Changing Systems That Influence Birth Outcomes in Marginalized Zip Codes.

Abstract

* Abbreviations: ECEP — : early childhood education provider FIMR-CAT — : Fetal and Infant Mortality Review Community Action Team GMCHL — : grassroots maternal and child health leader HP — : Healthy People IMR — : infant mortality rate MCH — : maternal and child health SDOH — : social determinants of health SSWG — : Safe Sleep Work Group Indiana’s government is prioritizing the reduction of the state’s persistently high infant mortality levels. Despite improvements in overall state and Black infant mortality rates, high rates persist within Indianapolis zip codes, characterized by multigenerational poverty and underrepresented minorities (Table 1). These rates occur in the presence of high-quality health care and home-visiting programs working to address the leading causes of infant death (birth defects, preterm birth and low birth weight, maternal pregnancy complications, and sudden unexpected infant death).1 Numerous studies, however, link infant mortality to underlying root causes associated with the social determinants of health (SDOH).2–4 Addressing the SDOH requires sustainable improvements in social systems that influence women’s health and birth outcomes. Our work complements the work of health care by building the capacity of individuals and organizations within targeted zip codes to remove social inequities that impact birth outcomes. View this table: TABLE 1 Indiana Urban Zip Codes With Persistently High Infant Mortality Rates, 2014–2018 Our work with families motivated and informed our approach. First, many families have experienced infant mortality across multiple generations. Second, even with public communication campaigns focused on prenatal care, safe sleep practice, and women’s health, many residents are unaware of the leading and root causes of poor birth outcomes. Third, residents are not aware of the linkages between social demographics and poor birth outcomes. Fourth, neighborhood networks within communities are often insular; likewise, policy-making networks are insular. There is a need to merge community and policy networks to facilitate dialogue and share realities and solution strategies. Finally, … Address correspondence to Nancy L. Swigonski, MD, MPH, MBA, FAAP, Department of Pediatrics, School of Medicine, Indiana University, 410 W 10th St, Suite 2000, Indianapolis, IN 46202. E-mail: nswigons{at}iu.edu