Local infant-mortality rates worse in nation

First of a two-part series

By KEITH BAKER,

AMANDA TONOLi,

and BRANDON PARK

TheNewsOutlet.org

Morgan Porada of Struthers lost her son Christian 17 days after he and his twin brother, Tanner, were born.

“I have lost grandparents. I’ve lost pets. I’ve had friends die, and nothing could ever come close to losing your kid. Nothing will ever compare, and it doesn’t go away. The pain is always with you.” Porada said.

Every day in Ohio nearly three babies die before their first birthday. The chances of that baby dying in Mahoning County are arguably greater than in any other county in the state.

And if that baby is black, the possibility of death increases dramatically.

“We are 50 out of 50 for black infant mortality,” said Erin Bishop, health commissioner for Youngstown.

Health officials met in Columbus in November 2012 and again in December 2014 to shed light on the problem and develop strategies.

Eventually, Gov. John R. Kaisch got involved. “Ohio has one of the worst infant-mortality rates in the nation, and that is simply unacceptable,” Kasich said.

Here are the facts as of 2012, Ohio ranked:

43rd in the nation with 7.6 infant deaths for every 1,000 births. The national rate was 6.0.

42nd in white infant deaths (6.4).

45th in black infant deaths (13.9).

Ohio had the highest death rate for black babies (14.1) for the most recent five-year period for which there is data, 2008 through 2012, health officials say.

In 2012, Mahoning County (10.8) was 10th-highest in the nation among counties with 250,000 people or more, but that’s largely because of the sky-high black infant-mortality rate of 23.7.

That’s almost triple the state’s death rate for all babies (7.8) and is higher than Third World countries such as Algeria (22.6), Belize (20.8) and Paraguay (21.5), according to the World Health Organization.

Officials say what’s so shocking about the situation is that Ohio’s high infant-mortality rate has remained stagnant for more than a decade, while most of the rest of the nation has improved. Sixteen states and the District of Columbia saw significant declines in their infant-mortality rates since 2005, CDC figures show.

“What I believe is happening is all the other states are getting better and Ohio is not getting better,” said Dr. Elena Rossi, a neonatologist at Akron Children’s Hospital.

STATE RESPONSE

At the December summit in Columbus, Kasich announced efforts to fix the problem.

The Ohio Department of Health will target “hot spot” communities where infant mortality is the highest in the state.

The state’s Medicaid program will help pregnant women in those areas get the proper medical care and education.

The Office of Health Transformation will make sure at-risk mothers get the care they need.

The state will spend $4.2 million on the Maternal Opiate Medical Support program to help pregnant women break drug addiction.

While these efforts toward education and medical care are needed, health officials say there are specific practices that would significantly curb the death rates.

SAFE SLEEP

The easiest way to curb infant death is to keep babies on their backs when they sleep.

“Every week in Ohio, three infants die in unsafe sleep environments or during sleep,” Dr. Rossi said. “If we could prevent two out of three of those unsafe sleep environment deaths a week, we would drop our number from 150 to 50. That’s 100 fewer deaths potentially [each year] in Ohio. Not all of them can be prevented. But, the majority can.”

This effort, she said, must start at the hospital and then extend to everyone in the baby’s family.

It also means no toys, no blankets, no crib bumpers.

“Most people don’t even know that infants should be placed on the back for sleep for the first year of life — the whole first year,” Dr. Rossi said.

As part of safe sleep, the baby must always sleep in a crib — never on an adult surface, such as a couch or a bed.

PREMATURE BIRTHS

Another focus is premature births.

“If you ask me what the leading cause of infant mortality is, I would tell you it is prematurity,” Dr. Rossi said.

Obvious ways to curb premature births include avoiding tobacco and drugs, eating well and getting prenatal care.

“The piece about premature birth that most people don’t know is that if you’ve had a premature birth, your risk of having another premature birth is still high,” Dr. Rossi said.

That’s where the little-known drug progesterone can help.

According to WebMD.com, progesterone helps prepare the lining of the uterus to receive the egg if it becomes fertilized by a sperm.

“What most people don’t know is that with [progesterone] starting at four months of the pregnancy, you can prevent the premature birth rate the next time by almost 40 percent,” Rossi said.

Health officials also urge new mothers to wait before getting pregnant again.

“When a baby is born, you should wait 18 months to get pregnant again from delivery,” Bishop said.

Some women resist, however.

“Thirty years ago, women were told if you had a baby, let your body recover, let your nutrition status recover, let your vitamins and minerals and your uterus all recover so you’ll have a healthy pregnancy next time. Well, people didn’t want to be told what to do. They still don’t want to be told what to do,” Bishop said. “But we have a better chance with women who’ve just delivered prematurely because they don’t want to go through that again.”

Dr. Rossi cited a 2014 study by Dr. Emily DeFranko, a maternal fetal medicine specialist and professor at the University of Cincinnati College of Medicine.

“What was compelling was if your race was black and you had an interval between pregnancies of less than 12 months ... you had a twentyfold increase in having a premature baby,” Dr. Rossi said.

While this may be “common sense” among the medical community, she said, that’s not the case with the general public.

“That message is not out there in the community. We really have to do a much better job of getting that message out,” she said.

BREAST-FEEDING BENEFITS

Infant-mortality rates in Europe are much lower than those in the United States. One reason is breast-feeding.

“If you’re in Europe, you don’t see any formula,” Dr. Rossi said. “They all breast-feed and they have healthier infants.”

Health officials recommend women exclusively breast-feed babies for six months.

“They see more babies live,” Bishop said. She said the state plans a large-scale health campaign promoting the practice.

The World Health Organization says, “Exclusive breast-feeding reduces infant mortality due to common childhood illnesses such as diarrhea or pneumonia, and helps for a quicker recovery during illness.”

Urban areas such as Youngstown also have underlying financial issues that contribute to overall poor health, Bishop said.

“[Kasich] called together nine city representatives, of which Youngstown was one, to a summit in Cleveland over a year ago,” Dr. Rossi said.

At that meeting, state and the urban health officials agreed to work together specifically to address issues specific to urban areas, with the state picking up half the cost and the local health organizations picking up the remainder.

Locally, Youngstown and Mahoning County decided to team up not only to share the fiscal costs, but also to develop a systematic strategy, which includes transportation for pregnant women to doctor visits and access to nutritious food.

“ODH is putting their faith into this and their monies into this, that we’re going to be part of the answer — the solution to it,” Bishop said. “We’re definitely seeing programs out there that are helping, but we still have a long way to go,” said Bishop.

“It’s going to take us some years to dig out of No. 50.”

TheNewsOutlet.org is a collaborative effort among the Youngstown State University journalism program, the University of Akron, Cuyahoga Community College and professional media outlets including WYSU-FM Radio and The Vindicator, The Beacon Journal and Rubber City Radio, both of Akron.