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Reporter examines causes of infant mortality in Indiana Date: 06/26/18

Giles Bruce

By Giles Bruce

Way too many babies die in Indiana.

In 2017, 623 children in the state died before reaching their first birthdays. Indiana has the eighth-highest infant mortality rate in the United States, with 7.5 deaths per 1,000 live births.

I explored why in my six-part series, "What's Killing Indiana's Infants," for The Northwest Indiana Times.

The main causes of infant death in Indiana, like the rest of the country, are preterm birth, low birth weight, birth defects and suffocation during sleep. But the reasons for the deaths go way beyond that, with socioeconomic and environmental factors playing a big role.

That's where Indiana struggles: the state ranks near the bottom of states for childhood poverty, air pollution and obesity. Indiana is covered in food deserts. It has a higher-than-average smoking rate, to go with one of the lowest cigarette taxes in the region. The state spends less than public health than all but one other state.

Access to health care is another issue. Indiana has a shortage of primary care physicians, including OB-GYNs, particularly in economically depressed and rural parts of the state.

This affects the health of women and infants in Indiana.

Take East Chicago, a Rust Belt city in the northwest corner of the state. The city has the highest infant mortality rate in the state, with 16.3 deaths per 1,000 live births.

Only half of pregnant women in East Chicago receive prenatal care during their first trimester, compared to 68 percent statewide, according to a 2011 study by the Indiana State Department of Health. Nationwide, that number is 77.1 percent, according to the Centers for Disease Control and Prevention.

Health care reform could change potentially that.

In the second year of Obamacare, then-Gov. Mike Pence opted for the law’s Medicaid expansion. He did it under the provision that certain beneficiaries would be charged a monthly premium for Medicaid, something the program had never done before. People who don’t make their payment can lose their insurance.

The intricacies of the state’s program, known as the Healthy Indiana Plan, or HIP, 2.0 has led to confusion, with many people being dropped from health coverage, often through no fault of their own. Other women have complained to me about having trouble signing up for the state’s pregnancy Medicaid program.

Despite the complications, HIP 2.0 has expanded health insurance to more than 400,000 Indiana residents. The state’s uninsured rate has dropped right along with the national average, to approximately 9 percent in 2017.

Whether this will help the state’s infant mortality problem remains to be seen. Indiana’s rate actually increased from 7.3 in 2015, the year HIP 2.0 went into effect, to 7.5 in 2016.

Infant mortality is a complex problem, created by an intersection of medical and socioeconomic factors that can be difficult to untangle.

"It's such a hard nut to crack," Dr. Debra Litzelman, a professor and researcher with the Indiana University School of Medicine, told me. "In Indiana, we rank poorly in so many areas: smoking, obesity, mental health, alcoholism, substance abuse, access to care. Each one of those is a cumulative risk for infant mortality.”

But in theory, health reform means that more women will have access to health care prior to giving birth, increasing the chances of having healthy babies.

"Improving the health of women in the state of Indiana will help addressing the infant mortality rate," Dr. Laura Haneline, head of neonatal and perinatal medicine at Riley Hospital for Children at IU Health in Indianapolis, told me. "If you come into pregnancy healthy ... it increases your chances of having a healthy pregnancy."

Giles Bruce is the health reporter for The Northwest Indiana Times, covering the business of health care as well as consumer and public health. He previously wrote about health for the Lawrence (Kansas) Journal-World.