Indiana ranks among the worst in the country in infant mortality rates, according to statistics from the Indiana Department of Health. Not only is the state above the national average for infant deaths, but it also has higher rates of pre-term births and prenatal smoking and a lower rate of pregnant women who receive prenatal care in the first trimester.
These problems are rampant in Indiana, but not across the entire population, said Dr. Jen Walthall, deputy health commissioner for the Indiana State Health Department.
“What we see in Indiana is that we can really do well ensuring prenatal care and healthy births in a select group of women,” Walthall said. “Our infant mortality rate in white women is much better than the national average.”
However, Indiana’s black infant mortality rate is 2.6 times higher than the white infant mortality rate — more than 15 deaths for every thousand live births.
Diseases that can lead to pre-term labor, such as diabetes and hypertension, are more common among black women and contribute to the high black infant mortality rate. The Hispanic rate is also higher than the white rate, though the black rate is by far the worst, Walthall said. Lack of access to healthcare is a huge barrier for black and Hispanic populations.
The gap in mortality rates between whites and minorities is an example of a health disparity. These are defined as “preventable differences in the burden of disease, injury, violence or opportunities to achieve optimal health that are experienced by socially disadvantaged populations,” according to the Centers for Disease Control and Prevention.
All of Indiana’s infant mortality problems are anchored in health disparity, Walthall said.
“We have a huge health disparity gap to the point that if we could fix that we could solve that problem entirely,” Walthall said. “Your outcome should not be based on who you are or where you live.”
Sen. Robin Kelly, D-Illinois, released a report this year on health disparities in America and said this is a national issue at the center of the health crisis.
“We are still a nation where minorities are less likely to get the preventive care needed to stay healthy, less likely to receive quality care and more likely to face poorer health outcomes,” Kelly said in the report.
Minorities often feel unsupported in many facets of life, especially health, said Jane Walter, El Centro Comunal Latino programs and IMCH health coordinator.
“People who are minorities often find themselves living in the shadows, and if you’re living in the shadows, you’re not getting what not you need from your community,” Walter said.
More than 50 percent of the infant deaths in Indiana are a result of prenatal complications. These deaths are preventable, Walthall said, and they represent instances where women did not have access to the care they needed.
Solving the health disparity problem means taking existing programs that work well and expanding them to underserved areas, Walthall said. The Baby & Me Tobacco Free program, which helps expectant mothers quit smoking, and the Nurse Family Partnership, which assigns nurses to first-time mothers and has them visit through the child’s second birthday, are examples of programs the state is planning to expand.
The adoption of the Healthy Indiana Plan 2.0 earlier this year means pregnant women have presumptive eligibility and are covered for the duration of their pregnancy and a certain time after the birth of their child. Walthall said she thinks there are many expectant mothers who are not aware of this.
Lack of insurance and awareness of available resources in minority communities is a huge part of the problem. To combat this, Walthall said the state wants to create an app or web portal that could show uninsured women all the places they can receive care in their area.
Better information campaigns could help too, Walthall said. Many of the infant deaths are a result of unsafe sleep, categorized as Sudden Unexplained Infant Deaths. Better education on safe sleep practice could greatly reduce SUID.
Overall, Walthall said the infant mortality rate problem is not a simple one but the key factor is recognizing that it is fixable.
“All of these deaths are tragedies, and many are avoidable,” Walthall said. “We need to focus on the ones that we can have some action in.”
