Breaking the Cycle of Inequality: Improving Maternal and Infant Health in Ohio

By: Dominique Johnson, Policy Associate

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Healthy pregnancies lead to healthy children. Healthy children grow into healthy adults, who then have healthy pregnancies and raise the next generation of healthy children. This is the cycle of health that every family deserves.

For too many Ohio families, particularly Black families and those living in poverty, that cycle is disrupted at every stage. Systemic inequality and economic instability cuts across pregnancy, infancy, childhood, and adulthood, leaving generational imprints on health and opportunity. Breaking this cycle requires investing in families from the very beginning, starting with maternal health.

Where the Cycle Starts

Ohio continues to see some of the nation’s worst maternal and infant health outcomes.

• Maternal mortality rate: 24.5 deaths per 100,000 births.

• Infant mortality rate: 6.6 deaths per 1,000 live births.

• Babies born to Black woman die at 2.2 times the rate of white babies.

These outcomes are not inevitable; they are the result of policy and investment decisions that create and perpetuate systemic barriers. In our 2025 Early Childhood Data Dashboard, we found evidence that before and during pregnancy, many Ohioans struggle with:

• Access to care: Nearly 1 in 4 pregnant women in Ohio did not receive prenatal care in the first trimester in 2022. Women of color were far less likely to access timely care.

• Geographic barriers: In rural Ohio, 23.4% of residents travel over 30 minutes to the nearest birthing hospital.

• Provider shortages: Ohio has 13 counties with no OB/GYN providers and 18 counties with no pediatricians.

• Pre-existing health conditions: Across Ohio, many women enter pregnancy already facing serious health challenges. Among women in counties with some of the highest disparities in maternal and infant health outcomes, 29.5% were estimated to have a pre-pregnancy condition such as diabetes, hypertension, or anxiety. These conditions increase risks for both mothers and babies, underscoring the urgent need for early intervention and preventive care.

Racism in health care compounds these barriers. African American women are more likely to receive lower-quality care and experience the chronic stress of racism. This chronic stress accelerates biological aging, also known as “weathering”. Weathering increases the risk of preeclampsia, embolisms, and other life-threatening conditions. When mothers face these systemic challenges, their babies enter life with unequal odds of survival.

Poverty and Generational Inequality

About half of an individual’s earning potential is inherited from their parents, meaning a family’s financial well-being is a significant predictor of lifelong health and achievement. In Ohio, too many children are starting behind, as one in five children ages 0-5 lives in poverty.

Poverty has many links to health outcomes, also known as social drivers of health. Insufficient finances lead to challenges with consistent access to transportation, food, housing, and services that families rely on. In Groundwork Ohio’s 2025 Early Childhood Data Dashboard, we found 29.9% of all young children 0-5 experienced food insecurity but 46.3% of Black, non-Hispanic young children face uncertainty about where their next nutritious meal will come from.

Ohio’s aging housing stock creates additional generational health inequities. With 66% of Ohio’s homes built before lead paint was banned in 1978, approximately 425,000 of those homes shelter children under age six. Ohio’s youngest children are the most vulnerable to the effects of lead poisoning, where even low levels of exposure without symptoms can disrupt brain development. This creates challenges as children enter kindergarten, as those with lead poisoning history experience more academic challenges with greater risk for reduced IQ, learning difficulties, shortened attention spans, behavioral challenges, and diminished educational attainment. As a child ages into adulthood, the links to health crystalize even further as early lead exposure increases the risk of anemia, hypertension, kidney disease, and reproductive complications.

Breaking the Cycle: A Full Picture of Health Equity

Maternal and infant health cannot be disentangled from the broader conditions that families face across their lives. When mothers lack access to prenatal care, when infants enter the world with higher risks of mortality, when young children are exposed to poverty, poor nutrition, inadequate child care, and environmental toxins, the cycle of poor health is set in motion and passed to the next generation.

Ohio has made progress. We’ve seen infant mortality decline, with the Ohio Department of Children and Youth’s latest report showing the state’s current infant mortality rate of 6.6 deaths per 1,000 live births - the lowest in years. Medicaid coverage for extended postpartum care, doulas, and some home visiting services is also a meaningful step forward, giving families the support they need before, during, and after pregnancy. These solutions are essential and must be met with an ongoing commitment to evaluate outcomes and support investments that evolve to meet the needs of young children and families.

Breaking the cycle of generational health inequities requires investments in broad health initiatives. Safe and affordable housing, early learning, health care access, food security; these priorities are essential, as health outcomes are not just determined at the hospital or doctor’s office. A child’s zip code, access to services and basic needs, and a family’s economic mobility is just as consequential. The opportunity is before us: build a future where no child is held back by the circumstances of their birth and where every parent has the tools to thrive.