Bartholomew County officials are looking closely at the risk factors revealed in a State of Our Health Town Hall Road Show — smoking, substance abuse and obesity — to determine why Bartholomew has the highest infant mortality rate in the state.
During Tuesday’s road show at the Columbus Learning Center, local experts spent the morning dissecting why Hoosiers have such unhealthy habits, as well as the health and financial consequences of not improving the statistics.
At least 150 people attended the presentations.
The main focus for much of the session was on tobacco use, with Indiana’s 21 percent smoking rate, and efforts to increase the cigarette tax to encourage smokers to quit, or never to start.
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But the infant mortality number for Bartholomew County was the one striking statistic that took many local health officials by surprise.
Columbus Regional Hospital statistics in the 2018 Needs Assessment show that while Bartholomew County has lowered its adult smoking rate from about 26 percent in 1996 to 15.3 percent this year, the county has more than doubled its obesity rate from nearly 17 percent in 1996 to just over 38 percent this year.
In infant mortality, Bartholomew County averaged 9.4 deaths per 1,000 live births in 2014-2016, compared to 7.3 percent in Indiana, and 5.9 percent nationwide. Bartholomew County’s rate is the highest in Indiana.
Looking for answers
“We don’t know the reasons yet,” said Beth Morris, director of Community Health Partnerships for Columbus Regional Health. “We’re just now digging into the data. We do know that substance abuse, tobacco and other factors affect infant mortality.”
Infant mortality is defined as the loss of babies at 20 weeks of gestation or later or an infant death within the first year of life, Morris said.
Hospital officials noted that since the Columbus-based health center is a regional facility, it is utilized by families throughout southeastern Indiana for their baby’s birth, not just by Bartholomew County parents.
Because the hospital is stringent on its reporting for infant mortality, some of the statistics may reflect more of a regional statistic rather than solely a county statistic, hospital officials said, as birth certificates are issued for the county where the birth occurred, not where the family lives at the time of the birth.
Bartholomew County’s statistic is reflected more heavily in the late miscarriages, after 20 weeks, Morris said. Some of that could be attributed to lack of prenatal care, and substance abuse or tobacco use, she said.
But until health officials are able to dig deeper into the statistics, local explanations regarding infant mortality are just speculation, she said.
Lack of prenatal care could be attributed to economic challenges in paying for health care. Women who don’t have insurance may be reluctant to try to find care, Morris said.
Health officials also suspect that some infant deaths are related to sleeping arrangements, such as allowing blankets, stuffed animals or baby bumpers in a crib with an infant, which can lead to suffocation.
Support for first-time moms
One of the ways Bartholomew County has been attempting to lower the infant mortality rate is through the Nurse-Family Partnership, an evidence-based community health program that brings nurses into a one-on-one coaching relationship with new mothers in their first pregnancy.
The median age of expectant mothers enrolled in the program, which is operated by Goodwill Industries of Central and Southern Indiana, is 21. Nearly 90 percent of enrollees are unmarried, according to program statistics. An estimated 75 percent of expectant mothers in the program receive Medicaid services.
Launched locally in February, the program is based at Columbus Regional Hospital and currently serves 70 expectant mothers in southern Indiana, with the capacity to serve 125. Among the 30 counties served by the Nurse-Family Partnership in addition to Bartholomew are Jennings, Jackson and Shelby.
As part of the program, nurses work with expectant mothers to reduce or cease smoking during their pregnancies, said Cindy Hunt, Goodwill Nurse-Family Partnership nurse supervisor for the southern region.
The nurses become closely involved in helping expectant mothers — from eating healthier and learning how to cook healthy meals, to getting more exercise and connecting them with community services, she said.
Through the program, nearly 90 percent of mothers in the Nurse-Family Partnership give birth to children with a healthy weight, and nearly 92 percent are born full-term, she said. Almost 70 percent quit tobacco usage before the baby is born and 30 percent reduced their tobacco use before the child’s birth.
The Nurse-Family Partnership also encourages breastfeeding for newborns, with nearly 90 percent of moms initiating breastfeeding after the birth and nearly 39 percent still breastfeeding at six months, she said.
The Nurse-Family Partnership also works with new mothers to make sure infant immunizations are up to date, with nearly 96 percent having completed needed immunizations at six months.
Hunt emphasized the safety of the babies is first and foremost for the nurses at all times.
Pre-term births, low birth weight, poor nutrition, smoking and toxic stress all can contribute as a threat to pregnancy or to a newborn, which culminates in the big issue of infant mortality, Hunt said. A mother’s chronic illness, such as diabetes, can play a role, she said, along with the mother’s health habits during pregnancy.
Hunt said the nurses who work with clients locally try to really understand the community they are working in, and the challenges that are there, in order to help the expectant mothers.
Nurse-Family Partnership is collaborating with Morris and the hospital as it begins to look into what could be contributing to Bartholomew County’s high infant mortality rate.
Local health officials hope to have some conclusions about the infant mortality data by the end of the year that will lead toward future solutions, Morris said.
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To learn more about the State of Our Health 2018 Town Hall Road Show, visit HealthierIndiana.org.
Upcoming road shows are planned in Bloomington on Thursday, Madison on Oct. 11 and Sellersburg on Oct. 12.
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Indiana ranks 38th among the nation’s 50 states in overall health, according to America’s Health Rankings 2017 Annual Report.
Indiana’s other rankings include:
- 34th worst in drug deaths
- 40th worst in obesity
- 41st worst in percentage of smokers
- 42nd worst in infant mortality
- 49th worst in public health funding
Source: Alliance for a Healthier Indiana
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What: Nurse-Family Partnership in Indiana
Families served: 2,588
Counties served: 36, including Bartholomew County.
Implemented by: Goodwill of Central & Southern Indiana
Goals:
- To improve pregnancy outcomes by helping women engage in good preventative health practices, including thorough prenatal care, improving their diets and reducing their use of cigarettes, alcohol and illegal substances.
- Improve child health and development by helping parents provide responsible and competent care.
- Improve the economic self-sufficiency of the family by helping parents develop a vision for their own future, plan future pregnancies and continue their education and find work.
To learn more about the Nurse-Family Partnership in Indiana, visit nursefamilypartnership.org or email [email protected].
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