“Infant mortality is so much more than just a medical issue; it's a sensitive measure of what's going on in the community, influenced by multiple intersecting social, economic, and environmental factors."
Amanda Zabala, MPH
Deputy Director, CelebrateOne
One hundred twenty-six.
That’s how many babies died in Franklin County, Ohio last year. That’s six kindergarten classes worth of children whose parents, families, and caregivers never celebrated their first birthdays. For some, these may just be numbers – the numerator in an equation that means nothing to the lay person. But for CelebrateOne and others who work in this space – doctors, birth workers, first responders, public health professionals and the like who know these families’ stories and the names of the children these families had to bury – the devastation of losing more than 120 babies every year is simply heart-wrenching.
Over the years people have asked and theorized why babies in our community continue to die. Perhaps it’s a healthcare access or quality issue, they’ve speculated. While certainly a contributor to the outcome, infant mortality is so much more than just a medical issue; it’s a sensitive measure of what’s going on in the community, influenced by multiple intersecting social, economic, and environmental factors. In Franklin County, the vast majority of deaths are due to babies being born too soon and from sleep-related causes. What’s more, Black babies die from these and other causes at a higher rate than any other racial group: for every one White baby that dies, three Black babies perish. We’ve deployed countless interventions in an effort to reverse our alarming rates of infant death, and while we’ve seen some improvements overall, the data show that these interventions are working better and faster for our White community than they are for our Black community, resulting in a persistent and widening racial disparity.
Why is this happening, you ask? The complicated answer is that the structures our society has put in place affect the conditions in which people live, thereby influencing (sometimes limiting) people’s opportunities to achieve optimal health. Simply put, that means things like classism, sexism, and racism have influenced whether people have access to affordable, quality housing, food, education, employment, transportation, health care, child care, and other basic needs – the things people don’t realize influence the health of a pregnancy or whether a child will live to see the age of one.
For decades we focused on improving individual health behaviors as a means of combatting infant mortality: eat well, exercise, rest, take a prenatal vitamin, breastfeed, put your baby to sleep alone, on their back, and in an empty crib…. The list goes on. While these behaviors are undoubtedly important, we have to realize that people don’t make decisions about their health behaviors in a vacuum. How often have we stopped to question whether someone has the resources to obtain healthy foods, or the time to exercise or rest if they work multiple jobs to make ends meet, or the human or financial supports needed to sustain breastfeeding or safe sleep practices? Or why we even have to ask these questions in the first place?
Fortunately, solutions to our infant mortality crisis are available; it’s simply a matter of funding and political will. We need to focus funding and programmatic efforts on addressing those key drivers of health, in addition to those that address individual behaviors; this includes housing programs for pregnant and newly parenting people, food prescriptions and community gardens, group prenatal care models and other forms of care coordination. We need to rethink funding models, focusing on participatory grantmaking, trust-based philanthropy, and low-barrier funding for grassroots organizations to build their capacity to sustain the work they’re already doing. We need policies, like paid leave and refundable child tax credits, that make it easier for families to care for their children. We need to intentionally invest in people and organizations that are working with or on behalf of the populations with the worst birth outcomes. We need lawmakers, gatekeepers, and decision makers to recognize the value of these investments and continually advocate for their inclusion in state operations and capital budgets. And we need every resident to acknowledge the historical and ongoing impacts of racism, sexism, and classism on health outcomes for all people, not just people of color, women, or low-income residents.
Change is possible. CelebrateOne, a collective impact organization charged with improving maternal and infant health in Columbus, Ohio, is working on this daily. Infant mortality is a complex issue and hopelessness is a feeling we all fight as we chip away at our stubborn rates. But this work is critically important. To the one hundred twenty-six families of 2023: We see you. We hear you. We’re fighting for you and anyone else having a baby in our city. And we’re confident that one day, every baby will live to see their first birthday. Will you join us in this fight?