The leading causes of infant death in Ohio are prematurity-related conditions (e.g., preterm birth before 37 weeks of pregnancy have been completed, low birth weight, respiratory distress syndrome, and neonatal hemorrhage), congenital anomalies/birth defects, Sudden Infant Death Syndrome (SIDS), obstetric conditions (e.g. premature rupture of membranes, incompetent cervix, placental separation and hemorrhage), and external injury (e.g. unintentional injuries, homicide, and injuries of undetermined intent). Sleep-related deaths are included in the SIDS or external injury categories depending on the exact cause of death. Other causes of infant death includes neoplasms (abnormal tissue growth especially as a characteristic of cancer), anemias (blood disorders), infectious colitis (inflammation of the lining of the colon caused by infection), enteritis (inflammation of the intestines, usually the small intestine), gastroenteritis (inflammation of the stomach and intestines), and other conditions not otherwise specified.
Since 2011, the Governor’s Office of Health Transformation, The Ohio Departments of Health, Medicaid, Mental Health and Addiction Services, and other partners at the state and local levels have pursued a comprehensive range of initiatives to help more babies reach their first birthdays. Ohio has invested nearly $87 million over the past six years to support state and local initiatives that help address infant mortality.
2017-2018 New Initiatives
Ohio is implementing new initiatives in 2017-2018 to address infant mortality, focus resources where the needs are greatest, implement system changes that will help save babies’ lives, and surge new resources and continue funding to support local infant mortality initiatives in high-risk communities.
- Progesterone is a hormone medication that has the potential to reduce the incidence of preterm birth. The state is working with the Ohio Perinatal Quality Collaborative composed of perinatal clinicians, hospitals, and government entities working together to improve birth outcomes through wider use of progesterone treatment. Ohio Equity Institute teams will begin implementing the collaborative’s evidence-based strategies in high-risk communities in late 2017 and 2018.
- Birth intervals of at least 18 months allow a woman’s body to recover between pregnancies and reduce the risk of preterm birth and low birth weight. Access to effective family planning methods, including long acting reversible contraceptives, is important to helping women avoid or delay pregnancy. The state is working on increasing access to long acting reversible contraceptives for women who want them.
- Helping women and men think about whether/when to have children can help reduce pregnancies at greater risk for preterm birth. The Ohio Department of Health helps reproductive health services clients develop life plans — a structured format to think about life goals and circumstances, and preferences about whether/when to have children.
- Smoking is one of the most common preventable risk factors for infant mortality as it increases the risk of preterm birth and low birth weight. The state is expanding into publicly funded maternal and child health programs recommended clinical practice guidelines from the U.S. Public Health Service about how to encourage people to quit smoking. The state also promotes a nationally recognized, evidence-based smoking cession model to reduce smoking among women during pregnancy. The Moms Quit for Two program utilizes the “Baby and Me – Tobacco Free” model and is offered across Ohio by many local health departments, Ohio Equity Institute teams and other community organizations.
- Some women develop diabetes or high blood pressure during pregnancy which increases the risk of preterm birth and/or low birth weight. The state is promoting the use of recommended diabetes screenings and prenatal care for early identification and treatment of diabetes and high blood pressure during pregnancy.
- The state provides evidence-based home visiting services through local partners to women during pregnancy. Services include providing expectant parents at risk for poor birth outcomes with information and support in the comfort of their homes.
- The state is supporting the Ohio Perinatal Quality Collaborative in a project to ensure that initiation of labor, and caesarean section of pregnant women who are not already in labor, are pursued only when obstetrically or medically indicated.
- A comprehensive birth defects surveillance data collection review has been completed, and an analysis is being conducted to help inform efforts to prevent birth defects that cause infant mortality.
- The Ohio Collaborative to Prevent Infant Mortality is promoting initiatives to help prevent birth defects and to foster early identification of children with birth defects for faster treatment to improve health outcomes.
- Ohio law requires hospital maternity units and freestanding birthing centers to conduct a safe sleep screening before a newborn is discharged from the facility to assess whether there is a safe sleep environment at home for the infant. The law requires these facilities to report safe sleep screening information to the Ohio Department of Health, which transitioned reporting via the state’s electronic vital records system in 2017 to improve the quality and timeliness of safe sleep screening data.
- The state funds a network of local partners to implement Cribs for Kids® programs that provide Graco® Pack ‘N Plays to families unable to afford a safe crib for their infant. During the 2017 grant year, 44 local partners are expanding their reach to serve 63 Ohio counties.
- The state is funding local partners to develop and support safe sleep policy and system changes to reduce sleep-related deaths. Partners include fire stations, police departments, childcare centers, homeless shelters, church nurseries, recreation centers, social services agencies and community organizations. These partners are being trained in safe sleep strategies and receiving support in developing safe sleep-related policy and system changes.
- The state relaunched a $500,000 public awareness campaign with increased reach in nine metropolitan areas that account for most of Ohio’s infant deaths to promote the ABCs of infant safe sleep practices. Babies who sleep on couches, in bed with others, or on their stomachs are more likely to die from an unexpected sudden cause. The campaign will be relaunched in 2018 incorporating lessons learned from the 2017 campaign.
- The state will conduct infant safe sleep “train-the-trainer” education in 2018 targeting African-American populations in nine metropolitan areas that accounted for 86 percent of Ohio’s black infant deaths in 2016.
- The Safe Sleep Subcommittee of the Ohio Injury Prevention Partnership is working on a strategic plan which includes a focus on reducing infant mortality in Ohio. The plan includes the development and distribution of a toolkit for obstetricians and gynecologists, certified nurse midwives and lactation consultants to address infant safe sleep practices with their patients.
- The state is receiving additional federal Home Visiting funding in 2018 to increase Ohio’s capacity to serve parents at risk for infant mortality within high-risk communities. Ohio’s Home Visiting program provides expectant and new parents at risk for poor birth outcomes with information and support in the comfort of their homes.
- The Ohio Department of Health in collaboration with other state and local partners released a new State Health Improvement Plan in early 2017 that addresses maternal and child health, including infant mortality as a statewide priority issue to be addressed collaboratively at the state and local levels.
- The evidence-based CenteringPregnancy© group prenatal care model continues to expand in Ohio, including the addition of new sites specifically dedicated to caring for opiate-addicted expectant women. The state also is promoting the CenteringParenting© care model which brings moms and their same-age infants together with their healthcare providers.
- Governor John R. Kasich signed into law Senate Bill 332 in January 2017, enacting recommendations of the Ohio Infant Mortality Commission. The new law’s requirements include giving funding priority to infant vitality initiatives to areas most affected by infant mortality.
The 2018-19 state budget dedicates nearly $50 million to improving birth outcomes and reducing racial and ethnic disparities, and builds on almost $87 million in investments made during the past six years. The majority of state funding is dedicated to supporting local community-driven proposals to combat infant mortality in high-risk areas. Nine metropolitan areas accounted for 59 percent of all infant deaths, and 86 percent of African-American infant deaths, in Ohio in 2016: Butler Co., Cleveland/Cuyahoga Co., Columbus/Franklin Co., Cincinnati/Hamilton Co., Toledo/Lucas Co., Youngstown/Mahoning Co., Dayton/Montgomery Co., Canton/Stark Co., and Akron/Summit Co. In these communities, local infant mortality coalitions are pursuing promising practices to reduce infant mortality supported by state and federal funding. During the next two years, additional community-based pilot programs with proven track records in reducing infant mortality will be launched, and the evidence-based CenteringPregnancy® group prenatal care model will be expanded. Ohio also will leverage federal grants to support local infant mortality initiatives during the next year:
- For 27 Ohio counties at risk for poor birth or childhood developmental outcomes to expand local voluntary, evidence-based home visiting services to women during pregnancy, and to parents with young children.
- For 14 Ohio counties with the highest infant mortality rates for African-American babies to promote healthy pregnancies, positive birth outcomes, and healthy infant growth and development.
2013: Smoking is one of the most common preventable risk factors for infant mortality, increasing the risk of miscarriage, premature birth, low birthweight and stillbirth. The 2014-15 state budget includes funding to expand women’s access to providers with tools and training to help them quit smoking.
2013: ODH and The Ohio Department of Medicaid begin working with the Ohio Perinatal Quality Collaborative on its Progesterone Quality Improvement Project. The project’s goal is to improve birth outcomes by encouraging wider use of progesterone treatment, a hormone medication that has the potential to reduce the incidence of preterm birth and reduce the number of infants born before 32 weeks when rates of infant mortality are highest.
2013: ODH and The Ohio Department of Medicaid in partnership with the Ohio Perinatal Quality Collaborative launch an initiative to ensure that all pregnant women at risk of delivering a baby prematurely between 24 and 34 weeks gestation receive antenatal corticosteroids, an evidence-based therapy shown to reduce mortality and morbidity among pre-term infants.
2013: ODH, The Ohio Department of Medicaid and the Ohio Perinatal Quality Collaborative launches an initiative to increase early feeding of mother’s milk to newborns since its protective properties are linked to a reduced risk of some infections and illnesses in newborns.
2014: ODH launches a public awareness campaign focused on pregnant women and second-hand smoke exposure.
2015: The Ohio Perinatal Quality Collaborative’s (OPQC) Progesterone Quality Improvement Project begins recruiting 23 outpatient clinics to participate in the progesterone project, 21 of them located in high-risk communities. ODH and The Ohio Department of Medicaid, in collaboration with The Ohio State University Government Resource Center and Cincinnati Children’s Hospital Medical Center, continue funding and support for OPQC’s progesterone project.
2015: ODH engages the Clinical Skills Education and Assessment Center at The Ohio State University Wexner Medical Center to provide obstetric emergency simulation training for labor and delivery and postpartum unit staff in birthing centers across Ohio. The training focuses on clinical simulations of three medical conditions that can contribute to infant mortality — postpartum hemorrhage, cardiomyopathy, and preeclampsia.
2016: ODH uses new state funding to expand tools, training and technical assistance for treating tobacco use; training for the Moms Quit for Two program; and to expand the Certified Tobacco Treatment Specialists program. Smoking during pregnancy is one of the most common preventable risk factors in infant mortality.
2016: ODH funds initiatives to educate healthcare providers and other professionals who interact with women of reproductive age and men on the use of planning tools to promote safe birth spacing and reproductive health planning. Birth intervals of at least 18 months reduce the risk of preterm birth, low birth weight, placental abruption and other poor birth outcomes.
2013: Folic acid is crucial to prevent neural tube defects, which occur in 1 per 1,000 pregnancies. ODH staff develop online training modules for health professionals about this issue.
2013: ODH launches an initiative to work with healthcare providers to increase postpartum screening rates for women with a history of gestational diabetes. Women who enter pregnancy with undiagnosed and uncontrolled diabetes are at greater risk of fetal death or having a child with a birth defect.
2014: In accordance with a new state law, ODH issues rules for the required reporting by birthing centers of results of newborn screenings for Critical Congenital Heart Disease. Heart defects are the most common birth defects reported in Ohio, and are the largest contributor of birth defects that cause infant mortality.
2015: ODH rolls out a new electronic birth defects information system used by hospitals to report to ODH children from birth to age 5 with birth defects. The system is linked with ODH’s vital statistics birth records and sends referrals for parents to early intervention programs in their area.
2016: As part of ODH’s public health preparedness for the potential impact of Zika virus in Ohio, the Centers for Disease Control and Prevention awards funding to ODH to implement systems to identify microcephaly, hydrocephaly, arthrogryposis and other brain reduction birth defects linked to Zika virus in pregnant women.
2011: In cases of sudden, unexpected infant deaths, accurate determination of the cause of death requires a review of the child’s health history, a complete autopsy, and a thorough scene investigation. To improve consistent scene investigations throughout Ohio, ODH begins conducting trainings for coroners, medical examiners and law enforcement jurisdictions to expand implementation of the Centers for Disease Control and Prevention’s Sudden Unexpected Infant Death investigation protocol.
2013: Suffocation is the leading cause of injury-related death for babies before their first birthday. Babies who sleep on couches, in their parents’ bed, or on their stomach are more likely to die from an unexpected sudden cause. The 2014-15 state budget includes funding for a targeted campaign to educate parents, caregivers and healthcare providers about the ABCs of safe sleep practices for infants (Alone, on their Back, in a Crib).
2014: ODH launches a statewide public awareness campaign to help reduce the number of Ohio babies who die in unsafe sleep environments by promoting safe sleep practices for infants.
2014: ODH sponsors the Ohio Sudden Infant Death Network’s “Safe Sleep Community Forums” across the state to increase awareness and education about preventing infant mortality.
2014: ODH and the Ohio Hospital Association has launched the Safe Sleep is Good4Baby statewide initiative to model safe sleep practices in the hospital and educate parents and families about safe sleep practices at home.
2014: A new state law establishes the Safe Sleep Education Program administered by ODH. The law requires hospitals with maternity units and freestanding birthing centers to implement an infant safe sleep screening procedure to assess whether an infant will have a safe crib or other suitable place to sleep after discharge. ODH provides free Cribs for Kids “survival kits” to families who meet financial eligibility guidelines.
2015: The 2016-17 state budget continues funding to support raising public awareness about infant safe sleep practices.
2016: ODH relaunches a $500,000 public awareness campaign with increased reach in nine high-risk metropolitan areas to promote infant safe sleep practices to prevent sleep-related deaths.
2016: Infant safe sleep screening data from maternity hospital and freestanding birthing centers indicates that these facilities provided 699 cribs to families in need and referred another 422 families to other sources to obtain a crib. Ohio law requires maternity hospital and freestanding birthing centers to conduct a safe sleep screening before a newborn is discharged from the facility to assess whether there is a safe sleep environment at home for the infant.
2016: ODH expands its infant safe sleep website which provides safe sleep information for parents, caregivers and others. The website includes information about how eligible families can obtain a free crib as a safe sleep environment for their infant.
2016: ODH strengthens the screening and referral process for Ohio’s free Cribs for Kids program to give priority to eligible families in high-risk communities. The Cribs for Kids® program promotes the use of cribs as a safe sleep practice for infants to prevent sleep-related deaths.
2016: ODH develops a safe sleep screening tool for Ohio’s local Home Visiting programs and mandates its use in all state-supported home visiting and community health worker programs.
2011: Governor Kasich addresses infant mortality in Ohio in his first State of the State Address and made reducing low birthweight babies a priority.
2011: Ohio Infant Mortality Reduction Initiative programs begin providing community-based outreach and care coordination services in targeted communities with high-risk, low income African-American pregnant women and their infants.
2012: ODH and the Ohio Collaborative to Prevent Infant Mortality host the first biannual statewide Infant Mortality Summit with more than 900 attendees who were encouraged to initiate local conversations about how to reduce infant mortality.
2012: ODH publicly releases Ohio’s infant mortality data for the first time, with the goal of raising public awareness about the issue.
2012: About half of all pregnancies in Ohio are unintended. The Ohio Department of Medicaid adopts a Medicaid Family Planning State Plan Amendment to expand eligibility for family planning services for women and men up to 200 percent of the federal poverty level.
2013: The Ohio Department of Medicaid negotiates new contracts with Medicaid managed care plans to include enhanced maternal care and inter-conception care requirements for women at highest risk for poor pregnancy outcomes.
2013: Ohio’s six children’s hospitals work together supported by a state grant to study babies born addicted to narcotics, known as Neonatal Abstinence Syndrome, and identify best treatment strategies.
2013: The Maternal Opiate Medical Support (MOMS) Project launches as a public-private collaboration to identify and implement promising treatment practices for opioid-dependent pregnant mothers eligible for or enrolled in Medicaid during and after pregnancy. The goal is to prevent Neonatal Abstinence Syndrome which contributes to infant mortality in Ohio.
2013: ODH partners with CityMatCH, a national organization that supports urban maternal and child health initiatives at the local level, to launch the Ohio Institute for Equity in Birth Outcomes, commonly known as the Ohio Equity Institute. The partnership includes nine Ohio metropolitan communities to improve overall birth outcomes and reduce disparities in infant mortality. These metropolitan communities include Butler County, Canton-Stark County, Cincinnati-Hamilton County, Columbus, Cleveland-Cuyahoga County, Youngstown-Mahoning County, Dayton-Montgomery County, Summit County, and Toledo-Lucas County.
2014: ODH and the Ohio Collaborative to Prevent Infant Mortality hosts the second biannual statewide Infant Mortality Summit with more than 1,700 attendees. Governor Kasich announces new initiatives to focus support and resources for the most at-risk mothers and babies.
2014: Governor Kasich signed into law House Bill 394 which created a Commission on Infant Mortality to study the current inventory of state programs and funding streams available to address infant mortality.
2014: ODH partners with the Black Mothers Breastfeeding Association to host regional breastfeeding workshops on “Cultural Competence in Breastfeeding Support for African Americans” for community health workers, staff in Women, Infant and Children programs, and other public health workers.
2014: Ohio Equity Institute teams begin reviewing local data with their communities and use it to select evidence-based interventions to address highest-risk populations in targeted areas.
2014: Eight Ohio Equity Institute teams are trained to conduct Fetal Infant Mortality Reviews, a multi-disciplinary, multi-agency, community-based process that identifies local infant mortality issues through the review of fetal and infant deaths and develops recommendations and initiatives to reduce them.
2015: ODH and the Ohio Hospital Association launches “Ohio First Steps for Healthy Babies” to encourage hospitals to promote and support breastfeeding by new mothers. ODH trains healthcare staff in Ohio’s birthing centers in an evidence-based practice that supports breastfeeding.
2015: The federal Agency for Healthcare Research and Quality developed a Pathways Community HUB Model as a community care coordination approach focused on reducing modifiable risk factors for high-risk individuals and populations. The Ohio Commission on Minority Health provides funding to expand the HUB model in Ohio, using certified community health workers to identify women at risk and connect them to healthcare and other social services using a prescribed pregnancy pathway.
2015: ODH partners with The Paul J. Aicher Foundation and its Everyday Democracy Program to support the nine urban Ohio Equity Institute teams. Everyday Democracy assists the teams by enhancing community engagement to raise awareness about the connections between social determinants of health and infant mortality; increase public knowledge and awareness around populations most impacted by high infant mortality; and engage the community in conversations.
2015: The Ohio Equity Institute teams launch evidence-based interventions to address highest risk populations. Interventions include Centering Pregnancy programs, safe sleep initiatives, use of progesterone to reduce preterm births, and smoking cessation initiatives.
2015: ODH launches a public awareness campaign to about infant mortality in the nine Ohio Equity Institute urban communities.
2015: The Ohio Collaborative to Prevent Infant Mortality compiles a set of policy recommendations for consideration by the Ohio Commission on Infant Mortality.
2016: The state surges millions of new dollars into local communities to support initiatives to improve birth outcomes and reduce racial and ethnic disparities in infant mortality. This includes $26.8 million through the Ohio Medicaid program to support 46 community-driven projects in nine Ohio metropolitan areas that accounted for 59 percent of all infant deaths, and 86 percent of African-American infant deaths, in Ohio in 2016.
2016: ODH helps Ohio Equity Institute teams build capacity for infant mortality data analysis by funding an epidemiologist in each of nine high-risk metropolitan areas. This data analysis support helps communities in planning, implementing and evaluating infant mortality activities at the local level.
2016: ODH in collaboration with state and local partners conducts a State Health Assessment that identifies maternal and child health issues like infant mortality as a priority, and begins development of a new State Health Improvement Plan that addresses maternal and child health, including infant mortality.
2016: ODH partners with the Ohio Department of Medicaid and the Government Resource Center at The Ohio State University to design and implement an updated Ohio survey of new mothers. Survey data will be used to help identify infant mortality risk factors in nine high-risk metropolitan areas and statewide.
2016: Since its inception in July 2015, 70 percent of Ohio’s maternity hospitals have been recognized by the “Ohio First Steps for Healthy Babies” recognition program co-sponsored by ODH and the Ohio Hospital Association to encourage hospitals to promote and support breastfeeding by new mothers. According to ODH vital statistics data, more newborns are breastfed before hospital discharge in 2016 (73.5 percent) than in 2015.
2016: ODH revamps Ohio’s Home Visiting program, including the use of vital statistics data to fund programs in communities at higher risk for poor birth outcomes. ODH also leverages state and federal funding to expand the use of evidenced-based home visiting approaches in Ohio’s most at-risk communities. Deploying evidenced-based home visiting models, the agency serves nearly 10,500 families in 2016.
2011: The Governor’s Office of Health Transformation works with Ohio Departments of Medicaid, Health, Mental Health and Addiction Services, and other human services agencies to initiate a comprehensive package of reforms to improve overall health system performance for pregnant women and infants.
2013: The 2012-13 state budget provides temporary Medicaid coverage enabling pregnant women to receive medical care while their Medicaid application is processed, accelerating quicker access to care for better birth outcomes.
2013: The Ohio Department of Medicaid promotes better birth outcomes and encourages appropriate postpartum visits as well as family planning services by holding managed care plans accountable for minimum performance standards on related measures.
2013: Ohio Medicaid managed care plans and hospital neonatal intensive care units (NICUs) forge partnerships focused on transitioning infants from NICUs to the home setting, including opportunities for the managed care plans to bridge gaps in care during the transition.
2014: The Pregnancy Associated Mortality Review program becomes one of six programs nationally selected to participate in the Every Mother Initiative, which enables Ohio to strengthen its maternal mortality surveillance system.
2014: Medicaid benefits are extended in Ohio, providing coverage for more women of reproductive age and increasing their access to healthcare services, including prenatal care.
2014: Ohio’s birth certificate begins tracking important indicators of evidence-based care including provision of progesterone therapy and exclusive breastmilk feeding during the hospital stay of mother and baby.
2015: ODH and its partners conduct a series of training sessions for hospital staff across Ohio on use of the Integrated Perinatal Health Information System which automates the reporting and collection of pregnancy and newborn data.
2015: “Centering Pregnancy” is an evidence-based health care delivery model that integrates maternal health care assessment, education, and support. ODH and the Ohio Association of Community Health Centers establish pilot Centering Pregnancy programs in four communities that are at high-risk for poor infant health outcomes in Columbus, Dayton, Zanesville and Toledo.
2016: ODH in collaboration with state and local partners conducts a State Health Assessment that identifiesmaternal and child health issues like infant mortality as a priority. They begin development of a new State Health Improvement Plan that addresses maternal and child health, including infant mortality as a statewide priority to be addressed collaboratively at the state and local levels.
2016: The CenteringPregnancy© evidence-based model of care expands to eight sites throughout Ohio.
2016: The state begins using data analytics in new ways to better understand how to identify women at risk for poor birth outcomes, and how to use data to inform initiatives addressing infant mortality and disparities.
2016: ODH and the Ohio Department of Medicaid develop common measures/outcomes and enhanced data sharing to address infant mortality.