For over a decade Indiana’s Infant mortality rate remains in the top seven highest in the nation. At 7.5 deaths for every 1,000, Indiana’s rate is well above the US rate of 5.9. For years our state studied the data and recognized the healthcare disparity between minority populations. We know the chief causes and what we need to fund :accessibility to pre-natal care, nutritional programs, availability of advisors or doulas, and education.
But year after year what has been funded are programs aimed at addressing the behavior of the expectant mother-: education on infant sleeping and primarily identifying expectant mothers who use drugs alcohol and smoke.
This week Governor Holcomb with Health Commissioner Dr. Kristina Box Health announced her standing order to allow the purchase of tobacco cessation products at Indiana pharmacies without having to obtain an individual prescription. Dr. Box emphasized reducing the smoking rate of expectant women is a main priority to get Indiana’s infant mortality to Holcomb’s “Best in Midwest” by 2024. And she cited alarming statistics connecting infant mortality to women who smoke.
It’s another smokescreen. as every year since 2014 Indiana’s Governors loudly promise to decrease infant mortality . And every year Indiana focuses on the mother’s behavior and refuse to address their own. The top five causes of infant mortality in the US have been virtually unchanged for years: birth defects, pre-term birth- low birth weight, pregnancy complications, sudden infant death syndrome, and injuries. Access to pre-natal and post-partum care would have an immediate impact on these causes. Smoking -by woman who are pregnant and second hand smoke are contributing factors along with food deserts, environmental toxins, and access to healthcare.
Thus Indiana will again fund smoke free organization rather than programs with proven results.This session legislators cut funding (on the last day of session) from Sen. Breaux bill which directly addressed access to pre-natal care .
Teen pregnancies, another contributing factor , prompted Rep. Kirchhofer and Sen. Leising to author legislation allowing teens to make medical decisions without guardian. The Senate defeat of Leising’s bill included no votes by lawmakers representing the seven Indiana counties with the highest rates of Infant Mortality. (Fortunately the House version passed.)
Healthcare disparity among minority populations increases mortality. Black infant mortality makes up half of Indiana’s 602 deaths. This year Rep. Greg Porter’s attempted amendment for funding those counties with highest rates was ruled out of order.
This continued funding of programs not based on sound research or evidenced based prenatal healthcare is futile, fatal, and fiscally irresponsible.
Why futile ? The above chart contains data from Division of Maternal and Child Health The last column is the infant mortality rate per 1,000 births. These are a few of the counties with the highest infant mortality rates over the entire state yet have significantly lower percentage of women who smoke during pregnancy. Moreover some of the counties with the lowest (unstable) rate of infant mortality have highest percent of women who smoke. (Keep in mind not all infant mortalities are connected to women who smoke) While there are some counties both higher infant mortality rate and greater percentage of smokers, overall smoking is a contributing factor to the causes but it is not the factor .
If Indiana has learned anything from these years of unsuccessful attempts to lower the rate it is clear that blaming the mother is not it. Her behavior is not the reason Indiana has a higher rate of Infant mortality than 43 other states and almost every nation .What needs to change is indiana’s behavior. Increase funding for pre-natal care, programs that enhance access to care, intentional efforts in minority and teen populations, and removing environmental toxins and economic barriers.
About removing the prescription requirement as it relates to women who are pregnant. While tobacco cessation products no longer carry an FDA warning, there remains concerns for side effects… To date there is no data to promote the safety of these products on women who are pregnant ot the fetus. There is also no data that correlates use of the product to negative effects. What IS clear is that women who are pregnant and using tobacco cessation products need to be regularly monitored by their OB.
But Indiana is not funding increased prenatal care.