Ashtabula County, about 66 miles east of Cleveland, is long way from the urban center but the two Ohio communities have one thing in common -- an above average rate of infant deaths in the first year of life.
ideastream’s Marlene Harris-Taylor reports, as part of our Zip Code: The Hidden Vital Sign series, lack of access to prenatal care and some unhealthy lifestyle choices is major problem in this rural community.
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Ashtabula County’s infant mortality rate of 8.5. per 1,000 live births, is higher than the state average of 7.7 said, Ashtabula County Medical Center V. P. Tina Stasiewski.
“We also have a higher percentage of births that are born to teenagers between the ages of 15 and 19 years old. Also, over 45 percent of the births in Ashtabula County are to unmarried women. So we have a lot of social determinants of health, as we call them, that do truly impact that rate, that mortality rate for infants,"Stasiewski said
The infant mortality rate refers to the death of children under a year old. In rural areas, where populations are smaller officials track baby births over a 10-year period to calculate the overall death rate.
Ashtabula County is a recovering former industrial community on Lake Erie, that is considered to be the northern tip of the Appalachian region. The county has an 18 percent poverty rate which is also higher than the state average.
The reasons for Ashtabula’s high infant death rates are complex – some are structural and while others are tied to personal health choices, Stasiewski said
There is only one hospital in the entire county, so lack of access to prenatal care and pregnancy education for women is a major factor.
“The county has a population of just under 99,000 people with three OB/GYNs. I'd love to say that we could take care of every single woman or every single pregnant woman, but I know that that's not feasible," she said.
Some women have to drive over 30 minutes for prenatal checkups.
According to Scientific American Magazine, Ashtabula is not alone. About six percent of the nation’s obstetricians work in rural areas, while 15 percent of the country’s population live in rural communities.
Regular doctor visits are very important during pregnancy but the strongest predictor of a healthy baby is the mother’s health during the time before she gets pregnant, said Sandy Oxley, the Ohio health department’s Chief of Maternal Child Health.
“And certainly we know, in some rural communities, access to healthy lifestyles are sometimes more challenging than in your more suburban and urban communities -- healthy foods, access to walking paths, and access to exercise opportunities are sometimes more compromised in the rural communities, as well as in a number of rural communities you see higher smoking rates," Oxley said.
The smoking rate for women in Ashtabula is higher than the state average, as are the rates of diabetes and heart disease, which are all indicators of infant mortality. Opioid abuse may also be an issue, Stasiewski said.
“That (smoking rate) has an extremely negative impact on the health of a growing baby, but very much like across the state of Ohio and across the nation, we have an ever-increasing drug problem in Ashtabula County and that may ha ve a connection to infant mortality," Stasiewski said.
Oxley from ODH said, however, currently there is no clear data which correlates opioid use with infant mortality directly. But Stasiewski noted people who are drug addicted often engage in behaviors that could be harmful to an unborn child, such as not showing up for prenatal doctor checkups.
“Going to your physician's office may make it more easy to be found that there is an underlying drug problem as well. In my mind, it has to have some connection. Maybe not as high as the unhealthy lifestyle habits, such as the smoking and the not eating properly, not getting enough exercise, but there has to be some connection," she said.
The Ashtabula County Medical Center offers first trimester prenatal office visits with a nurse, who can spend more time educating women on how to have a healthy pregnancy. And they are also exploring the idea of providing free nicotine patches to pregnant women who smoke to help them quit, Stasiewski said.
ODH is focusing on the high infant death rate through a special program which provide resourcws to some counties around Ohio to help combat the infant mortality problem. Most of the resources, however, are aimed at large population centers, including Cuyahoga County, and not in rural areas like Ashtabula County.
