Report Explores Effectiveness of Current Efforts to Reduce Infant Mortality Rate
While safe sleep has been the main priority in initiatives tackling Central Ohio’s devastating infant mortality rate, a new study reveals the ways these efforts need to change in order to make a real impact.
Birth Equity — A Pathway Forward revisits the idea of addressing the social determinants of health to achieve better birth outcomes, emphasizing the effect that racism and adverse childhood experiences can have on general health and health during pregnancy, and providing strategic steps to lowering Ohio’s infant mortality rates and the racial disparity within them.
- The Ohio Black infant mortality rate is one of the worst in the country
- In the Buckeye state, 15.2 Black infants die per 1,000 born, nearly three times the rate of the White infant mortality rate of 5.8
- The United States as a whole is failing, ranking 56th out of 225 countries in infant mortality
Found to have serious negative impacts on one’s health are adverse childhood experiences (ACEs), such as emotional, physical or sexual abuse, neglect, household dysfunction, divorce, and incarceration or death of a family member. Other contributing factors are many, including trauma, chronic stress, poor health prior to conception, unsafe or unstable living conditions, and maternal stress.
But, at the top of the list are racial stressors:
“Perceived racism across the lifetime, especially childhood experiences of racism, are strongly linked to low birth weight. And a body of research has found that perceived experiences of racial discrimination resulted in 1.3 to 3 times higher risks of preterm birth for Black women,” the study reports. “In one study, Black mothers who delivered very low birth weight preterm infants were more likely to report experiencing racial discrimination during their lifetime than Black mothers who delivered normal weight infants at term.”
The Steps to Take
“Address the mental and physical consequences of trauma, chronic stress and racism.”
The study suggests creating trauma-informed communities, those that implement principles of safety, trustworthiness, peer support, collaboration, empowerment, and sensitivity (“to cultural, historical and gender issues”). The Self-Healing Communities Model (SHCM) aims for just that, gathering leaders from different neighborhoods, socioeconomic backgrounds, and political affiliations, establishing communal goals based on community values, and exchanging new information, perspectives, and ideas “through peer-to-peer connections, community conversations, and community celebrations.”
Full community involvement has demonstrated real, positive results. Cowlitz County, Washington, who employed the SHCM, saw its infant mortality rate decrease by 43 percent and its birth by teen mothers rate decrease by 62 percent.
“Emphasize preconception health, with a special focus on preconception mental health screening and treatment.”
Preconception maternal health determines prenatal health, fetal development, infant health and postnatal maternal health. Women who are regularly visiting the doctor and receiving mental healthcare are less likely to have unintended pregnancies, and are more likely to quit drinking before a pregnancy, receive prenatal care, and take daily multivitamins. Screening for mental health issues is one of the most important steps in having a better pregnancy and birth.
The study recommends that Ohio “expand the number of providers who emphasize preconception care and conduct psychosocial risk assessments before and throughout pregnancy.”
“Directly address the social determinants of health utilizing a combination of short-term targeted approaches and long-term inclusive neighborhood revitalization approaches to remedy the present and historic consequences of disinvestment in our high-risk communities.”
The study focuses largely on housing and transportation, where some of the biggest barriers to good health lie. Homelessness directly correlates with premature birth and low birth weight, and for some mothers, just having the child can throw them from unstable housing into homelessness. Ohio is inching forward on tackling homelessness and transportation. The Department of Health’s partnership with the Ohio Housing Finance Agency established a pilot program providing housing for high risk pregnant moms. And the Smart City initiative would provide access to reliable public transportation and ride-sharing services, increase access to WiFi, and allow individuals to use digital currency without getting a credit card.
Community-oriented efforts are encouraged, and the study cites Cincinnati’s use of Best Baby Zones (BBZ) as one approach. BBZ “focuses on some traditional health care services, including home visits, referrals for families, and breastfeeding support. However, most of the efforts rely on nontraditional sectors, including education, economic support, built environment, and other community services.”
Roughly 40 percent of residents and 56 percent of children live in poverty in Cincinnati’s pilot BBZ community, Price Hill, but half of the residents feel that people are willing to help their neighbors.
“This strong sense of community contributes to the success of this program,” the study notes.
Current initiatives to decrease Ohio’s infant mortality rate are critiqued for their focus on the nine months of pregnancy, and their neglect of the lifetime that came before them. Many programs address safe sleep, perinatal smoking, community HUBs with pregnancy services, breastfeeding, and progesterone to prevent preterm birth.
“Bringing Ohio’s strong medical interventions together with social, emotional, and community strategies could be the key to long-term success in reducing our infant mortality disparities and dramatically lowering our overall infant mortality rate,” states the report.
For more information, visit cdfohio.org.