Black Infant Mortality Rate Tough to Reduce — But Lorain County Did It

Lorain County's five-year average infant morality rate in 2018 was eight deaths per 1,000 live births. In 2011, it was more than twice that.

“21.7 [per 1,000 live births] was our five-year rolling average, which is a pretty high rate," said the county's health commissioner Dave Covell. "Our average rate among white babies was 7.2, so you can see there's a huge discrepancy.”

In its 2011 community health improvement plan, Lorain County Public Health identified infant mortality as a health outcome to address over the next several years. Covell said public health agencies in the county launched a collaborative effort to reduce the overall rate, and they focused efforts on reducing the racial disparities between black and white babies.

A key part of that was connecting moms with community health workers.

"We do a lot of work on home visiting, where we have community health workers working in the community, with moms. They'll try to get to moms early on, prenatally if possible, and then try to work with them through the birth and then all the way through the first year," Covell said.

One county partner that provides home visit services is the Mercy Health Resource Mothers program. The Resource Mothers assist moms in the county with services and information throughout their pregnancy and until their child turns one.

"In a doctor's office, they can say whatever they want. But we can actually see what's going on in the home and address it and maybe make some suggestions," said Jill Sands, one of the Resource Mothers.   

Some of the services they provide moms include education about car seat safety, sleep death prevention, and smoking during pregnancy. The Resource Mothers often give their clients more than just medical insight, Sands said.

"It's kind of like visiting a friend," she said.

Resource Mother Jill Sands discusses Isaiah's development with her client, Anahjae Milton. [Anna Huntsman / ideastream]

One of her clients, Anahjae Milton, said Sands helped her gain confidence in breastfeeding her 8-month-old son, Isaiah. They even put together a breastfeeding schedule so Milton could start taking classes at Lorain County Community College this semester.

“It’s a huge support system for people who feel like they can’t do stuff by [themselves] or just feel like they don’t have the strength to be a parent," she said. "There is somebody out there who will help you.”

Home visits likely contributed to the county's black infant mortality rate going down, Covell said, but he can’t pinpoint an exact cause for the dramatic drop yet. County data shows there was no decrease in premature births and no change in birthweights or prenatal appointments. The data suggests only one significant change: a decrease in African American moms smoking while pregnant.

“Of all the smoking guns, if you will, of the things that we think really made an impact, reduction in tobacco use was clearly one," he said.

The five-year average maternal tobacco use rate for African Americans decreased 15 percent from 2011 to 2018, which Covell credits to home visits.

But, he says the biggest reason for the overall drop in black infant mortality was simple, effective collaboration across agencies.   

"We kind of brought all those groups together and started to make sure that we're all working in unison," he said. "I'm a big believer in collective impact —  this idea that if we work together on a problem, we have a better chance to have success."

This coordination of efforts has been his biggest piece of advice to other areas in the state looking to replicate Lorain County's efforts, including First Year Cleveland, a public health coalition focused on reducing infant mortality in Cuyahoga County. 

“[Lorain County's} home visiting really attracted us," said Executive Director Bernadette Kerrigan. "We have increased our home visiting slots, but we have to make sure that's more coordinated."

Lorain County public health officials plan to continue focusing on infant mortality, but are now looking to extend their efforts to kindergarten readiness.