KOKOMO — Long one of the states with the highest infant mortality rates, Indiana has made improvements thanks to recent efforts and initiatives, but experts say there’s still work to be done.
Historically speaking
Being in the top 10 of something is usually a good thing, but not when it comes to infant mortality.
Near the top of infant mortality rates per 1,000 births is where Indiana has historically been, though.
In 2017, the state’s 7.5 deaths per 1,000 births was ninth-highest in the state. Infant mortality is defined as the death of an infant before the baby is 1 year old.
The rate per 1,000 has stayed in the 7s for most of the past decade — above the national average, which has hovered around 6 per 1,000 over the same time period and dropped to 5.6 per 1,000 in 2019.
Many factors, including a mother’s overall health, contribute to infant mortality rates. That said, Indiana’s historically high infant mortality rate is unsurprising, as the state was also the 12th-most obese state in the U.S. in 2017, according to CDC data, and 13.4% of pregnant Hoosier mothers smoke during their pregnancy, according to the ISDH.
Since 2017, though, the state’s infant mortality rate has been on a slight but steady decline.
In 2019, the Indiana State Department of Health reported an infant mortality rate of 6.5 deaths, the lowest rate in the state’s recorded history. In all, 527 babies died before their first birthday in 2019, down from 559 in 2018 and 602 in 2017. In the past five years, more than 2,900 infant lives in Indiana have been lost.
Perhaps most notably has been the decline in infant mortality among Black Hoosiers.
Over the past decade, the mortality rate for Black infants has been on a roller coaster ride, going down and back up since 2010. From 2017-2019, though, the infant mortality rate among Black infants has shown a steady decline, from a decade high of 15.4 per 1,000 in 2017 to a decade low of 11 in 2019.
That said, infant mortality for Black people in the state are still markedly higher than other races. Those racial disparities can be seen not only in Indiana but across the United States.
According to the ISDH, the mortality rate among white infants in Indiana was 6 per 1,000 in 2019. The mortality rate among Hispanic infants was 6.4 per 1,000 last year.
As a whole, though, the trend in the state is a positive one. Unsurprisingly, state officials last year expressed happiness over the most recent numbers.
“We are committed to ensuring the best chance for a healthy pregnancy and a strong start to life for Indiana’s newborns,” Gov. Eric Holcomb said in a written statement last fall. “While we celebrate these results, our work is far from finished, and we won’t rest as we work to protect our youngest.”
While the state’s infant mortality as a whole has declined in recent years, two of its regions saw an increase over the past five years.
The state’s eastern region — Howard, Tipton, Madison, Delaware counties and more — and the central southwestern region — Vigo, Vermillion, Clay counties and more — are seeing some of the highest infant mortality rates among the state’s 11 hospital regions, increasing 0.6% and 1.8%, respectively, from 2015 to 2019, according to a March ISDH presentation.
Perhaps more alarming, though, is the statewide increase in Sudden Unexpected Infant Death (SUID).
As the name suggests, SUID is the sudden, unexpected death of an infant under the age of 1, and it includes sudden infant death syndrome (SIDS), accidental suffocation in a sleeping environment and other deaths from unknown causes.
Unlike infant mortality, the SUID rate has been on the rise since 2010.
According to the ISDH, the state’s SUID rate per 100,000 live births was 69.2. In 2019, it was 122.4 — the highest it’s ever been since 2010. The state’s eastern and central southwest regions have the second- and third-highest SUID rate among the state’s 11 regions, with 156 deaths per 100,000 live births and 150.3 per 100,000, respectively.
While any infant death is tragic, local experts say SUID deaths are particularly tragic, as they’re almost always avoidable with proper education.
“We really think this is one of those preventable things,” said Barb Hilton, director of Prevent Child Abuse Howard County and member of the Infant Mortality Prevention Action Team of Howard County task force. “If people followed the different practices to reduce risk, we could eliminate these.”
Education, education, education
Indiana made one of its biggest steps toward tackling infant mortality in 2019, when House Bill 1007 was passed.
The bill pairs women covered by Medicaid in high-risk ZIP codes with a health care worker to help coordinate their care during and immediately after pregnancy.
Dubbed “My Healthy Baby,” the program has launched in 42 counties, including Vigo, Cass, Miami, Elkhart and Madison counties, with planned rollouts to other counties — including Howard and Tipton — in 2022. By 2023, all 92 counties will be in the program.
The initiative is part of Holcomb’s legislative agenda and part of his goal to make Indiana’s infant mortality rate the lowest in the Midwest by 2024.
While My Healthy Baby is an important piece of the puzzle in lowering the infant mortality rate, community outreach, classes teaching proper and safe infant care and programs within the hospitals are just as important, especially for those not eligible for Medicaid.
Elaine Smith, director of Women’s and Children’s Services at Community Hospital of Anderson and Kokomo, said the Community Hospital network now shows video testimonies from mothers who have lost their babies to SUID and tell their experience in hopes that will better make the information stick more than simply a physician saying it.
“It’s one thing for me to come into the room and tell you this ... but when you actually talk to somebody who has experienced it, maybe there will be a little more bang for your buck when it’s talked about,” Smith said.
In Howard County and other communities across the state, the ISDH and Indiana Department of Child Services have collaborated with local agencies to create task forces with the sole aim to educate the community on how to prevent infant deaths.
Hilton is part of the task force in Howard County, which was created in March. According to the ISDH, Howard County has seen 36 infant deaths — 25% of which were sudden, unexpected infant deaths, including sleep-related suffocations — between 2015 and 2019.
The task force has been busy in October, running billboard and radio ads, holding virtual “Baby Boot Camps,” giving every new family in October an educational booklet on safe sleep and hosting free training sessions. October is Sudden Infant Death Syndrome awareness month.
Hilton said the group’s biggest obstacle so far has been changing learned habits from family members.
“I do think it takes a while to change habits,” Hilton said. “Even though your parents may have done it a certain way, now we know it may not be the safest way of doing it.
“Part of it is also that it’s just hard. It’s hard not not to fall asleep on the couch with a baby when you’re tired. Sometimes it’s easier when a mother is breastfeeding to have the baby in bed with them, and that’s OK as long as the baby is put back. But it’s hard to follow all the different recommendations.”
Both Hilton and Smith are also concerned about the negative effects the COVID-19 pandemic had on the state and region’s positive strides on infant mortality. With face-to-face and elective visits to physicians and hospitals temporarily put on hold for months and groups unable to hold training sessions for safety reasons, both expect to see cases of SUID tick up.
Regardless, Smith said it’s important — maybe even more so now — to continue with the education and training efforts to not only save lives but also improve overall health, as those who lost an infant are more likely to never have a kid again, abuse drugs or develop mental health problems.
“There’s now billboards around, but people get immune to those things, so it’s difficult to get to people, but we have to keep trying,” Smith said.