Top state health officials detail commitment to enable moms, babies to live and thrive
ISMA is pleased to publish this column by Indiana Family and Social Services Administration Secretary Jennifer Walthall, MD, MPH; Indiana State Health Commissioner Kris Box, MD, FACOG; and Indiana Department of Child Services Director Terry J. Stigdon, MSN, RN. It details a coordinated, multiyear commitment led by the three agencies to make Indiana’s infant mortality rate the best in the Midwest by 2024.

Infant mortality is the measure most often used across the world to assess the health of a community. The number of infants who die in their first year of life reflects how our health care systems are designed and shines a spotlight on other critical areas – from early diagnoses, referrals, and access to care to smoking rates, substance use, poverty and other socioeconomic factors. A failure at any of these points not only affects babies but impacts their families and our communities.

Where we are
Decreasing Indiana’s infant mortality rate has consumed the focus of public health champions for years, yet success remains elusive. In Indiana, 623 babies died before their first birthday in 2016, and that’s 10 more than 2015. This rate puts Indiana’s infant mortality rate at 7.5 babies per 1,000 live births, and it’s unacceptable.

Complicating this picture is the sobering fact that maternal mortality is also on the rise. Being able to safely plan pregnancies for Indiana women and babies is paramount to achieving health for our state.

Governor Eric J. Holcomb has committed Indiana to having the lowest infant mortality rate in the Midwest by 2024. Reaching that goal will require both an understanding of the challenges Indiana faces and partnerships at all levels.

The opiate epidemic
The current landscape of the opiate epidemic in Indiana is contributing to increased maternal and infant mortality. Delayed prenatal care, poor maternal health, increased smoking, and contributions to unsafe environments for infants put families at risk. Planning for 2024 must include social services for pregnant women – not only for their comprehensive health needs, but also for substance use disorder treatment and sustained recovery.

How we will get there
Three state agencies, the Indiana State Department of Health, the Indiana Family and Social Services Administration and the Indiana Department of Child Services, have pledged to work collaboratively with stakeholders statewide to make meaningful and lasting change. Through a public health lens (ISDH), health care delivery and social services programs (FSSA) and a supportive child and family services landscape (DCS), we feel confident the momentum around infant mortality continues to grow, and we must ensure its effectiveness.

Those who paved the way
The Indiana State Department of Health made infant mortality a priority area in previous years. During that time, the Indiana Perinatal Quality Improvement Collaborative (IPQIC) was subsequently formed and has had success in improving policy, funding and outcomes. From neonatal abstinence syndrome, to contraception and, levels of care designation for delivery centers, this group of tireless and creative subject-matter experts continues to lead the way.

ISDH’s charge for 2018 is to deliver recommendations that will standardize and streamline care across important topic areas, including educating on timing of pregnancies and job training. Young people who have children before they are prepared to be parents oftentimes are at risk for poverty and ongoing socioeconomic disadvantage. By ensuring childbearing becomes a choice and not an accident, we can address many factors that impact infant mortality.

Holcomb administration goals
The infant mortality initiative has been described as a “surprise addition” to Governor Holcomb’s Next Level agenda but when analyzed more closely, it is a logical addition to the overarching theme of his administration. Indiana’s families lie at the heart of the administration’s bold goals to cultivate a strong and diverse economy, maintain and build the state’s infrastructure, develop a 21st century skilled and ready workforce, attack the drug epidemic and deliver great government service. If we can provide a foundation for our most vulnerable new lives, just imagine what else is possible.

Laborers of Love
When it comes to saving babies, everyone has a part to play. A few key calls to action for our healthcare system and physicians include:
  • Promote evidence-based smoking cessation programs.
  • Support easy healthcare access.
  • Ask about safe sleep.
  • Look for opportunities to incorporate social determinants of health (transportation, housing supports, food and nutrition, etc.) into health and wellness planning.
  • Acknowledge health disparities and work to narrow the gap – whether it be in individual practice or more global guideline adherence.
As the old saying goes, “You can’t whistle a symphony.” Together, our symphony can be beautiful. #BestINtheMidwest2024

Kris Box, MD, FACOG
Indiana State Health Commissioner

Terry J. Stigdon, MSN, RN
Director of the Indiana Department of Child Services

Jennifer Walthall, MD, MPH
Secretary of the Indiana Family and Social Services Administration