Our Country's Maternal and Infant Health Crisis Is Worsening - It's Time for Targeted Action

By: Erin Ryan, Director, Policy Advocacy & External Affairs at Groundwork Ohio

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When a family is welcoming a new baby into their lives, it should be a time focused on the excitement, joy, and anticipation of this big life moment. Unfortunately, this unique time can quickly change for those who face pregnancy complications or poor health outcomes, which can become deadly for moms and babies. As a country, we are facing a maternal and infant health crisis, with vast racial disparities in outcomes. Ohio is home to regions experiencing some of the most abysmal maternal and infant mortality rates across our nation.


There has been a movement, spearheaded by Black female lawmakers and Black-led maternal health organizations, to call attention to the devastating problem, focusing on the damaging racial inequities and pushing for an end to the crisis. Along with the advancement of policy change, there has been a growing body of research to demonstrate the urgency of the problem, highlight the inequities that exist, and inform policies and programming.

The data could not be clearer: At the root of the problem is the reality that we are failing Black women and babies.


The March of Dimes recently released its 2022 Report Card, which highlights the latest key indicators to describe and improve maternal and infant health for each state. The report also presents public policies that state lawmakers can implement to improve equitable maternal and infant health for families.


The report card indicates that, despite the heightened attention and awareness of the issue, the maternal and infant health crisis is worsening. And the numbers are even more desolate for Black women and babies who experience worse maternal and infant health outcomes, even when accounting for different factors of the pregnant person such as socioeconomic status, education, and insurance coverage. In fact, while overall infant mortality rates have decreased slightly from 2019 to 2020, racial disparities continue to persist, according to the 2020 Infant Mortality Annual Report released by the Ohio Department of Medicaid.


Ohio is not making the grade. The March of Dimes’ report is a stark reminder of the work ahead in the maternal and infant health space, particularly in the effort to dismantle the racial inequities that exist in health outcomes. For example, Ohio earned a D+ in preterm birth grade overall. The report also found that in Ohio, the preterm birth rate among Black women is 51% higher than the rate among all other women.


Both internationally and within the United States, preterm birth and the complications that accompany it are some of the key factors that contribute to infant mortality. Ohio’s infant mortality rate is higher than the national average, and the gap in racial outcomes between Black babies (14.1 infant mortality rate) and white babies (5.5 infant mortality rate) is alarming.


There are opportunities for improvement on the horizon as Ohio lawmakers consider legislative solutions.


Last week, as the Ohio Legislature returned to work for what’s known as the “lame duck” session, the Ohio Senate Health Committee held a hearing on a piece of legislation highlighted in the report: allowing for the passage of Medicaid coverage for doula care. In addition to providing the ability for Medicaid to reimburse for doula services, Ohio House Bill 142 (Crawley, Brinkman) would establish a Doula Advisory Board within the Board of Nursing and Medicaid for a certification process for doulas in the state.


“Doulas are birth workers who provide health education, advocacy, and physical, emotional, and nonmedical support for pregnant and postpartum persons. With their support, women were less likely to have pain-relief medications administered and less likely to have a cesarean birth. Women also reported having a more positive childbirth experience… It is our responsibility to do everything we can to ensure that families come first in Ohio and mothers can live their lives without the fear of dying during or after childbirth.” – State Representative Tom Brinkman


The two sponsors of the bill, Representative Tom Brinkman and Former Representative (now Franklin County Commissioner) Erica C. Crawley, were invited to provide testimony at the hearing about the legislation and how it would work to address the maternal and infant health crisis, particularly for Black women and babies. They talked about the state of the crisis in Ohio, highlighting the ways in which discrimination and racism experienced by Black women from individuals, institutions, and systems (including our health care system) contribute to the racial inequities in pregnancy outcomes. In Ohio, Black women are two and a half more times likely to die due to a pregnancy-related death than white women. The bill sponsors stressed the importance of making doula services more available in the state as a strategy to better support pregnant women, particularly Black women, before, during, and after childbirth.


“The work of doulas can help families identify issues that cause complications that ultimately lead to death, because they are with the families before, during, and after birth. Doulas are especially important when we talk about addressing health disparities and outcomes for pregnant people. Every family deserves to bring a child into this world, safely, with competent and attentive care, and without fear.” – Franklin County Commissioner Erica C. Crawley (former State Representative co-sponsoring the legislation)


House Bill 142 is one of many concrete, actionable steps that our state can take to better support the health and well-being of pregnant women, moms, and babies across Ohio. A foundational component of achieving better outcomes across the board is to implement targeted action for the individuals and communities who are most at risk.


In order to more effectively address our mounting maternal and infant health crisis, it is crucial that we focus efforts on solutions that center on the needs of Black women and babies, as well as other women and babies of color, who are facing disproportionately higher rates of poor health outcomes, such as preterm birth rates or maternal mortality. We can and must do better in our communities to ensure that every mother-to-be has a healthy and safe pregnancy and every child has the opportunity to reach their full potential.


Download the March of Dimes report on the state of Ohio or read the Ohio Supplemental Report