Infant mortality is defined as the death of a live-born baby before his or her first birthday. Throughout the world, the infant mortality rate is an important indicator of the health of a whole community. If the community is safe and has good access to health care and education, more babies will thrive beyond their first birthday.
Though Ohio’s rate is not among the highest in the country, there has been little positive change, and disparity among demographic groups continues to be a concern. Officials in Columbus and Franklin County have taken steps to push back against infant mortality, and Nationwide Children’s Hospital has been a crucial part of the efforts.
Dr. Deena Chisolm, a principal investigator in the Center for Innovation in Pediatric Practice at the hospital’s Research Institute, answers questions about infant mortality and the fight against it in Ohio with help from Christine Sander, director of infant wellness initiatives.
HealthScene Ohio: What causes infant mortality in a community?
Dr. Deena Chisolm: Prematurity remains the leading cause of infant mortality. While there are several known underlying health factors that contribute to prematurity, other, non-medical factors are not yet fully understood. Known factors include having a prior pre-term birth, hypertension, diabetes, closely spaced pregnancies and smoking while pregnant. Health care equity can be defined as “the state in which access to and use of high-quality health care is determined by the level of health care needs, and not by demographic factors.” The lack of health care equity is seen in lingering gaps in access to and use of high-quality preconception and prenatal care by racial-ethnic group, income and geography that could address these risk factors before they influence the outcome of a pregnancy.
HSO: What infant mortality factors related to health care equity might people not be aware of?
DC: It is important to remember that health care is an important factor, but not the only factor, in influencing birth outcomes. That is why we try to redirect the discussion from health care equity to health equity. A health equity focus considers equity in all of the factors that impact health, including the social determinants of health: housing instability, food instability, economic instability, community and family violence, environmental concerns, stress, and more.
HSO: What effects of health care disparities have you seen in at-risk moms?
DC: Some at-risk moms avoid care for fear of being disrespected, being unable to understand the provider due to health literacy issues, being unable to carry out instructions due to financial or other barriers, or even being referred to the justice system. Our data sometimes makes it look like moms just don’t come to the doctor or do not follow instructions, but we have to look at the upstream causes of health care disparities.
HSO: What is being done to address the rates in and around Columbus?
DC: Ohio’s infant mortality rate currently stands at 7.4 per 1,000 live births, with minimal change over the past five-plus years. Disparity also remains an issue, with the infant mortality rate for non-Hispanic blacks (15.2) almost triple that of non-Hispanic whites (5.8). Franklin County experiences similar trends with overall infant mortality rate at 8.4 and a disparity ratio of 2.9.
In Franklin County, there are many organizations working together to improve this outcome. These organizations’ efforts are coordinated by the backbone entity CelebrateOne, a department of the mayor’s office in Columbus. The health care arm of this effort is called Ohio Better Birth Outcomes (OBBO) and has representation from the four major health systems in the community, PrimaryOne Health and Columbus Public Health Department. The efforts are divided into three work teams: Prenatal Care, Perinatal Quality and Reproductive Health. Work teams are comprised of medical professionals who use a quality improvement approach to implement changes in clinical care that affect the key drivers of infant mortality.
HSO: What are some of the ways you’re working to bolster health equity for at-risk moms?
DC: A continued focus for OBBO will be increasing access to quality, consistent prenatal care as well as linking pregnant moms to additional support services. Over the past few years, a centralized intake source, StepOne, was established and promoted to target audiences in high-risk neighborhoods. StepOne finds an appointment in a clinic that accepts mom’s insurance – or lack thereof – and is easy for mom to get to. Over the next year, OBBO clinics will be working on increasing the number of prenatal appointments a mom attends prior to delivery, and also consistently screening for certain medical and non-medical risk factors that qualify mom for further intervention through home visitation programs. We are also engaging communities to address the social determinants of health through programs targeted at improving educational, employment and housing opportunities.
HSO: What are the challenges you’re facing in achieving this goal, and what would help mitigate them?
DC: The greatest strength that our community has in the effort to achieve a reduction in both infant mortality and disparity is a focused and coordinated approach within the medical community via OBBO, and across sectors outside of health care via CelebrateOne. Our greatest strength is also our greatest challenge. The issue of disparities in infant mortality is multi-factorial and multi-sectoral. Bringing together different sectors – government, health systems, education, social services, criminal justice, housing – all of which speak different languages, collect different data and have different strategic approaches can make it hard to develop and maintain a unified approach. The community-wide groups described above are working to bring these varied voices together.
We are also challenged to find the right mix of approaches that don’t just lower overall infant mortality, but that really close the gap in infant mortality by moving the needle fastest in the populations of greatest need. Finding this mix requires more research focusing on the specific questions of disparities and equity.
HSO: What should some women understand about their risk factors?
DC: Women should understand that a big part of the health of their baby even before it is born is their own health. You can’t wait until you are pregnant to make the healthy lifestyle changes that can make a difference for you and your child.
HSO: What actionable advice do you offer expectant or new moms regarding obtaining health equity?
DC: Connect with an OBBO clinic at one of the central Ohio hospitals if you are pregnant and need support in finding a doctor you trust, quitting smoking, obtaining health care coverage or additional support. Don’t hesitate to ask questions so that you can advocate for yourself and your unborn child. If you feel you are not receiving the care you need because of who you are, don’t just stop seeking care; seek referrals from trusted sources for a provider that makes you feel comfortable and respected.
HSO: Where can new or expectant moms go for help or more info in combating this issue?
DC: New or expectant moms can find more information on many topics by visiting the CelebrateOne web site, www.celebrateone.info. Moms can find information on locating a prenatal provider, smoking cessation and obtaining health care coverage, as well as home visitation and other support services.
Debbie Rigaud is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Deena Chisolm, Ph.D. is a Principal Investigator in the Center for Innovation in Pediatric Practice at The Research Institute at Nationwide Children’s Hospital and is an Associate Professor of Pediatrics at The Ohio State University College of Medicine and Public Health. She is a Health Services Epidemiologist whose research is focused on measuring and improving the effectiveness, efficiency, and equity of pediatric health care. Much of her current research is focused on the role of health care technology in improving pediatric health care quality. She is also interested in research investigating the factors associated with the use of e-health services by at-risk youth. In addition, Dr. Chisolm serves as a resource to Nationwide Children’s Hospital clinical researchers on issues including the use of clinical and administrative data in research, cost-effectiveness analysis, and quality indicator development.
