Indiana is focusing resources on some of the state’s most vulnerable communities to address a major health inequity. Earlier this month, Governor Mike Pence signed legislation to authorize $13.5 million over the next two years to a grant program aimed at reducing infant mortality, a problem which disproportionately affects African Americans. The program, called Protecting Indiana’s Newborns, or Safety PIN, is the latest in a series of state initiatives to address Indiana’s infant mortality rate -- the eleventh highest in the nation. Of these funds, $2.5 million will go to develop a web application to reach out to mothers and mothers-to-be.
The State Department of Health plans to issue requirements for grantees by the end of the summer and start funding programs in the fall. The state aims to fund initiatives that perform services proven to reduce infant mortality, and which offer innovative ways to reach communities most in need of support. Deputy State Health Commissioner Jennifer Walthall says reducing black infant mortality is top-of-mind. "We don't have an infant mortality problem in the state of Indiana, we have a disparity problem,” she says. “When you look at the gap between the white population in our state and the black population in our state it is truly appalling.”
Nationally, the black infant mortality rate is more than twice that of whites and Hispanics, and Indiana mirrors that disparity. The rate for black infants in Indiana was 2.6 times higher than that for whites. In 2013, the most recent year for which there is data, 58 white babies died for every 10 thousand born in Indiana, while 153 black babies died for every 10 thousand births. While rates for both races dropped nationally between 2003 and 2013, in Indiana, neither the black nor the white infant mortality rate showed significant change.
One organization planning to apply for funding is the Indiana Minority Health Coalition, which works with 23 local minority health organizations around the state. The group’s vice president Carl Ellison says his organization is already working on this issue, but he thinks the Safety PIN program could help his organization find new ways to reach mothers in their communities. It’s crucial, he says, to get community members involved to form a bridge between pregnant mothers and medical care. Research shows that prenatal care, starting in the first trimester, is correlated with lower infant mortality, “but we know among black women that there's a low entry rate into prenatal care,” he says. “Whether it's prenatal care coordination, whatever the activity is, we're probably going to have to take it to the community. We have to go find the pregnant woman and pick them up early on.”
The Health Department will be looking for programs that “highlight how to reduce barriers to care,” according to Walthall. This includes targeting zip codes that were identified as highest-risk areas in a $9.1 million data analysis commissioned by the governor last year. The report also found young maternal age, Medicaid status and inadequate prenatal care to be the highest predictors of infant death. Walthall says initiatives should target connecting young mothers on Medicaid to prenatal care. She also wants to see Safety PIN add to existing state initiatives that target unsafe sleep practices, which cause many infant deaths. “Nearly all of those deaths are preventable,” she says.
Ellison says if the Indiana Minority Health Coalition receives funding, they will distribute it to groups in urban areas—Indianapolis, the Chicago metro area, South Bend and Fort Wayne—where 80 percent of black infant deaths occur: “It becomes a matter of, can you mobilize community resources to help get the message to people you need to?”
What might mobilizing community resources around infant mortality look like? Ellison says some of the groups his organization works with have already developed some innovative programs, including a social media outreach initiative for minority mothers and prenatal support groups. But he imagines something even more out of the box, such as a program in which a “cadre of grandmothers” go door-to-door talking to pregnant women about pre-natal care. There could even be a high-tech component: “Arm the grandmothers with some technology, like a tablet, so they can actually capture additional information on this person,” he suggests. “And the second tier is if you get the community to do this, can you get the doctor to then be there and not make this mother wait three weeks to get in?”
The Safety PIN program is set to launch this fall, and continue until October 2017.