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Solutions Series
Healing Hope

Infant mortality a complex problem locally and nationally

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"Void"

EDITOR'S NOTE: This is part one of a three-part series on infant mortality in Richland County. Parts two and three will follow on Wednesday and Thursday.

MANSFIELD – There are seven plots of land in Mansfield Cemetery where babies are buried.

Scattered across the cemetery’s expansive grounds, these sections play host to hundreds of tiny coffins. They’re easy to spot, often decorated with stuffed animals or balloons commemorating birthdays that will never come. Brightly-colored children’s toys contrast sharply with the dull granite headstones.

One stone in the cemetery is etched with the name of 34-year-old Shanay Crawford’s infant daughter, Jesselyn – born May 17, 2005 and died July 20, 2005 just after her two-month milestone. Hers is one of the few headstones with the luxury of having a death date separate from her birth date.

Jesselyn

Shanay Crawford holds a portrait of her angel baby, Jesselyn.

Jesselyn was born with a cleft palate, the fourth most-common birth defect in the United States, and jaundice. Crawford remembers calling her daughter’s doctor with concerns about her baby continuously losing weight and projectile vomiting. She made an appointment with a gastroenterologist.

“As a mom, you know your kid and you just get this feeling,” Crawford said. “I remember feeling like this was never going to end, and I didn’t think she was going to make it. But as a mom I’m doing whatever I can to make sure my feelings are wrong.”

Jesselyn died before she made it to the doctor. She stopped breathing in her sleep while taking a nap at daycare. Cause of death was determined as SUID – sudden, unexpected infant death.

“It was surreal,” Crawford remembers. “When your baby passes, in your mind you want the whole world to stop and mourn with you.”

No parent expects the hopes and dreams they have for the tiny person they created to end in a tiny grave. But this is a reality for hundreds of parents in Ohio and Richland County whose children become a victim of infant mortality – the death of a live-born baby before his or her first birthday.

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. Jesselyn is part of that statistic.

This equals an infant mortality rate of 7.3 infant deaths per 1,000 infants born – only slightly lower than the state’s 10-year rate of 7.6.

Rate is calculated as the number of babies who died during the first year of life per 1,000 live births. A 10-year aggregation is used due to Richland County's low annual birth numbers rendering a yearly infant mortality rate statistically invalid. 

Comparatively, the United States has an infant mortality rate of 6.1 per 1,000 live births. However, stacked against other wealthy countries, the nation’s rate is abysmal; a study by the Center of Disease Control (CDC) compared the U.S. infant mortality rate with 26 other wealthy European countries. The U.S. was ranked dead last.

Why are our babies dying at such an alarming rate?

“It’s a socioeconomic problem,” said Peggy Sutton, former public health nursing supervisor at Richland Public Health. “We’ve lost jobs, we have a high rate of public assistance in Richland County. And it’s a statewide issue because of economic and racial disparity.”

The problems in Richland County trickle down from fundamental problems nationally. For example, national statistics say states with the highest level of infant mortality also have high rates of poverty. In 2015, 15.9 percent of the population in Richland County was living in poverty, according to the U.S. Census Bureau.

These “big-picture” problems directly affect three of the leading causes of infant mortality in Ohio and Richland County: Child Fatality Reviews in Ohio show that 46.6 percent of infant deaths in 2013 were due to premature and pre-term births, 15 percent of infant deaths were due to sleep-related causes including SUID, asphyxia or other undetermined causes, and 13.8 percent of deaths were due to serious birth defects.

These numbers have mobilized Richland County into taking action. Local doctors Mark and Sarah Redding have created the Community Health Project and “Pathways” model to address risk factors that lead to infant mortality. A partnership between Third Street Family Health Services, OhioHealth and the March of Dimes brought a Mom & Baby Mobile Unit to reach pregnant women with limited access to healthcare. The local infant mortality task force hosted a community forum last fall to illustrate the serious nature of this problem in the minority community.

Richland Public Health also leads a number of efforts to combat the causes of infant mortality. For example, Public Health Nurse Jennifer Crotty heads the organization’s prenatal home visit and newborn home visit program, aimed at assessing a mother’s needs.

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“We talk about taking prenatal vitamins, eating correctly, not smoking and drinking,” Crotty said. “We also start safe sleep education there.”

Education extends to making mothers aware of the services available across the county to encourage healthy pregnancies and healthy babies.

“I went into the home of a woman who has lived here for two years and she didn’t know half the services she could get,” Crotty said. “Sometimes mothers don’t know what services are available, and sometimes they don’t necessarily know what they need to be doing to take care of themselves.”

The “ABCs of Safe Sleep” campaign is Richland Public Health’s biggest educational effort to combat infant mortality. They encourage babies to sleep alone, on their backs and in a crib with a firm mattress.

In 2015, the Ohio Department of Health released its annual Child Fatality Review for the years 2009 through 2013. It determined that 836 infants died in a sleep environment - 16 percent of the total 5,174 infants to die over the five-year period in Ohio. 

Of the 836 infants who died in a sleep environment, 26 percent (219) of the infants were asleep in a crib or bassinet, as is recommended. However, 56 percent (471) of the deaths occurred in adult beds, couches or chairs. 

The numbers don't lie, and yet it's still not enough to convince some parents to put their babies in a safe sleep environment. The American Academy of Pediatrics recently released a study that video-recorded infant sleep patterns - most parents, even when aware of being recorded, placed the infants in environments with established risk factors for sleep-related infant deaths, including positioning the infant on their side or stomachs, on a soft sleep surface, with loose bedding or bed-sharing.

Still, Richland Public Health's safe sleep campaign is a tangible step in a fight that often seems futile.

“We’d love to drive mothers to all their appointments and make sure they get prenatal care,” Sutton said. “We’d love to prevent all congenital disorders, but we can’t. What we can do is educate people on the right way to put your baby in bed.”


Fortunately, Sutton and Crotty aren’t alone in their fight against infant mortality in Richland County. From task forces to community health initiatives – across the medical and political landscape, at the county and state level – people are working diligently to answer one question: How do we keep our babies alive?

Journalism nerd. Adopted Shelby resident; Dayton native. Proud OSU alum. Coffee enthusiast.