In the November 22nd Megaphone we reported on how Ohio children on Medicaid are faring when measured by specific outcomes. We focused on whether Ohio adolescents on Medicaid have visited their primary care provider at least one time in the last two years. On that measure Ohio performed under the median of states reporting the metric, and we talked about steps Ohio might take to improve PCP visits by adolescents.
Today we are highlighting another measure of child well-being where improvement is needed—the percentage of babies born to moms on Medicaid whose birthweight is low, that is less than 25 grams or 5 lb., 8oz. In this case fewer is better, i.e. we want to reduce the birth of infants with low birth weight (LBW).
The 2016 data show that 10% of Ohio’s babies born to moms on Medicaid are born with a low birth weight. This contrasts to the median of 8.9% among the 26 states that report this measure to the Centers on Medicare and Medicaid Services (CMS), and puts Ohio behind three-quarters of the other states that reported this metric.
Why is Low Birth Weight important?
The leading causes of infant death in Ohio (death before age 1) are prematurity-related conditions, and one of these is low birth weight. A premature birth is one that takes place before 37 weeks of pregnancy. A study published in the summer of 2017 by the Center for Community Solutions found that 62 percent of low-weight births were also premature and 40 percent of premature births were also low birth weight.
Low birth weight is associated with infant deaths that occur after birth and before 28 days of age. Of those infants who die before 1 year of age, more than 2/3 die during the first 28 days. Thus to make a dent in Ohio’s stubborn infant mortality rate it is important to identify the interventions that will impact prematurity and low birth weight. This is especially true for black women who are more likely than white women to deliver a low birth weight infant.3 And while the top cause of infant mortality nationwide is birth defects, in Ohio prematurity and low birth weight lead the causes.
What Can Be Done?
Much is being written about infant mortality as Ohio struggles to do better. Below we identify recommendations that have emerged from public health leaders and researchers in Ohio, some of whose research has been informed by many stakeholders in Ohio. It is not intended to include all avenues of improvement that the Ohio legislature, administration and public health leaders could undertake, but rather to capture some of what could be done, in addition to entering prenatal care in the first trimester of pregnancy.
Assist women with their doctors to manage chronic health conditions before becoming pregnant. Smoking cessation must be encouraged and preconception physicals must be given.
Assist women with access to birth control. Many of the infants that died resulted from pregnancies that were not intended. Birth spacing of at least 18 months between pregnancies is recommended.
Conduct ongoing holistic assessment of pregnant women’s medical needs.
Conduct ongoing assessment of nonmedical needs, such as housing, food, income and transportation.
Layer supports for women with multiple stressors including home-visiting, after-hours medical care.
Increase awareness of community based HUBS (and increase the number of HUBS themselves), centers in which community health workers connect pregnant women to care and services.
Standardize fetal “kick count” education (to help a woman quickly know if the fetus is moving less and emergency help is needed).
Make progesterone treatment programs (in which progesterone is used to delay and prevent preterm delivery) available and well-advertised to at-risk women and to health care providers
Discuss post-partum birth control.
Better understand the role that maternal infection plays in fetal and infant death, and gather and analyze data that will allow for targeted infection control efforts.
Prioritize housing and employment.
Connect families with low incomes to jobs, transportation, postsecondary education and social support.
Acknowledge and address the roles of racism, discrimination, violence and toxic stress.
Balance short-term fixes with longer-term change. Address immediate needs, such as homelessness, but also pursue fundamental changes to the housing, transportation, education and employment sectors that ensure that all Ohio families can participate in the economy, build positive social relationships and attain optimal health.
To learn more about this important topic join Voices for Ohio’s Children on Monday, January 8, 2018 at 2 PM EST for a free one hour webinar on Infant Mortality. Also, later this year Voices will release an issue brief on infant mortality.
Ohio Department of Health, 2016 Ohio Infant Mortality Data: General Findings
 Center for Community Solutions, Low Birth Weight And Prematurity in Ohio: A Multivariate Analysis (July, 2017)
 Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, (12/1/1016)
 Recommendations drawn from Franklin County Fetal-Infant Mortality Review—Case Review Team Findings: Year Two (January – December 2016), published May 2017; Health Policy Institute of Ohio, A New Approach to Reduce Infant Mortality and Achieve Equity: Recommendations to Improve Housing, Transportation, Education and Employment (December 2017); Center for Community Solutions—see footnote 3, above.
Note: The HPIO report was prepared for the Legislative Service Commission, which was a requirement of Senate Bill 332.
Note: The Franklin County Fetal-Infant Mortality Review focused on reviewing 48 deaths that included the death of the fetus at or later than 24 weeks gestation, and those infants who died within 28 days of birth. Therefore, some of the recommendations incorporate actions to prevent fetal as well as infant deaths.
 For more info on HUBS or Ohio Department of Health
 For more information about Progesterone