The Butler County Partnership to Reduce Infant Mortality (PRIM) will host a “Day of Dialogue on Race and Infant Mortality.” This is the second in a series of ongoing meetings designed to start and support conversations around disparities between white and black babies in birth outcomes and infant mortality.
Two sessions will be held on Saturday, Jan. 23 at the YWCA, 244 Dayton St. in Hamilton. The first session will be held from 9 a.m.- 12:30 p.m. (includes free breakfast sponsored by Paramount), or 1 -4:30 p.m, (includes free lunch sponsored by CareSource).
About the series
This is Part 1 of a 3 part series that examines why black babies in Butler County are dying at twice the rate of white babies. The series will explore the problem, causes and possible solutions. Through our coverage we want to inform readers, raise awareness and provide you with information about how you can aid in solving the problem.
Today: An overview of Butler County’s infant mortality rates
Saturday: Local black mothers who have lost children speak about infant mortality rates
Sunday: Community, political and health leaders discuss possible solutions
Black babies in Butler County are dying before the age of 1 at twice the rate of white babies.
It's a troubling and puzzling statistic that local and state health experts say contributes to Ohio's high infant mortality rate, which is among the worst 10 percent in the nation.
This medical and social issue is being addressed by several health agencies in the area and nationwide, but most of the data compiled so far has left the experts puzzled as to why this is happening.
Tracking the data
The Ohio Department of Health and the Butler County Health Department have been actively tracking the issue for several years. Cathy Bala, of ODH, explained that the Infant Mortality Rate is calculated as the number of babies who died during the first year of life per 1,000 live births.
ODH and the Butler County Health Department have compiled some eye-opening statistics and recently shared their findings with the Journal-News. From 2007 to 2014, there were 37,840 births in Butler County and a total of 288 deaths.
Of those total births, 29,537 were non-Hispanic white, and of those, 213 died. That calculates to a 7.2 infant mortality rate. Similarly, there were 3,253 non-Hispanic black babies born in the same time period with 40 infant deaths resulting in a 12.3 rate.
Angela Koenig, of the Cincinnati Children’s Hospital Medical Center, released statistics compiled by the hospital, revealing that 522 babies died in Hamilton County from 2010 to 2014.
“This puts our infant mortality rate at among the worst 10 percent in the nation,” her report stated. “While we are optimistic about improvement from an infant mortality rate of 10.5 percent in 2010 to 8.8 in 2014, this change is not enough.”
The Centers for Disease Control offered a look at the national data and reported that the infant mortality rate for non-Hispanic blacks was 11.11 in 2013, while the rate for non-Hispanic whites babies was 5.06 in the same time period.
Getting at the root of the problem
Bala said that ODH is has been looking at several ways to address the issue, and there are plenty of different angles to pursue.
"The reasons for disparities in birth outcomes are highly complex, ranging from socio-economic issues to healthcare issues and lack of good social supports," she explained. "We do know that infant deaths likely involve one of the three leading causes of infant mortality in Ohio – babies born prematurely, sleep-related deaths and birth defects. The 2014 Ohio Infant Mortality Report released in December outlines Ohio's initiatives to address infant mortality, including these leading causes."
ODH has partnered with a national organization in 2013 called CityMatCH to form the Ohio Institute for Equity in Birth Outcomes (OEI).
Bala said CityMatCH has experience nationally in supporting urban maternal and child health initiatives at the local level, and has an interesting component to it.
“We are partnering with nine high-risk metropolitan communities in Ohio, including Butler County, to improve overall birth outcomes and reduce disparities in infant mortality,” she said. “In 2015, OEI teams launched evidence-based interventions to address highest risk populations.”
ODH is also addressing disparities in birth outcomes through its Ohio Infant Mortality Reduction Initiative home visiting program.
“The program addresses financial, geographic, cultural and other barriers that African-American women and children experience, and works on improving their access to healthcare and social services,” Bala explained. “It also provides community-based outreach and care coordination services in targeted communities with high-risk, low-income pregnant African-American women and their babies.”
Butler County expanding efforts to address the issue
Jenny Bailer is the nursing director at the Butler County Health Department and co-lead of the Partnership to Reduce Infant Mortality (PRIM). She has been a leader in organizing the county’s fight to help reduce the infant mortality rate. The nine city urban center ODH plan is one of the ways Butler County is addressing the issue.
Bailer said that research done by a variety of agencies reveals that socio-economic status — including poverty, education, access to prenatal care, smoking, transportation issues limiting visits to a physician and even low birth weight do not alone explain the racial gap in infant mortality, and that even black women with terminal degrees are more likely to lose a child in its first year than are white women who dropped out of high school.
She emphasized that the county has joined ODH and other agencies in tackling the problem. One thing locally that has been addressed is the issue of health care. That is not a problem in the area, according to Bailer.
“We don’t feel like a lack of health care resources is a problem here in Butler County,” she said. “The first thing that people think about if babies are dying is that must mean that we don’t have good medical services. In fact, in Butler County we have a lot of really good medical services.
“We have five hospitals here that all deliver babies. We have the world-renowned Children’s Hospital that has neo-natal intensive care in Cincinnati, and similar service in Dayton - high risk pregnancy services at Bethesda, Dayton Childrens and Good Sam hospitals,” Bailer said.
She added that the Butler County region is not under-served.
“We have lots of doctors, midwives and nurse practitioners in the area,” Bailer said. “We are not known as an under-served area.”
Bailer said the group PRIM, which is made up of 100 community partners, including health officials, political leaders and social service agencies, has been a success in addressing the infant mortality rate.
The group has eight focus areas: Smoking Cessation; Centering Pregnancy; Safe Sleep; Breast Feeding Support; Teen Pregnancy Reduction; Father Involvement; Faith-Based Support and the Leadership Team.
PRIM has been working with ODH on its nine county urban center program to come up with some answers.
“Hamilton, Butler, Lucas, Summit, Franklin, Montgomery, Mahoning, Cuyahoga and Stark are the nine counties involved,” Bailer said. “We were asked to study our data and then choose two evidence based data driven projects to implement countywide. We chose Smoking Cessation and Centering Pregnancy.”
Three counselors were put on the Smoking Cessation project and it was labeled, “Baby and Me Tobacco Free.” Michelle Tubbs was the leader, and it encourages women to quit smoking while pregnant, and it gives them free diapers every month for a year ($25 voucher/month).
Centering Pregnancy is a pre-natal delivery program that is done in a group.
“So usually when a pregnant woman goes to see her doctor, she’s sees him or her for 10 minutes once a month and then every other week for 10 minutes right before the baby is born,” Bailer said. “When we do Centering, it is a different delivery model. A group of 8 to 12 women go through pre-natal together.”
The women while in the program meet for two hours every month as a group with their provider and then at the end two hours every two week right before the deliver.
“It becomes a support group and women can learn from other women and what their struggles are,” Bailer said. “Studies show that it is fabulous for improving birth outcomes. It is like having a surrogate partner. They help each other.”
Dr. Robert Arrom, and his practice at the Center for Women’s Health in Fairfield, will host the first Centering program that will start at the end of this month. Bailer said she hopes to start to other Centering program in the county as soon as possible.
Boots on the ground
High Hopes is a program offered by the Butler County Health Department that is an outreach program designed to help African-American women in the area deal with pregnancy issues.
Certified community health workers make scheduled home visits during a woman’s pregnancy and will visit until her child reaches age two, helping with health education and life skills training.
“In public health, we target our programs to those who need it the most,” Bailer said. “The health workers are our boots on the ground. High Hopes has been around for 13 years and was in Middletown originally and four years ago it transferred to the Butler County Department of Health, and we made it available to everybody. It is funded by the ODH and is available in 13 counties.”
Jennifer Carter is one of the certified community health workers that has boots on the ground. She said her eyes have witnessed several problems that African American women deal with while pregnant.
“I contribute a lot of the factors stress. You are stressed as an African-American woman when you walk out the front door,” Carter explained. “There is a conglomerate of things that create stress for you. Not having enough food, not having any food. No furniture at all. Once you get that stress, it is hard to talk a young lady into not worrying.”
She said it is depressing to conduct a home visit and find a pregnant woman sleeping on an air mattress and surrounded by pizza boxes.
“Sometimes you have to pry information out of them about what is wrong,” she said. “Not being able to get to the doctor or having to change doctors — going to a food pantry waiting for food. It’s not just for African American babies. We have to address the issue for white babies and all races.”
Bailer and Carter hope to see plenty of people come out and address the issue this weekend as PRIM is hosting a “Day of Dialogue on Race and Infant Mortality.” This is the second in a series of ongoing meetings designed to start and support conversations around disparities between white and black babies in birth outcomes and infant mortality.
Two sessions will be held on Saturday, Jan. 23 at the YWCA, 244 Dayton St. in Hamilton. The first session will be held from 9 a.m.- 12:30 p.m., or 1 -4:30 p.m.
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