EDITOR’S NOTE: This article is part of an ongoing series on infant mortality in Richland County and has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems.
MANSFIELD – Growing a baby inside the body is no simple task.
Pregnancy brings about a host of changes in a woman’s life, from preparing for the new life they’re incubating to the physical transformation their body will undergo. In addition to the new cocktail of hormones a woman’s body produces, inevitably one of those hormones will be stress.
Stress can come in many forms during pregnancy. A woman may be stressed because of physical discomfort as their body changes, or may be worried about the upcoming labor and birth.
But what if a woman’s stress comes from worrying whether she can feed her family that day? Or not knowing whether her baby will have a house to come home to?
These are real concerns for populations of pregnant women affected by the risk factors identified by Drs. Mark and Sarah Redding in their Community HUB Pathways model. Community health workers address risk factors including primary care, prevention programs, mental and behavioral health facilities, housing, food, clothing, and adult education and employment.
Any one of these risk factors may lead to a poor birth outcome, largely because these risk factors cause significant stress in a pregnant woman’s life, and may lead to preterm birth, the leading cause of infant mortality.
“Stress weighs really, really heavy on a pregnant woman,” said community health worker Kimberly Phinnessee. “It can also cause preterm delivery because if she’s stressed out, then the baby becomes stressed, and it’s a snowball effect.”
There are known medical causes of infant mortality, including preterm birth, unsafe sleep environments and congenital birth defects. However, equally responsible for poor birth outcomes are the root social causes of infant mortality and the chronic stresses and other psychological and environmental barriers associated with these socio-economic conditions.
The effects of stress on infant mortality are documented in the Ohio Commission on Minority Health (OCMH) published a white paper in September 2015 addressing health equity and eliminating infant mortality disparities within racial and ethnic populations.
“Ohioans who have untreated hypertension, undiagnosed or uncontrolled diabetes, or are classified as obese have a higher probability of adverse prenatal and postpartum outcomes,” the OCMH paper states.
“Mothers who reside in ‘food deserts’ where fresh nutritional choices are a limited commodity, are also most certainly residing in a community that is lacking in educational, employment, and life enhancing opportunities. These social factors can result in persistent low-level life stressors.”
According to the paper’s medical expert panel, these chronic stressors result in the release of stress hormones that can contribute to the development of chronic disease processes and place fetal development at risk.
“This is why any solution to the infant mortality problem must be viewed from a ‘life course’ correction perspective in all females who reside in these ‘low opportunity deserts,’” the paper reported.
These stressors certainly exist in Richland County. According to the U.S. Census Bureau, in the year 2014, 15.9 percent of the population in Richland County was living in poverty. That same year, 13.3 percent of the population had not graduated from high school, and 10.9 percent of the population was without health insurance.
According to stateofobesity.org, Ohio has the eighth highest adult obesity rate in the nation at 32.6 percent. The city of Mansfield also struggles with food insecurity, “the state of being without reliable access to a sufficient quantity of affordable, nutritious food.”
“Census tract 6 (in Mansfield’s north end) is probably the truest food desert in that there is low access to transportation, low income and it fits the criteria for the distance from a supermarket, or some venue with fresh produce,” said Tony Chinni, community development manager with Mansfield’s North End Community Improvement Collaborative.
Related to these statistics is Richland County’s infant mortality rate of 7.3 infant deaths per 1,000 infants born. Between the years 2005 and 2015, there were 14,877 live births in Richland County and 108 deaths, according to the Ohio Department of Health.
In the year 2016 alone, the county’s infant mortality rate was 10.4 per 1,000 live births. This equates to 12 infant deaths out of 1,157 live births in Richland County in 2016.
The effect of a woman’s environment on her health is defined by Dr. Maya Rockeymoore as “social determinants of health.” Rockeymoore is the founder of Allies in Reaching Community Health Equity (ARCHE), a network of health and racial justice experts committed to ensuring all Americans have the opportunity to live healthy lives.
“We created (ARCHE) because we felt like there needed to be an emphasis in public health on health equity,” Rockeymoore said. “We needed the field to understand the importance of health equity approaches in addressing some of the more outstanding public health challenges of our time.”
ARCHE was created as a project of the Center for Global Policy Solutions, a 501c3 nonprofit organization dedicated to driving society toward inclusion, of which Rockeymoore is the president. She discovered that often times, low income populations and rural communities were pockets of stubborn resistance to issues related to typical mainstream policy options.
“There is a burgeoning amount of evidence and research that shows it’s not just whether or not a person makes a decision to be healthy, it’s a whole host of factors that actually contribute to health outcomes,” Rockeymoore explained. “Because those host of factors are influenced by broader cultural, social and political structures, we have a whole host of challenges we have to understand beyond the individual.”
Does your job provide health benefits? Do you live in housing detrimental to your health? Does your neighborhood have a grocery store? Do you feel safe going outside to get exercise? Does your neighborhood support your health?
“These are issues that are cross-cutting and intersectional,” Rockeymoore said. “When you have high infant mortality rates, you tend to have higher poverty, weaker social structures, less investment in healthcare and less coordinated care focused on supporting low income populations. You might even have issues of obesity or drug abuse.
“Infant mortality is the canary in the coal mine,” she said. “If you have higher infant mortality rates, you do have other indicators showing there are challenges and problems in that community.”
For this reason, when it comes to alleviating the stressors surrounding women and pregnancy, it’s important to take a broader view. The OCMH paper specifically mentions the Life-Course Perspective researched by Dr. Michael Lu, associate administrator of the Maternal and Child Health Bureau of the Health Resources and Services Administration.
“The Life- Course Perspective means that birth outcomes are the product of not only nine months during pregnancy but experiences over the lifespan,” the paper states. “Chronic and repeated stress over the mother’s lifespan can adversely influence birth outcomes.”
The Life-Course Perspective suggests that many of the risk factors that influence health and wellbeing across a person’s lifespan also play an important role in birth outcomes and in health and quality of life beyond an infant’s initial years.
For Rockeymoore, addressing this problem starts with policy makers. In the meantime, the influence of social and political factors on outcomes is, in her opinion, unacceptable.
“We know we have challenges in this country still, and what’s so sad about it is we’re the richest and most powerful country in the world, and yet we allow this,” Rockeymoore said.
“I say ‘allow’ because it’s structural in nature. This could be solved tomorrow if there was the political will to do what’s needed in order to address the circumstances of lower income women who are pregnant and giving birth.”
