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More than a decade of effort to address infant mortality has brought success, opportunities, and “areas where progress remains inadequate,” according to a new study from an Ohio advocacy group.
The new research from Groundwork Ohio reflected on the fact that Ohio had become one of the worst in the country for infant mortality rates in the last 10 years, despite hard work to stem the problem in the 1990s.
“The mortality rate (10 years ago) for Black infants was nearly double that of white infants, and one ZIP code in Akron recorded the highest infant mortality rate in the country,” wrote Groundwork president and CEO Lynanne Gutierrez in introducing the report.
The indications of an area’s infant mortality rate not only show problems in ensuring children make it to their first birthday, Gutierrez wrote, but also expose “broader systemic challenges.”
“Infant mortality reflects not only the quality of health care but also the persistent inequities in access to care,” according to Gutierrez. “It underscores the importance of addressing disparities and strengthening the overall health system to mitigate future public health challenges.”
The effort to bring about improvements to the state’s infant mortality has been bipartisan, according to Shannon Jones and Charleta B. Tavares, former state senators from both sides of the aisle whose statements were also included in the report. Legislation was brought forth after 2012’s rate was reported as 7.6 deaths per 1,000 births, putting the state at 45th in the nation. The national rate at that time was 5.98 deaths per 1,000 live births.
For Black infants, the situation was even more grim in Ohio, at 13.9 per 1,000 live births, versus white infants, who were dying at a rate of 6.4 per 1,000, Ohio Department of Health data showed.
The state was among the country’s worst for infant birth weight among Medicaid enrollees, and premature birth rates have increased since 2019, according to the report.
The Ohio Commission on Infant Mortality was created after the 2012 data came about and Senate Bill 332 was passed, targeting health care for mothers and babies.
Since then, the mortality rate has declined, from 7.6 in 2012 to 7.1 in 2022. The rate for Black infants rose steadily upward from 2012 until 2017, when the rate was 15.6 deaths per 1,000 births. In 2018, the rate dropped back down to 2012 rates (13.9 per 1,000), but the 2022 rate has only improved slightly, to 13.4 per 1,000. White infant mortality rates have remained in the single digits, never rising to the highest rate recorded by the study, 2012’s 6.4 per 1,000. As of 2022, there were 5.7 white infant deaths per 1,000 live births.
“The leading causes of infant death in Ohio remain prematurity (a birth less than 37 weeks’ gestation), congenital (birth) defects and external injury,” the report stated.
The report also acknowledged slowed momentum caused by the COVID-19 pandemic, which “laid bare the impact of health inequities within the state.”
Despite slight decreases in the mortality rates recently, Jones and Tavares said “the latest data paints a disappointing picture” with disparities in deaths among Black and white babies growing even more.
“This persistent disparity highlights the troubling reality that, despite legislative efforts and targeted interventions, Black babies in Ohio are still dying at alarming rates,” Jones and Tavares wrote.
Adding to that, Ohio set a goal of no more than 6 deaths per 1,000 births by 2022, which was not met, despite the fact that this was a national average in 2006. A “state health improvement plan” for 2020-2022 maintained the plan, but pushed the target date to 2028, the report stated.
“While other states have continued to reduce infant deaths, Ohio has failed to keep pace with the rest of the nation,” Groundwork Ohio wrote. “A more recent Ohio plan has not been published.”
Ohio’s Medicaid program was spotlighted in the report as a major part of the state’s infant landscape.
“The Medicaid program plays a crucial role in maternal and infant health, as it covers nearly half of all births in Ohio,” the report stated.
More than half of infant deaths that occurred in the state in 2022 were to mothers with Medicaid as their insurance source.
It’s the national Centers for Medicare and Medicaid who oversee Medicaid programs federally, and in 2024, the CMM required reporting from states on metrics and “the measurement and reporting of health disparities.”
Ohio conducts a survey called the Pregnancy Risk Assessment Monitoring System in partnership with the CDC, as other states have done, and it implemented another survey in 2016 called the Ohio Pregnancy Assessment Survey.
In a glimmer of progress, Groundwork’s analysis of the state’s clinical metrics showed Ohio “performing better on some of the clinical metrics compared to other states.”
Metrics include prenatal care, postpartum follow-ups, postpartum contraception and low-risk cesarean deliveries.
Those under the state’s Medicaid program showed a higher performance on “timely prenatal care” than Ohio’s overall population and the national average for both, according to Groundwork, and a higher performance than the national Medicaid average as well.
Ohio Medicaid is “among the ten best states for care provided prior to hospital discharge,” the report found.
But efforts are still “missing too many women,” leading to outcomes that still “trail the nation in most cases.”
Postpartum follow-up for Medicaid users is “significantly less” than the overall state population, as well as the national average for both Medicaid and other populations.
In Medicaid populations, the amount of low birth-weight babies in Ohio stands at 11.4% in state data, above the national Medicaid average of 10.2%, the overall Ohio population rate of 8.7% and the national average of 8.6%.
Preterm births in the state were reported at 12.8% in Ohio Medicaid patients, versus 10.8% for the state overall, and 10.4% in the nation.
The report noted a targeted approach to reducing infant mortality by hitting “hot spots,” namely the counties that accounted for most of Ohio’s Black infant deaths and those spotlighted in overall infant deaths.
The targeted approach used the Ohio Equity Institute, in collaboration with the Ohio Department of Health “to address racial inequities in birth outcomes.” It started in 2012 in nine counties and has since expanded.
“While this is the right strategy, the implementation has fallen short in some areas – as not all of the major providers are engaged in this work in their communities,” the Groundwork report stated.
Expansion of home-visiting services has also helped, along with improvements to Medicaid managed care, but there is still concern for those who fall through the cracks.
“Even with expansion, home visiting is still missing many families, particularly those who are harder to reach and engage – those who would benefit from the service the most,” according to the report.
Moving forward, counting the implementation of programs and policies is no longer a good measure success in infant and maternal health, according to Jones, now a senior advisor for Groundwork Ohio, and Tavares, now the CEO of PrimaryOne Health.
To eradicate disparities and bring about real change, the state must have “strong, consistent and accountable leadership at both the state and local levels.”
“The slow pace of progress over the past decade demands a renewed and united commitment from all stakeholders to prioritize maternal and infant health and to hold themselves accountable through data-driven results,” the two wrote in the report.
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