Study: Racial disparities in infant mortality persist in Ohio over past decade

A new study reveals lingering gaps in infant mortality among minorities in Ohio that require more than just health care intervention.

A report by the Ohio Health Policy Institute over the past decade showed that infant mortality has been gradually decreasing overall, but for black Ohioans the rate is still 164% higher than for white Ohioans.

“Despite the efforts of many in both the public and private sectors, progress since 2011 has been minimal and uneven, and Ohio’s infant mortality rate remains higher than most other states,” the study says.

From 2011 to 2021, the overall infant mortality rate rose from 7.9 to 7 per 1,000 births. But among blacks, the rate has risen from 16 per 1,000 births in 2011 to 14.2 in 2021.

Hispanic infant mortality rates are also slightly higher than the state average, at 7.4 deaths per 1,000 births.

“These racial disparities in infant mortality persist even after controlling for parental income and education,” the study says. “Rather, the evidence is clear that racism is a major cause of racial disparities in child mortality.”

The study also comes after new data from the CDC shows maternal mortality among young mothers is higher than in other industrialized countries, and black infant deaths across the country have increased in the course of the COVID-19 pandemic.

Half of the “modifiable factors” found by the institute in a 2023 report that could affect overall health were related to “community conditions” such as education, employment, housing and transportation.

The main causes of infant mortality have been found to be poor birth outcomes; sudden unexplained infant death; and accidents, injuries and violence. Linked to these reasons is insufficient access to prenatal and postnatal care, as well as a lack of access to healthy diets, physical activity, education and employment.

In the HPIO study, poverty and “toxic and persistent stress” are seen as additional negative health and equity outcomes, causing higher rates of infant mortality.

The recommendations made in the study for non-health interventions included job support, employment benefits and leave policies, rental assistance, medical support, and public transportation support.

The Institute used this report for a 2017 HPIO study and found that only 17% of the 127 recommendations made in that year’s report were implemented.

Progress has been made in education and transportation through the prioritization of home visits by Ohio families and the statewide ODOT plan for cyclists and walkers. HPIO found “some progress” in employment, thanks to an increase in Ohio’s earned income tax credit from 10% to 30% in 2019 and an increase in 2021 in state childcare subsidies from 130% to 142% of the federal poverty level.

The institute found that the state has made no progress on housing, notably noting House Bill 430, last year’s law that would bar local governments from moving forward with rent stabilization policies or rent controls.

Legislators can incentivize employers to provide childcare, especially for low-wage workers, and could change Ohio law to use gasoline taxes and vehicle fees for transportation systems, the study says.

While organizations and government agencies have made efforts to prevent infant mortality, measures that have focused only on public health and pregnancy health can do little, the HPIO researchers concluded.

“Improving factors other than access to healthcare is needed to revive Ohio’s stalled progress in reducing infant mortality,” the study said.

Removing racism in general and “structural barriers” remains one of the highest and most important priorities HPIO sees in addressing infant mortality in the future.

“Racism does not only occur between individuals, but is sustained by institutions and systems in society,” the 2023 study says.

The process of eradicating racism must begin with a genuine partnership with black Ohioans, and with policies and programs designed for them to build trust and engagement.

HPIO recommended that the State General Assembly require an impact assessment.

“Public policy makers can continue to implement and fund evidence-based policy in existing plans to achieve equity in community settings and birth outcomes,” said HPIO.