Infant mortality continues to be an issue in Ohio, and two former legislators who worked to bring the problem to the forefront are urging the state to do more.

Former Democratic state senator Charleta Tavares and former Republican senator Shannon Jones were a bipartisan duo who spent 2017 getting Senate Bill 332 through the General Assembly. The bill directed the Legislative Service Commission to work with the Health Policy Institute of Ohio on a new approach to addressing infant mortality.

“If we don’t do something as a state, we’re never going to see the changes for infants and moms, but also for the state of Ohio,” Tavares said of her motivation at the time.

Out of that bill came a report with more than 100 recommendations, on every social determinant category from housing to education.

Racial disparities were also shown as major drivers of health outcomes, and they continue to be a big part of the state’s health outlook, with studies showing infant and maternal mortality span all socioeconomic categories and stretch over decades, but still impact people of color more than whites.

“Infant mortality is often referred to as a tip of the iceberg problem, which signifies that there are much bigger problems underneath the surface,” said Amy Rohling McGee, president of the HPIO said in a Thursday meeting with medical professionals and other interested parties.

Recommendation vs. Implementation

Ohio struggles with infant and maternal mortality rates, landing at 41st out of 50 states and the District of Columbia for infant outcomes according to HPIO data. A 2021 study of racial disparities showed a 164% higher mortality rate for black babies over white babies.

Some changes were made to address the issue in the most recent state operating budget, such as doula regulation being put under the direction of the Board of Nursing and doula services being included in Medicaid coverage.

“We are enthused about the opportunities to include doulas in our care for moms in our program,” said Dr. Mary Applegate, director of the Ohio Department of Medicaid, as part of the HPIO meeting. “The budget process did help us sort out regulatory paths in conjunction with the Board of Nursing. It will take us a few months to put those pieces together.”

Applegate said progress is being made at the state Medicaid department, which she said serves as the “majority payer for 52% of moms and infants.”

What would help most would be an aligning of services from federal to state, agency to agency to be able to establish a universal standard to address mortality rates.

“The idea here is that we get to a critical mass and if we organize this way, we now have amplified our effect,” Applegate said.

Though there has also been progress made outside of the budget, including one Central Ohio program that showed the positive outcomes that can come from safe housing for pregnant people and babies, the implementation of the 2017 senate bill recommendations statewide didn’t go as planned.

McGee said at HPIO, “we see the proverbial glass as being half-full,” with 44% of the recommendations showing “some progress,” according to a recent implementation check-in.

But only 17% of the recommendations were fully implemented, 26% were not implemented, and 2% went in the “wrong direction.”

Among the issues headed in the wrong direction according to the HPIO was a recommendation that state legislators pass measures “to reduce or eliminate barriers to obtaining affordable housing,” for which “banning the box” – the term for removing questions about criminal backgrounds from tenant screening as a condition of housing – has not been a legislative priority.

Ohio policymakers also haven’t directed state agencies to “establish low-cost financial incentives that will help public housing authorities to implement housing preferences for pregnant women who are homeless or experiencing housing insecurity,” per the recommendations.

According to advocates, the state has gone in the wrong direction when it comes to creating incentives for municipalities that encourage and develop affordable housing in “high opportunity areas.”

Also not implemented was a recommended incentive program to develop “affordable residential and mixed-use development” close to public transit to help reduce accessibility issues that come with a lack of transportation.

“The most obvious connection between transportation and maternal and child health is that people who are pregnant need transportation to get to prenatal care appointments,” said Dr. Tonni Oberly, HPIO senior policy analyst.

Oberly added that there are other more broad impacts on health outcomes when it comes to transportation, including access to employment and education, and even trips to the grocery store for necessities.

‘Raising Cain’

For the former legislators, it’s been frustrating to watch as the state continues to languish under high infant mortality numbers, without implementing the needed changes that would protect the children current legislators say are their highest priority.

“I wish I could say I was surprised,” said Jones, now CEO of the research and advocacy group Groundwork Ohio. “I just think that’s the nature of government, and I think if Charleta and I were still in the legislature, we would be raising Cain all over to try to keep focus on this issue.”

Tavares, who now heads PrimaryOne Health, said it was helpful at the time to be able to reach across the aisle and have someone on the “opposite side of the political spectrum” understand that infant mortality was an issue in desperate need of a solution.

Once the two became united in their goal, the issue that is entangled in every aspect of health outcomes and socioeconomics suddenly became much less complicated.

“Once I really took the time to understand a very complicated issue, I knew that the two of us were unified behind the common purpose of wanting to support pregnant women and babies in our state,” Jones said.

Both women expressed disappointment at the progress the state has made with such specific recommendations at its disposal. Tavares doesn’t believe it’s a matter of a lack of resources within the state, but a lack of focus on the urgency of need.

“I think when you don’t have a timeline, when you don’t force yourself to do something … you pick the (recommendations) that either you want to do or the ones that are easiest to do,” Tavares said.

Getting the public, along with policymakers and providers, to connect the health issues with outside impacts such as housing, transportation, and the systemic racism that still exists within state institutions, is important in driving home the need for policy changes, according to Jones and Tavares.

“There is not a Staples ‘easy’ button when it comes to advocacy, I think you just have to be relentless,” Jones said. “…This has been 10 years since I’ve been talking about it and I’m way late to the party, so I don’t know what it’s going to take.”