Confronting Infant Mortality in Erie County, Ohio

In 2014, more than 23,000 infants in the U.S. died before their first birthday. That means for every 1,000 live births, 6 babies died in their first year of life. The U.S. ranks among the worst compared to other developed nations, and ranked 27 out of the 34 nations comprising the Organization for Economic Cooperation. Compared to the national average infant mortality rate, Ohio ranked near the bottom of the 50 states, with an infant mortality rate of 6.8 per 1,000 live births, more than 13% higher than the national rate. The statistics are even worse for African American babies; while the rate of infant deaths was 11.2 infant deaths per 1,000 live births for Black babies nationwide in 2013, the latest year for which comparable data are available, in Ohio there were a staggering 13.8 infant deaths per 1,000 live births, and the statewide figure increased in 2014. When Troy Chaffin, Director of Finance, Administration, Grants and Accreditation at Erie County Community Health Center learned how his home state ranked, he was astounded. “I had no idea it was that bad” he recalled. In Erie County, which is located in Northwest Ohio, for every 1,000 live infant births, 12 babies die before their first birthday; for African Americans that number is closer to 35.

National studies rank birth defects, preterm births, low birth weight, maternal pregnancy complications, Sudden Infant Death Syndrome (SIDS) and injuries such as suffocation as the leading causes of infant mortality. In Ohio, the leading cause of infant deaths is preterm births. But why are infant mortality rates in the United States so high compared to other wealthy nations? And why the markedly worse outcomes for Black infants? Endemic poverty is one clear cause. States with the highest infant mortality rates are among the poorest, and there are persistent disparities in income by race.  In Chaffin’s words, “lower income individuals have poorer health outcomes compared to middle and upper class individuals,” and this includes infants born into impoverished families and communities. Socioeconomic status, lack of access to adequate healthcare, lack of prenatal care, and mother’s age put infants at greater risk. Erie County is predominantly rural and inadequate transportation is a huge barrier to receiving care, particularly for those who are low income. Maternal depression, birth spacing, cigarette smoking, and substance and alcohol abuse are also key determinants.

Erie County Community Health Center, part of the County Health Department, is working to confront this epidemic head on. The health center was awarded a grant from RCHN Community Health Foundation to pilot the “African American Infant Mortality Prevention and Reduction Initiative.”  With the goal of developing a comprehensive plan to reduce the number of infant deaths, they first created a questionnaire on infant mortality as part of the Erie County Community Health Assessment on Women of Childbearing Age.  The survey sample included women throughout the six counties of northwest Ohio. Survey data was analyzed andassembled into a report and distributed to key stakeholders including the state health department, local and regional health providers, elected officials and others. This past April, the county convened an Infant Mortality Prevention Summit which brought over 200 attendees, including the Erie County health commissioner, U.S. Senator Sherrod Brown, and medical experts in the OB/ GYN and neonatal medicine fields.  Health Commissioner Peter Schade kicked off the conference, commenting that the words “infant” and “mortality” should never appear in the same sentence. Speakers reviewed the Infant Mortality Assessment survey results and discussed best practices in maternal and infant health. The summit was an important step in creating a dialogue between the health centers, local hospitals and other social service agencies. As a result of the summit, an Executive Steering Committee made up of health care providers and organizational allies now meets monthly and has begun the process of formulating a strategic action plan.

One priority already identified by the Executive Steering Committee is the need to do a better job of educating expectant mothers about the importance of prenatal care, the risks of co-sleeping and the health benefits of breast feeding for healthy infants. Chaffin described the idea of a “circle of care” where services are integrated and coordinated for expectant and new mothers, either on-site or through comprehensive referrals with sustained follow-up. Erie County has the unique benefit of housing a CHC and local health department under the same roof. When a mom comes in for WIC services, her infant is also able to receive immunizations that same day. There is also an Outreach and Enrollment specialist at the center who can assist her in applying for insurance and connect her with additional social services.  A Community Health Worker will visit new mothers in their homes. Erie County hopes to create a better system to track and provide outreach to mothers who miss prenatal appointments or who are identified as high risk pregnancies. This is vital to making sure these mothers don’t fall through the cracks. The health center’s focus will be to continue building community capacity, bringing media and political awareness to this issue and creating local system changes to improve access and remove barriers to care. The goal is be sure that “infant” and “mortality” cease to be used in the same sentence, and that all babies can thrive and grow.