The singularly focused 2019 Health Equity Summit is fighting to reduce infant mortality with a three-year strategy to meet that goal.
To halve the disproportionately high rate of children dying before their first birthdays in Akron, dozens of diverse community and health advocates from more than 20 local organizations gathered Tuesday at the John S. Knight Center to find long-term solutions to a problem steeped in inequity and misunderstanding.
“We’ve had years of planning meetings and years of sewer meetings and years of other meetings about economic development. I think it’s finally time we institutionalize all of this, so that [the collective effort to combat infant mortality] outlasts all of us until we drive these numbers down to zero,” Akron Mayor Dan Horrigan, the opening speaker, told the crowd.
Epidemiologists at Summit County Public Health report that there were 7.1 infant deaths per 1,000 born in Summit County in 2018 before turning 1 year old. That’s up from 6.9 in 2017, but down from 7.6 in 2016. In a county with one of the worst infant mortality rates in a state that ranked second from the bottom last year, “this is unacceptable,” Horrigan said. “Really, the goal is zero. I’m not happy about just cutting in half [the infant mortality rate by 2025].”
More granular county data from 2015 to 2017 show decreases in premature births, low birth weights and smoking in the third trimester for African-American and overall pregnancies.
Horrigan credited the early signs of success to 19 organizations that came together with the city and county in late 2017 to form Full Term First Birthday. The education, advocacy and research collaborative is led by his Health Equity Ambassador Tamiyka Rose, who hosted the annual Health Summit Poll.
The day of expert testimony called for the expansion of programs working in Akron, from group counseling and wraparound nursing for new and expecting mothers to advertising safe sleep habits to cultural and racial training for institutions.
Blinded with data
Health experts familiar with the statistics said they’re not hearing from enough grieving mothers. They have the data but not enough of the stories that would help them understand the factors contributing to infant loss.
“As we went through the strategic planning with the city, it became very apparent that we don’t know why these babies are dying. We can certainly tell you what” the death and birth certificates say, explained Dr. Jennifer Savitski, an obstetrician-gynecologist with the Cleveland Clinic. “And in those cases where the health department is able to interview the family, we are able to glean some information, but that is only telling a fraction of the story.
"For the majority of cases, we don’t have a full picture of why those babies die.”
“We want to know were you having trouble getting prenatal care? Were you having trouble with housing or transportation or even a domestic violence situation?" said Shaleeta Smith, the supervisor for Maternal & Child Health at Summit County Public Health. "Those are things that we need to know in order to figure out how we can drive change in our community.”
Research compiled by the Health Policy Institute of Ohio says 20 percent of the general American population die due to a lack of access to high-quality health care, 30 percent due to health-related behaviors like smoking, poor nutrition and physical activity and 50 percent due to community conditions like housing, education, transportation and unemployment.
In Summit County in 2017, the health department recorded 92 child deaths, Smith said. About half (44) had not yet turned 1. Of those 44 infants, 28 died less than a month outside the womb.
These figures do not include the 57 babies who last year were born without heartbeats after 20 weeks in utero. “What we tend to forget is fetal deaths. That’s not something we talk about often,” Smith said. The same racial disparities that put minority women and children at greater risk of premature birth and infant mortality are present in the limited data on stillbirth.
Smith was excited to report that her office interviewed six families that suffered stillbirth in 2018, or five more than in most years.
Every speaker and panelist touched on why African-American mothers and babies are dying two to three times more often than their white counterparts.
The Ohio Department of Health reports that from 2011 to 2017 infant deaths statewide fell 19 percent for white families and climbed 16 percent for black families across the socioeconomic spectrum. This longstanding and widening disparity is steeped in what Horrigan “painfully” recognized as “decades-old systematic, structural and social injustice.” A growing body of national and local research is pointing to institution-level racism, from limited access to jobs, housing, transportation and quality health care.
“When we first started this collaboration, there were a lot of buzz words that I had to look up and understand, things like unconscious bias, systematic oppression and maternal stress,” said Dr. Cheryl Johnson with Summa Health, which has paired with Project Ujima and Minority Behavioral Health Group to add cultural and racial understanding to the hospital's separate group counseling for new and expecting mothers who are black, Bhutanese or drug addicted.
Partnering with the community is key to bridging trust and addressing otherwise overlooked biases within systems, Johnson said.
Myths and misconceptions are another major barrier to better outcomes for the black community.
Savitski said efforts to educate or help mothers wait 12 to 18 months before getting pregnant again, which research says can reduce premature births and infant mortality, are tough when mothers listen instead to friends and family who confuse the healthier birth control implants of today with infamous versions popularized in the 1970s. Some needle-averse communities are more likely to turn down vaccines for children, birth control injections or, believing incorrectly that all drugs are bad when trying to get pregnant, such as shots of the hormone progesterone, which helps the uterus prepare for a healthy pregnancy.
Citing concerns about "their willingness to engage in services," Clinical Director Tania Lodge with Minority Behavioral Health Group said its paramount to identify and treat mental health issues in minority women before they create the toxic stress that kills pregnancies and infants.
Reach Doug Livingston at email@example.com or 330-996-3792.