In 2012, Ohio ranked 47th in the nation for its infant mortality rate, with 1,045 babies dying before their first birthday. If the health of a community’s youngest members is an indicator of the overall health of that community, the Buckeye State is clearly in desperate need of an overhaul.
Earlier this year, the Ohio Hospital Association developed a strategic plan in collaboration with its member hospitals and health systems. The plan includes addressing seven key focus areas, which include integrating safe sleep practices, eliminating health disparities and increasing access to prenatal care.
In Lucas County, understanding and working on this complex issue begins with collaboration – discovering what resources are currently available, connecting people to those resources and identifying and addressing any gaps.
Connecting People to the Right Resources
Kent Bishop, MD, an obstetrician/gynecologist with ProMedica Physicians, is one of the doctors taking the lead on tackling the issue of infant mortality from a health system perspective. Dr. Bishop shares, “Right now, ProMedica has a team of people looking at the issue and discovering what we do within our system and throughout our community to address infant mortality. There are so many great resources within our community and sometimes just making a connection can make a difference.”
For ProMedica, connecting people to needed community resources has become part of the process for improving patient health. Like many health systems throughout the country, ProMedica is widening the scope of care beyond a clinical diagnosis by addressing “social determinants of health” — factors such as lack of nutritious food or shelter that impact a person’s lifestyle and health.
This year, the system introduced hunger screenings within their hospitals and physicians’ practices, giving patients in need an emergency food supply and connecting them to community resources for future assistance. These social determinants undoubtedly play a role in infant mortality, too.
“Babies are dying because people don’t have access to the things they need…”
“Babies are dying because people don’t have access to the things they need,” said Dr. Bishop. “Some women don’t have reliable transportation to get their prenatal appointments; some babies don’t have a crib for a safe place to sleep. By asking important questions that address factors like hunger, living conditions and transportation, we can help connect women and their families to what they need to keep their babies healthy.”
Recognizing core challenges like transportation may lead to a positive ripple effect, with more women receiving prenatal care, which in turn leads to more pregnant women receiving important vaccines or being diagnosed and treated early with a high-risk pregnancy.
Educating Communities on Healthy Practices
Other factors that play into infant mortality involve a change in culture or breaking habits that were formed generations ago.
“Encouraging safe sleep practices is a key piece to addressing infant health,” said Dr. Bishop. “Forty-two percent of infant deaths that occur between the ages of one month and one year are sleep-related [separate from Sudden Infant Death Syndrome (SIDS)]. There’s really good data that shows that having a baby sleep on its back can help prevent sleep-related deaths, as can making sure that a baby has its own safe space to sleep in rather than sharing a parent’s bed.”
Commonly referred to as the “ABCs of safe sleep”, babies should sleep Alone on their Backs in a Crib. But making this a habitual practice requires educating not only parents, but grandparents and other friends or family members who may care for the baby.
Safe spacing between pregnancies is another factor in infant mortality. “By allowing for at least 18 months between deliveries, women can reduce their risk of having a preterm birth. They also have an easier time making prenatal appointments, going on bed rest when necessary and breastfeeding because they don’t have two very young children to care for,” explained Dr. Bishop.
The Impact of Prenatal Care
Although caring for an infant certainly impacts that infant’s health, so does the care their mother receives while she is pregnant. Preterm delivery and low-birth weight babies have a higher risk of birth defects and infant mortality. In addition to standard prenatal care, high-risk patients (such as those who have already had a preterm delivery) typically need more consistent monitoring.
“As a pregnant woman gets closer to delivery, the length of her cervix shortens. By monitoring the cervical length of high-risk patients, we can act as needed to help the pregnancy last so that the baby can further develop,” said Dr. Bishop. This may mean prescribing modified bed rest or a hormone called progesterone that will work to maintain the length of the cervix and reduce preterm labor.
Healthcare providers can also help address other factors, such as smoking, which has been shown to increase the risk for preterm labor.
In Ohio, black babies die at more than twice the rate of white babies, and even when economic factors are removed, the risk is still higher.
A Community Initiative
The issue of infant mortality is complex and finding the answers isn’t easy. In Ohio, black babies die at more than twice the rate of white babies, according to the Ohio Hospital Association. And, even when economic factors are removed, the risk is still higher. Babies of well educated, professional black women have a higher risk of infant mortality than babies of white women who haven’t graduated high school.
Ohio ranks 49th for its infant mortality rate in the black population. Addressing the role of race in infant mortality requires honest discussion and collaboration among health systems, community organizations and the public. But it’s an issue that needs to be tackled, together.
“Infant mortality rate is an indicator of how healthy and vibrant your community is overall. It shows what your community thinks is important,” said Dr. Bishop. “No one wants to live where there are unnecessary infant deaths. We need to work together to help those who need it the most.”