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Amid a high infant mortality rate, Ohio researchers look beyond healthcare

 A premature baby being monitored for oxygen levels. A small infant's foot is held by a nurse.
Kristina Bessolova
Researchers say initiatives to reduce Ohio's infant mortality rate should expand past healthcare and into the housing, transportation and education sectors.

It will take more than just increasing access to health care to address Ohio’s infant mortality rates.

Ohio has one of the worst rates in the nation: more than 800 infants dying before their first birthday in 2020, according to the Centers for Disease Control and Prevention. Lawmakers and community members have long been discussing how to improve the problem.

A new report by the Health Policy Institute of Ohio (HPIO) urges leaders to broaden their approach to the issue. It argues social factors like housing, education, employment and transportation are key to better birth outcomes.

“Changes beyond health care are very important to ensure that every baby thrives in our state,” said Amy Bush Stevens, the author of the HPIO report.

Community-driven change

Community conditions can have a large impact on maternal and child health outcomes, Stevens said. Research has shown that overall health is heavily influenced by socioeconomic factors, and the same holds true for babies.

Many investments have been made in healthcare initiatives – like prenatal care programs and pregnancy risk assessments – but Stevens said often environmental factors are overlooked.

“If we're really going to have an impact, we've kind of done a lot of what we can do on the healthcare side,” she said. “Now it's time to go further upstream.”

“Changes beyond health care are very important to ensure that every baby thrives in our state."
Amy Bush Stevens, author of Ohio Health Policy Institute's latest report on infant mortality

For example, Stevens said the state legislature could allow for eviction expungements. That could help residents find secure housing, and, in turn, improve birth outcomes.

The report also advocates for higher wages for childhood care professionals, expanding paid family leave benefits and expanding the transit revenue sources.

It outlines ways to enact change on a local level, too.

“The best place for local partners to start is really engaging their local community, and working with folks in their community who are most affected by infant mortality,” Stevens said.

Stevens said some communities have already begun implementing policies that could make a difference – like incentivizing affordable housing development and expanding protections for renters.

Sometimes, she said, it’s a matter of allocating funding to wherever a community sees the most need locally. If access to transportation is the biggest barrier, then developing discounted transit passes for customers with low incomes is the first step, for instance.

Progress in policies

This isn’t the Health Policy Institute of Ohio’s first set of recommendations. In 2017, the organization issued 127 recommendations on housing, transportation, education and employment.

But, Stevens said progress since the first report has been mixed.

Overall, 17% of recommendations were implemented fully, while 44% were partially adopted. Some areas saw more success than others: 87% of the education recommendations were fully or partially implemented. That number was just 35% for economic policies.

A graph shows the amount of policy recommendations implemented from OHPI's 2017 report. 17% have been fully implemented, 44% have some progress made, 26% have made no progress, 2% have went in the opposite direction and 11% are unknown.
Ohio Health Policy Institute
Since 2017, Ohio Health Policy Institute has been tracking progress on their initial recommendations. The report mentions that accountability on infant mortality initiatives is imperative.

Overall, more than a fourth of the recommendations have been ignored.

“We learned from that experience that it's important to prioritize recommendations and give actionable guidance on how to advocate for change,” Stevens said.

Looking forward, the report notes that the end of some pandemic-related funding could hinder further progress.

Eliminating disparities 

Black mothers are disproportionately impacted by infant mortality. The rate for Black Ohioans is 164% higher than it is for white Ohioans.

Stevens said racism fuels infant mortality – both directly and indirectly.

“It's absolutely critical to talk about racism when we're talking about decreasing infant mortality in our state,” she said.

The toxic stress caused by experiencing racism can contribute to poor birth outcomes, including preterm births. On top of that, Stevens said it’s important to take into account institutional barriers for Black people.

“So things like discriminatory housing practices that then lead to housing instability, or things like difficult working conditions that can be bad for maternal health,” she said.

A line graph shows the disparity between infant mortality rates for Black Ohioans (16) and white Ohioans (7.9).
Ohio Health Policy Institute
Stevens says eliminating disparities between Black and white Ohioans' rates of infant mortality is critical.

Building trust within the community and investing in programs that promote justice and fairness are the keys to moving the needle, she said.

“The first step is to acknowledge and talk about it,” Stevens said. “Making sure that Black Ohioans, who are most affected by infant mortality, are at the table and making decisions to move these policy changes forward."

But, that’s not enough. She said it’s also important to monitor policy changes and their impact, in order to hold people accountable.

Kendall Crawford is a reporter for The Ohio Newsroom. She most recently worked as a reporter at Iowa Public Radio.