INITIATIVES

Baby in mothers handsMost infant deaths in Ohio occur when babies:

  • Are born too early (pre-term births are those before 37 weeks gestation).

  • Die due to sleep-related causes, including Sudden Infant Death Syndrome (SIDS), asphyxia and undetermined causes.

  • Are born with a serious birth defect.

Some risk factors, such as smoking, may contribute to more than one of the above factors. Since 2011, the Governor’s Office of Health Transformation, The Ohio Departments of Health, Medicaid, Mental Health and Addiction Services, and other partners at the state and local levels have pursued a comprehensive range of initiatives to help more babies reach their first birthday. Ohio has invested nearly $41.3 million over the past five years to support state and local initiatives that help address infant mortality.

2016-2017 New Initiatives

Ohio is implementing new initiatives in 2016-2017 to tackle the leading causes of infant mortality, focus resources where the needs are greatest, implement system changes that will help save babies’ lives, and surge new resources and continue ongoing funding to support local infant mortality initiatives in high-risk communities.

  • Smoking during pregnancy is one of the most common preventable risk factors in infant mortality. New state funding is being used to expand tools, training and technical assistance for treating tobacco use; train for the Baby & Me, Tobacco Free and the Moms Quit for Two programs; expand the Certified Tobacco Treatment Specialists program; and evaluating progress through data analysis.

  • Birth intervals of at least 18 months reduce the risk of low birth-weight, pre-term birth, placental abruption and other poor birth outcomes and maternal morbidities. ODH is funding initiatives to educate healthcare providers and other professionals who interact with women of reproductive age and men on the use of planning tools to promote safe birth spacing and reproductive health planning, in addition to providing comprehensive reproductive health and wellness services to approximately 30,000 women, men and adolescents.
  • ODH maintains a birth defects surveillance system of reportable birth defects to detect trends and epidemics; facilitate access to treatment and intervention services to improve children’s health outcomes; and inform and educate health professionals and the public about birth defects and how they may be prevented. The Centers for Disease Control and Prevention has awarded funding to ODH to implement systems to identify potential birth defects linked to the Zika virus in pregnant women – microcephaly, hydrocephaly, arthrogryposis and other central nervous system brain reduction birth defects.
  • ODH is strengthening the screening and referral process in its free Cribs for Kids program to give priority to eligible families in in high-risk communities. The Cribs for Kids program promotes the use of cribs as a safe sleep practice for infants.

  • ODH is investing another $500,000 in a comprehensive public awareness campaign in the nine Ohio Equity Institute communities about the risk of sleep-related deaths and the ABCs of safe sleep practices for infants (Alone, on their Back, in a Crib).
  • ODH is supporting the Ohio Equity Institute communities in building capacity for data analysis by funding epidemiologists in each community. This data analysis support will equip communities in planning, implementing and evaluating infant mortality activities at the local level. An evaluation of the overall statewide and local Ohio Equity Institute infant mortality efforts will be conducted using a model developed in collaboration with Harvard University and the Centers for Disease Control and Prevention.

  • Infant mortality evidence-based interventions are being implemented and evaluated by Ohio Equity Institute communities. The Centering Pregnancy model of care and safe birth-spacing life planning are being implemented in five communities; safe sleep initiatives are being implemented in three communities; increased community engagement and progesterone therapy are being pursued in two communities; and smoking cessation and case management are being implemented in one community.
  • The Ohio Department of Medicaid is investing $26.8 million in State Fiscal Year 2016-17 through its five Medicaid managed care plans to support work in the nine Ohio Equity Institute communities. The funding is being used to increase awareness about infant mortality in high-risk communities through community engagement, and to increase care coordination among agencies that provide care for at-risk women and infants.

  • ODH and The Ohio Department of Medicaid are partnering with the Government Resource Center at Ohio State University to design and implement a new Ohio survey of new mothers. Data from the survey will be used to assess infant mortality risk factors in Ohio Equity Institute communities and to monitor statewide infant mortality risk factors.

  • The Governor’s Office of Health Transformation, along with partnering state agencies, are facilitating an Infant Mortality Research Partnership with Ohio’s universities through the Government Resource Center at The Ohio State University. The research is focused on identifying high-risk communities; predictive modeling for infant mortality; assessing the impact of improved access to care, safe sleep practices, home visiting programs and use of progesterone on infant mortality.

  • A hormone medication called progesterone has the potential to reduce the incidence of preterm birth. Supported by ODH and The Ohio Department of Medicaid, the Ohio Perinatal Quality Collaborative’s (OPQC) progesterone project is expanding from five community health center pilot sites to all 46 of Ohio’s federally qualified health centers, and from 21 to 23 other outpatient clinics. They are joining the original 20 hospitals and healthcare systems participating in the progesterone project. To record and track performance of dozens of its quality improvement measures, OPQC is launching a data infrastructure development project with more than 1,110 users at approximately 125 Ohio hospitals and medical practices.

  • The Governor’s Office of Health Transformation, ODH and other partners are aligning state and local public health and population health planning in a new State Health Improvement Plan which addresses maternal and child health, including infant mortality. The plan is based on a recent State Health Assessment and will be completed in late 2016. The State Health Improvement Plan and local Community Health Improvement Plans will be aligned to ensure that infant mortality is a priority statewide with targeted, complementary initiatives at the state and local levels.

In the 2016-17 state budget, Ohio allocated $26.8 million through the Ohio Medicaid program to support community-driven proposals to combat infant mortality at the local level. In June 2016, The Ohio Department of Medicaid announced that the funding would support 46 local projects in nine Ohio metropolitan areas that accounted for close to two-thirds of all infant deaths, and 90 percent of black infant deaths, in Ohio in 2015. These communities are Butler Co., Cleveland/Cuyahoga Co., Columbus/Franklin Co., Cincinnati/Hamilton Co., Toledo/Lucas Co., Youngstown/Mahoning Co., Dayton/Montgomery Co., Canton/Stark Co., and Akron/Summit Co. Together with its five contracted managed care plans, Ohio Medicaid engaged local leaders in these communities to identify innovative projects that will connect women and infants to quality health care and care management. Here is more information about this funding and the projects it will support:

In 2017, the state will provide continuing funding to support ongoing local infant mortality initiatives through a combination of general revenue dollars and federal grants:

  • $5.8 million for 27 Ohio counties at risk for poor birth or childhood developmental outcomes to expand local voluntary, evidence-based home visiting services to women during pregnancy, and to parents with young children.

  • $2.6 million for 14 Ohio counties with the highest infant mortality rates for African-American babies to promote healthy pregnancies, positive birth outcomes, and healthy infant growth and development.

  • $2.5 million to support infant mortality initiatives of local Ohio Equity Institute teams.

2011-2015 Initiatives

2013: Smoking is one of the most common preventable risk factors for infant mortality, increasing the risk of miscarriage, premature birth, low birthweight and stillbirth. The 2014-15 state budget includes funding to expand women’s access to providers with tools and training to help them quit smoking.

2013: ODH and The Ohio Department of Medicaid begin working with the Ohio Perinatal Quality Collaborative on its Progesterone Quality Improvement Project. The project’s goal is to improve birth outcomes by encouraging wider use of progesterone treatment, a hormone medication that has the potential to reduce the incidence of preterm birth and reduce the number of infants born before 32 weeks when rates of infant mortality are highest.

2013: ODH and The Ohio Department of Medicaid in partnership with the Ohio Perinatal Quality Collaborative launch an initiative to ensure that all pregnant women at risk of delivering a baby prematurely between 24 and 34 weeks gestation receive antenatal corticosteroids, an evidence-based therapy shown to reduce mortality and morbidity among pre-term infants.

2013: ODH, The Ohio Department of Medicaid and the Ohio Perinatal Quality Collaborative launches an initiative to increase early feeding of mother’s milk to newborns since its protective properties are linked to a reduced risk of some infections and illnesses in newborns.

2014: ODH launches a public awareness campaign focused on pregnant women and second-hand smoke exposure.

2015: The Ohio Perinatal Quality Collaborative’s (OPQC) Progesterone Quality Improvement Project begins recruiting 23 outpatient clinics to participate in the progesterone project, 21 of them located in high-risk communities. ODH and The Ohio Department of Medicaid, in collaboration with The Ohio State University Government Resource Center and Cincinnati Children’s Hospital Medical Center, continue funding and support for OPQC’s progesterone project.

2015: ODH engages the Clinical Skills Education and Assessment Center at The Ohio State University Wexner Medical Center to provide obstetric emergency simulation training for labor and delivery and postpartum unit staff in birthing centers across Ohio. The training focuses on clinical simulations of three medical conditions that can contribute to infant mortality — postpartum hemorrhage, cardiomyopathy, and preeclampsia.

2013: Folic acid is crucial to prevent neural tube defects, which occur in 1 per 1,000 pregnancies. ODH staff develop online training modules for health professionals about this issue.

2013: ODH launches an initiative to work with healthcare providers to increase postpartum screening rates for women with a history of gestational diabetes. Women who enter pregnancy with undiagnosed and uncontrolled diabetes are at greater risk of fetal death or having a child with a birth defect.

2014: In accordance with a new state law, ODH issues rules for the required reporting by birthing centers of results of newborn screenings for Critical Congenital Heart Disease. Heart defects are the most common birth defects reported in Ohio, and are the largest contributor of birth defects that cause infant mortality.

2015: ODH rolls out a new electronic birth defects information system used by hospitals to report to ODH children from birth to age 5 with birth defects. The system is linked with ODH’s vital statistics birth records and sends referrals for parents to early intervention programs in their area.

2016: As part of ODH’s public health preparedness for the potential impact of Zika virus in Ohio, the Centers for Disease Control and Prevention awards funding to ODH to implement systems to identify microcephaly, hydrocephaly, arthrogryposis and other brain reduction birth defects linked to Zika virus in pregnant women.

2011: In cases of sudden, unexpected infant deaths, accurate determination of the cause of death requires a review of the child’s health history, a complete autopsy, and a thorough scene investigation. To improve consistent scene investigations throughout Ohio, ODH begins conducting trainings for coroners, medical examiners and law enforcement jurisdictions to expand implementation of the Centers for Disease Control and Prevention’s Sudden Unexpected Infant Death investigation protocol.

2013: Suffocation is the leading cause of injury-related death for babies before their first birthday. Babies who sleep on couches, in their parents’ bed, or on their stomach are more likely to die from an unexpected sudden cause. The 2014-15 state budget includes funding for a targeted campaign to educate parents, caregivers and healthcare providers about the ABCs of safe sleep practices for infants (Alone, on their Back, in a Crib).

2014: ODH launches a statewide public awareness campaign to help reduce the number of Ohio babies who die in unsafe sleep environments by promoting safe sleep practices for infants.

2014: ODH sponsors the Ohio Sudden Infant Death Network’s “Safe Sleep Community Forums” across the state to increase awareness and education about preventing infant mortality.

2014: ODH and the Ohio Hospital Association has launched the Safe Sleep is Good4Baby statewide initiative to model safe sleep practices in the hospital and educate parents and families about safe sleep practices at home.

2014: A new state law establishes the Safe Sleep Education Program administered by ODH. The law requires hospitals with maternity units and freestanding birthing centers to implement an infant safe sleep screening procedure to assess whether an infant will have a safe crib or other suitable place to sleep after discharge. ODH provides free Cribs for Kids “survival kits” to families who meet financial eligibility guidelines.

2015: The 2016-17 state budget continues funding to support raising public awareness about infant safe sleep practices.

2011: Governor Kasich addresses infant mortality in Ohio in his first State of the State Address and made reducing low birthweight babies a priority.

2011: Ohio Infant Mortality Reduction Initiative programs begin providing community-based outreach and care coordination services in targeted communities with high-risk, low income African-American pregnant women and their infants.

2012: ODH and the Ohio Collaborative to Prevent Infant Mortality host the first biannual statewide Infant Mortality Summit with more than 900 attendees who were encouraged to initiate local conversations about how to reduce infant mortality.

2012: ODH publicly releases Ohio’s infant mortality data for the first time, with the goal of raising public awareness about the issue.

2012: About half of all pregnancies in Ohio are unintended. The Ohio Department of Medicaid adopts a Medicaid Family Planning State Plan Amendment to expand eligibility for family planning services for women and men up to 200 percent of the federal poverty level.

2013: The Ohio Department of Medicaid negotiates new contracts with Medicaid managed care plans to include enhanced maternal care and inter-conception care requirements for women at highest risk for poor pregnancy outcomes.

2013: Ohio’s six children’s hospitals work together supported by a state grant to study babies born addicted to narcotics, known as Neonatal Abstinence Syndrome, and identify best treatment strategies.

2013: The Maternal Opiate Medical Support (MOMS) Project launches as a public-private collaboration to identify and implement promising treatment practices for opioid-dependent pregnant mothers eligible for or enrolled in Medicaid during and after pregnancy. The goal is to prevent Neonatal Abstinence Syndrome which contributes to infant mortality in Ohio.

2013: ODH partners with CityMatCH, a national organization that supports urban maternal and child health initiatives at the local level, to launch the Ohio Institute for Equity in Birth Outcomes, commonly known as the Ohio Equity Institute. The partnership includes nine Ohio metropolitan communities to improve overall birth outcomes and reduce disparities in infant mortality. These metropolitan communities include Butler County, Canton-Stark County, Cincinnati-Hamilton County, Columbus, Cleveland-Cuyahoga County, Youngstown-Mahoning County, Dayton-Montgomery County, Summit County, and Toledo-Lucas County.

2014: ODH and the Ohio Collaborative to Prevent Infant Mortality hosts the second biannual statewide Infant Mortality Summit with more than 1,700 attendees. Governor Kasich announces new initiatives to focus support and resources for the most at-risk mothers and babies.

2014: Governor Kasich signed into law House Bill 394 which created a Commission on Infant Mortality to study the current inventory of state programs and funding streams available to address infant mortality.

2014: ODH partners with the Black Mothers Breastfeeding Association to host regional breastfeeding workshops on “Cultural Competence in Breastfeeding Support for African Americans” for community health workers, staff in Women, Infant and Children programs, and other public health workers.

2014: Ohio Equity Institute teams begin reviewing local data with their communities and use it to select evidence-based interventions to address highest-risk populations in targeted areas.

2014: Eight Ohio Equity Institute teams are trained to conduct Fetal Infant Mortality Reviews, a multi-disciplinary, multi-agency, community-based process that identifies local infant mortality issues through the review of fetal and infant deaths and develops recommendations and initiatives to reduce them.

2015: ODH and the Ohio Hospital Association launches “Ohio First Steps for Healthy Babies” to encourage hospitals to promote and support breastfeeding by new mothers. ODH trains healthcare staff in Ohio’s birthing centers in an evidence-based practice that supports breastfeeding.

2015: The federal Agency for Healthcare Research and Quality developed a Pathways Community HUB Model as a community care coordination approach focused on reducing modifiable risk factors for high-risk individuals and populations. The Ohio Commission on Minority Health provides funding to expand the HUB model in Ohio, using certified community health workers to identify women at risk and connect them to healthcare and other social services using a prescribed pregnancy pathway.

2015: ODH partners with The Paul J. Aicher Foundation and its Everyday Democracy Program to support the nine urban Ohio Equity Institute teams. Everyday Democracy assists the teams by enhancing community engagement to raise awareness about the connections between social determinants of health and infant mortality; increase public knowledge and awareness around populations most impacted by high infant mortality; and engage the community in conversations.

2015: The Ohio Equity Institute teams launch evidence-based interventions to address highest risk populations. Interventions include Centering Pregnancy programs, safe sleep initiatives, use of progesterone to reduce preterm births, and smoking cessation initiatives.

2015: ODH launches a public awareness campaign to about infant mortality in the nine Ohio Equity Institute urban communities.

2015: The Ohio Collaborative to Prevent Infant Mortality compiles a set of policy recommendations for consideration by the Ohio Commission on Infant Mortality.

2011: The Governor’s Office of Health Transformation works with Ohio Departments of Medicaid, Health, Mental Health and Addiction Services, and other human services agencies to initiate a comprehensive package of reforms to improve overall health system performance for pregnant women and infants.

2013: The 2012-13 state budget provides temporary Medicaid coverage enabling pregnant women to receive medical care while their Medicaid application is processed, accelerating quicker access to care for better birth outcomes.

2013: The Ohio Department of Medicaid promotes better birth outcomes and encourages appropriate postpartum visits as well as family planning services by holding managed care plans accountable for minimum performance standards on related measures.

2013: Ohio Medicaid managed care plans and hospital neonatal intensive care units (NICUs) forge partnerships focused on transitioning infants from NICUs to the home setting, including opportunities for the managed care plans to bridge gaps in care during the transition.

2014: The Pregnancy Associated Mortality Review program becomes one of six programs nationally selected to participate in the Every Mother Initiative, which enables Ohio to strengthen its maternal mortality surveillance system.

2014: Medicaid benefits are extended in Ohio, providing coverage for more women of reproductive age and increasing their access to healthcare services, including prenatal care.

2014: Ohio’s birth certificate begins tracking important indicators of evidence-based care including provision of progesterone therapy and exclusive breastmilk feeding during the hospital stay of mother and baby.

2015: ODH and its partners conduct a series of training sessions for hospital staff across Ohio on use of the Integrated Perinatal Health Information System which automates the reporting and collection of pregnancy and newborn data.

2015: “Centering Pregnancy” is an evidence-based health care delivery model that integrates maternal health care assessment, education, and support. ODH and the Ohio Association of Community Health Centers establish pilot Centering Pregnancy programs in four communities that are at high-risk for poor infant health outcomes in Columbus, Dayton, Zanesville and Toledo.