Indiana Infant Mortality- another smokescreen

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.

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