Local, state officials attack infant deaths

Second of a two-part series

By KEITH BAKER, AMANDA TONOLi

and BRANDON PARK

TheNewsOutlet.org

In April 2012, Dr. Arthur R. James of Ohio State University sent out a press release announcing that Ohio was 48 out of 50 in infant deaths.

Then he sat by the phone waiting for a response.

He got one call.

The university did a survey to find out why.

The answer they got was surprising.

“‘Well, that’s just how it is.’ Babies not living to their first birthday is just how it is, and we’re supposed to be 48,” said Erin Bishop, health commissioner for Youngstown.

That was the wrong answer for some health officials.

“I was just with Dr. James ... and he said, ‘You know, if Ohio State’s football team was No. 50, we would fire that coach,’” Bishop said. “I was like, ‘You are so right.’”

ONE DOCTOR’S CRUSADE

In November 2012, Dr. James organized the first summit “Turn Up the Volume on Infant Mortality.”

A second followed in December 2014.

“I think people really opened their eyes then and thought, ‘This is serious,’” Bishop said.

Dr. James had experience in dealing with this problem while working in Kalamazoo County in Michigan.

“I arrived in Kalamazoo in 1988 at which time Michigan had the highest black infant-mortality rate in the nation, and Kalamazoo had the highest ... of all the counties in the state,” Dr. James said.

He and several community leaders studied the problem via statistics.

“Patterns began to emerge. Black babies were dying at three to four times the rate of white babies. Blacks generally had more high-risk pregnancies,” he said.

“Poverty, high teen-pregnancy rates, unemployment, high-crime neighborhoods, poor school performance, higher dropout rates — it’s all there. And, it all contributes to the racial disparity,” the doctor said.

His group went to the black community.

“We talked about the importance of [early] prenatal care, some of the risk factors associated with compromised birth outcomes,” Dr. James said. “Most of all, I think we conveyed to them that we cared.”

From 1992 to 1999, under his leadership, Kalamazoo County reduced African-American infant-mortality rate from the worst in the state at 29.7 deaths per thousand to the best in the state at 10.2 per thousand.

Then, it changed.

“When you look at the current black infant-mortality rates for Kalamazoo and the racial disparity, they are both embarrassingly bad once again,” Dr. James said.

A DIFFERENT APPROACH

Ohio health officials say they plan to succeed where Kalamazoo failed.

“We usually think of it as a medical issue and attempt to improve it by clinical interventions. Clinical interventions are extremely important, but insufficient,” Dr. James said. “[For] long-lasting improvement, one has to address ... the socioeconomic, cultural, community, educational, public safety, employment, contributors to survival of babies through the first year of life.”

He believes this approach, though difficult, is the only way to keep infant-mortality rates low.

“Ohio State University along with the Ohio Department of Health summoned the nine urban areas to University Hospital up in Cleveland and they brought out these statistics and said, ‘We want to do something that no other state has done before,’” Bishop said.

That was the start of the Ohio Institute for Equity in Birth Outcomes.

“All the health commissioners that they summoned got on board. Some of them decided to do two separate teams,” Bishop said. “We chose to do ours together with Mahoning County because it’s not just a Youngstown thing.”

The institute works with CityMatch, a national organization dedicated to improving mother and child health in urban areas. Together they analyze data to create a systematic strategy.

The cost to join: $40,000. The Ohio Department of Health pays $20,000, with the local health departments paying the other $20,000.

Mahoning County agreed to pay for the first year. Bishop is working with Youngstown to fund the second year.

“And then the third year, we’re hoping maybe to do a grant,” Bishop said. “Our city thinks it’s important and our board of health thinks it’s important.”

STEP 1: IMPROVING MOM’S HEALTH

A healthy mother will have a better chance of having a healthy baby, health officials said.

“Most of our women were seeing the doctor for at least seven prenatal visits, which is good. It’s just they go see the doctor for their 15 minutes and then what other help are they getting?” said Bishop, citing diabetes and obesity as illnesses not addressed.

To fix this, Bishop and Patricia Sweeney, Mahoning County Health Commissioner, are establishing “centering pregnancy programs,” whereby pregnant women meet in groups for health assessments, education and support.

“We don’t have any of these centering programs here in Mahoning County. They do have them in Cincinnati, and up in Cleveland and Canton,” Bishop said. “It’s like a collaboration among different agencies that work with women who are pregnant, dealing with issues that they aren’t [addressed] in the 15-minute prenatal.”

Mercy Health has agreed to develop a centering program at its hospitals — St. Elizabeth Youngstown Hospital, St. Elizabeth Boardman Hospital and St. Joseph Warren Hospital.

Bishop and Sweeney also hope to get ValleyCare Health System of Ohio involved, as well as OB-GYN practices. ValleyCare operates Northside Medical Center in Youngstown and Trumbull Memorial Hospital in Warren.

STEP 2: BIRTH SPACING

Birth spacing, while not a new concept, isn’t common knowledge.

“When a baby is born, you should wait 18 months to get pregnant again from delivery,” Bishop said “When I had my two kids, I was never told that. The first time I ever heard about that was just recently with doing this in the last couple years.”

To address this issue, the health commissioners will urge doctors to promote the use of long-lasting contraception between pregnancies and talk to their patients about birth spacing.

“We want to have physicians use more of these longer-lasting contraceptives so it spaces out the births,” Bishop said. “Insurance pays for it. It’s just do the doctors push their patients to get it? We want to get more information. We don’t know. So, we’re going to survey the physicians and see. Do you talk about birth spacing? Do you let your patients know?”

Then, the commissioners plan to go into the communities and work with local agencies to get the word out.

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.