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State programs aim to prevent premature births as part of strategy to reduce rates of infant mortality

by Tim Anderson ~ December 2015 ~ Stateline Midwest »
Three years ago, wanting to know the story behind the troubling data about infant mortality in Ohio, Sen. Shannon Jones decided to take a tour of her home state. Along with a colleague, Sen. Charleta Tavares, Jones organized visits to local hospitals and met with health care practitioners and social service providers.
Why were infant mortality rates so high in Ohio (almost the nation’s highest at the time)? Why was there such a huge disparity in the rates between black and white infants? What could be done to fix the problem?
Legislators didn’t come back from the statewide tour with any easy answers or magical fixes, but they did return with a resolve to do more to address the problem.
“It’s very complicated,” Jones now says about infant mortality. “The more I learn about it, the more I realize how hard it is to get your arms around. “You’re dealing with a lot of social determinants of health. You think of things like education, transportation and housing, and these are very much related to health outcomes, but not necessarily health care.”
Jones is now helping lead a Commission on Infant Mortality, which began meeting this fall. A primary goal of the group (formed as the result of SB 276, which passed in 2014) is to develop policies that reduce preterm births — the leading cause of infant death.
According to the March of Dimes, about 1 in 10 babies are born prematurely in the United States (defined as the birth of an infant before 37 weeks of pregnancy). The health impacts of preterm births can be devastating, from death to long-term neurological disability. And the costs to a state’s Medicaid system can be enormous.
In Ohio, healthy full-term babies generally cost the Medicaid system $5,000 per delivery. The cost of a pre-term baby averages $50,000 per delivery. The average cost of caring for preterm babies in their first year of life is $32,000 — almost 10 times the average medical expense for full-term babies.
Not all preterm births can be prevented (the causes are numerous and complex), but addressing risk factors such as smoking, lack of prenatal care, and stress can help reduce the rate at which they happen. Separate studies from Illinois and Minnesota (both the result of bills passed by the state legislatures) lay out some of the policy alternatives. In Illinois, for example, the Department of Public Health recommended:
• improving data collection on preterm births in order to make more-informed decisions about intervention and prevention strategies;
• providing high-risk, Medicaid-eligible pregnant women with intensive prenatal case management;
• working with hospitals to eliminate elective, early-term deliveries; and
• bringing more resources to communities with high rates of “adverse pregnancies” — for example, providing pregnant women in these areas with the chance to meet in small groups and learn about healthy behaviors.
In Ohio, Jones believes a mix of new state strategies can lower the state’s rates of preterm births and infant mortality. But an initial step will be to identify the programs already in place and analyze their effectiveness.
“The challenge will then be to bring some of our evidence-based practices to scale,” she says.
One of these is the use of progesterone — a hormone that can prevent some women from delivering early. In Ohio, a statewide Progesterone Project is under way to improve screening of pregnant women and increase use of the hormone among those at risk for preterm birth.
More policy alternatives for Ohio will come when the legislative commission completes its work.