workers in the South Linden area, so that huge area, and we’re not gonna be able to touch everyone.”
The class started with 24 students, three from each highest risk neighborhood. Since the start, seven people have dropped out.
The program isn’t over yet. The $1.7 million grant is projected to touch 27,000 women each year is runs.
And CelebrateOne is proud of its progress. This month they released their first annual report and came together to review the taskforce’s accomplishments since it began addressing the original report’s recommendations last year.
Taskforce leaders, including CelebrateOne Executive Committee Co-chairs Michael Fiorile and Donna James, CelebrateOne Executive Director Liane Egle, and others spoke at the event. Mayor Andrew Ginther, who started CIMT as a city council member, said the initiative is accomplishing its goals and now just requires further implementation.
“We’ve all come together and focused our work to help improve the lives of our youngest citizens, to save our babies,” Ginther said. “That is a win for families and babies in our community, and it is a win for our city.”
The report includes statistics for progress in each of the eight recommendations. They name their safe sleep ad campaign one of their biggest accomplishments. The campaign was launched to educate communities on the “ABCs of Safe Sleep:” a baby should be Alone, on his or her Back, and in an empty Crib.
Ads for this have been on benches and billboards and broadcast on radio and TV.
Data from the month of March, the latest available at the time of research, shows little difference in numbers, though. That month 13 babies died in Franklin County, four of which were sleep-related. Ten of them were born to Non-Hispanic black women.
Moms2B’s intervention in the neighborhoods of their four locations has proven to be an asset and a rarity in its comprehensiveness, but it needs to expand. Plans are developing to establish the program in four more locations and potentially tackle the unstable housing situation many moms are dealing with.
“We still need to address housing. Housing is a huge issue for our moms, 25 percent of our moms,” said Gabbe. “So we need to have a better connection with the powers that be, the people that develop housing, the people that determine how to make affordable housing. What’s affordable to a woman who has no income, and who’s pregnant and has other children?”
CelebrateOne Director Liane Egle said the whole initiative is intended to have impact beyond its five-year existence. The collaborating programs are all in their pilot phases, so it’s hard to know exactly how much progress is being made at this point.
“What we’re trying to do is actually embed [the recommendations] within the organizations that are doing the work for all time,” she said. “Because with any kind of public health issue like this, if we achieve our goal and bring the rates down, but then take our foot off the gas, the rates will spike back up.”
It’s a steep goal, and one that has promise only with investment from people like Scales and other community members.
For Scales this fight is the ultimate personal investment. She struggles every day with the weight of her loss, but her involvement is a kind of empowerment.
“I’m getting educated on why something like this could happen. Prior to that, I didn’t think about how things could have been,” she said. “Being involved with the Connectors training has really helped me understand why it happens. It allowed me to look beyond my own flaws, to gain a whole, total different understanding.”
For more information on CelebrateOne, visit www.celebrateone.info.
For more information on Moms2B, visit wexnermedical.osu.edu/obstetrics-gynecology/moms2b.
For more information on Father 2 Father, visit www.cul.org/african-american-male-initiati/.