When it comes to the deaths of babies before their first birthdays, Stark County was one of the worst counties in one of the worst states in the nation. But the latest figures show that is changing, especially when it comes to narrowing the huge gap between the deaths of African American and white infants.
A crucial component of the change is the widespread use of community health workers, the bridge for mothers like Latasha Mathews. She’s 26, a first-time mom, and, as she acknowledges, the nervous sort. Ten-month-old Sophia is her delight and her worry.
“I just felt like I was going to fail at everything,” Mathews said, remembering the early days of her pregnancy and motherhood. “I felt like, even if I felt I was doing everything right, I still wasn’t.”
Mathews is single. She was homeless and money remains tight. She’s living a number of what are called the social determinants of health: things like poverty, inadequate housing and food insecurity that can predict health problems over a lifetime. But she’s also developing a confidence in herself and her baby’s future.
For that, she and her sister Clarissa credit Marcy Smith and a kind of life-balance she shares with them.
“A lot of people like to dwell and dwell and dwell, and it puts you in a really dark place,” said Latasha. Then, pointing to Smith, she added, “She refuses to let anybody stay in a dark place, which is awesome.”
Clarissa echoed, “Awesome.” Then Smith picked up a refrain they all know.
“You want to sit in a dark place, I’m going to sit there with you, but then we’re coming back into the light,” Smith said.
Marcy Smith works with new moms as part of Stark County's THRIVE program. [M.L. Schultze]
Smith is a community health worker for the YWCA. Her job is to visit pregnant women and new moms in their homes. She’s a walking directory of medical and community services, a deliverer of diapers and car seats, a human appointments calendar, and a mother of four boys who herself struggled with poverty. Most importantly, she said, she’s a listener.
“I’m there to help them, not push what I feel is important. Just let them be valued as a person,” said Smith. “Just because you’re struggling don’t mean you don’t have an opinion, feelings, your own thoughts, things that matter.”
The YWCA is one of 10 agencies, ranging from public housing to the Fatherhood Coalition, that contract with the Canton Health Department’s THRIVE program to try to stem an infant mortality rate that hit 9.5 deaths for every 1,000 live births in 2017. Last year, that rate fell by a third. And overall, the five-year average shows a downward trend in children who die before their first birthday — from 8.2 per 1,000 live births in 2014 to 6.4 last year.
A History of Disparity in Stark County
Canton Health Department epidemiologist Jessica Boley looks back at a decade of data, noting that Stark’s infant mortality rate had long been among the highest in the state. But a special concern here and elsewhere in Ohio is the racial gap.
Back in 2009, “we were losing 5-and-a-half black babies for every one white baby,” Boley said. “It’s sad to look at that.”
The pattern continued in Stark and eight other large, predominantly urban counties through 2013, when Ohio had the third highest infant mortality rate in the nation. For African American children, Ohio was the second worst. That’s when the state started funding programs including THRIVE (Toward Health Resiliency for Infant Vitality and Equity) in Stark County.
The programs have a variety of approaches, including centering pregnancy, where groups of women attend prenatal appointments and counseling together. Stark County’s effort incorporates most of those approaches, but it’s especially focused on the community health workers like Smith.
Ohio’s new governor Mike DeWine wants to triple funding for such programs in his first state budget. He held a roundtable this week in Cincinnati to discuss a pilot program aimed at preventing infant deaths.
Stark County’s program has grown to $3.5 million a year, funded by Medicaid, the Ohio Department of Health, local charitable foundations and other community organizations. Last year the mortality rate for black babies, which had remained in the high double digits, dropped to 5.7, lower than among white infants.
Canton Health Commissioner Jim Adams says a key effort is healthy pregnancies and cutting down on premature births.
“If they (mothers) can be healthy when they enter their pregnancy, if they can remain healthy throughout their pregnancy and carry their baby to full term, that’s what we’re really focusing on,” Adams said.
But THRIVE goes beyond that. Stark’s approaches include the practical: providing pack-n-plays, for example, so parents are less likely to co-sleep with their babies. They include medical: from prenatal care to smoking cessation to progesterone treatments to family planning. And they include social: linking women with housing, transportation, and teaching expectant mothers to read to their child in the womb.
Canton Health Commissioner Jim Adams stands next to a pile of car seats [M.L. Schultze]
Beyond the First Year
Clarissa Mathews’ daughter, Jordan Edwards, shimmies onto Marcy Smith’s lap and settles in. She’s two, which puts her well beyond the first birthday cutoff for Smith’s services. But Mathews says Smith remains a presence in all their lives, in part by empowering Mathews to take better control of a chaotic life (sticky notes are key, she jokes) and of her children’s future.
“I really didn’t know how to be a mom until now. And she’s helped me do that,” Mathews said. That includes, for example, “‘You take them to school and you interact with teachers; you don’t be shy.’”
Her sister, Latasha, says its a matter of confidence. “I don’t wake up thinking, ‘Am I doing this right?’ No more. I wake up with that confidence of, ‘This is what we’re doing, Sophia, and, ‘We got this,’ and we go.”
Smith says she sees it all as an investment in the women and their children. “Once you lay the groundwork of how to parent and how to hold your household down, you can take it past a year, and you can pay it forward.”
Kent State University School of Public Health researcher Peter Leahy is part of a team that’s tracked Stark’s THRIVE program for nearly three years, mapping outcomes and pathways for more than 400 women. They’ve also done deeper interviews with a small group of women to find out more about what’s working best.
Leahy says there’s a theme to the responses when expectant and new mothers talk about the health workers.
“They say, ‘They’re like us. They’ve been through the experience, in some cases they look like us; they live in the neighborhoods. They know what it’s like, so we can trust them,’” said Leahy.
The short read, he says, is that lectures don’t work; relationships do. His research is now delving into deeper quantitative and qualitative analysis: How many contacts should a community health worker make? Can texting play a role? What about the initial and ongoing training the workers get?
It’s also looking at the best practices that could be replicated at a state and even a national level.