OKPOLICY.ORG
Cassidy Hamilton is one of four 2014-2015 OK Policy Research Fellows. Cassidy graduated magna cum laude with a degree in Economics and is currently pursuing a Masters of Public Administration at the University of Oklahoma. She works as an AmeriCorps volunteer in Norman where she coordinates a tutoring program for at-risk students. Cassidy is interested in health and housing policy, economic development, community lending in low-income areas, and the interconnectedness of fiscal and monetary policy.
Infant mortality is the death of a child under one year of age, and the infant mortality rate (IMR) is the number of those deaths per every 1,000 births (see chart below). According to the CDC, the IMR is an important measure because the mortality of a population’s infants can be indicative of broader factors affecting the health and well-being of the population at large. Beyond its importance as a public health measure, for families of babies who die before they reach their first birthday, infant mortality is an immeasurable personal tragedy.
Oklahoma’s IMR is 7.6 per 1000 children, according to figures released by the Oklahoma State Department of Health, the seventh-worst rate in the nation. Oklahoma’s infant mortality rate places it between Russia and Kuwait. This is actually good news—seven years ago, when the state’s IMR was 8.6, it would have fallen between Nauru and Latvia.
At just above six percent, the United States’ infant mortality rate is one of the highest among developed nations. Its rate is three times more than Finland and almost double South Korea, ranking it at 26th place among OECD countries. Infant mortality has long been associated with a country’s public health, socioeconomic status, and its standard of living.
This is especially true in Oklahoma, where the infant mortality rate is starkly divided along racial lines. Oklahoma’s IMR for black infants was 16.5—170 percent higher than the national average of 6.1. Black infants in Oklahoma are more likely to die in their first year of life than children born in the Gaza Strip or in Saudi Arabia. Most alarming is that Oklahoma’s black infant mortality rate has risen since it was last measured; nationwide, this measure has been the fastest falling.
According to the Center for Disease Control and Prevention, low birth weight, poor maternal nutrition, and limited or absent access to care are the main contributors to infant mortality. The age of the mother at the time of her first birth is highly correlated with these factors. Oklahoma is first in the country in rate of pregnancy among mothers 18-19, and third among mothers 15-17. The average age of Oklahoman mothers when they deliver their first child is lower than the national average, and for African American Oklahomans, the average is even lower. Oklahoma has no statewide sex education program, even though more Oklahoman teenagers report that they are sexually active than the national average.
Another factor that places infants at risk is their mothers’ cardiovascular health and nutrition—infants of mothers with heart disease, hypertension, or diabetes are more at risk of being born underweight or premature. A full ten percent of Oklahomans have been diagnosed with diabetes, and a third of the population is obese. Both of these populations are increasing faster than the national average, and the trend is even more pronounced among African Americans. This problem is exacerbated by the lack of full-service grocery stores in many urban and rural areas in Oklahoma; large sections of Oklahoma have been labeled “food deserts”—which contributes to obesity by increasing consumers’ reliance on fast food and unhealthy food. Healthy food also tends to be more expensive, which is especially problematic in Oklahoma, where 24 percent of children live in poverty and over 15 percent of its inhabitants receive SNAP benefits.
The percentage of Oklahoman women who smoke remains well above the national average. More than a third of Oklahoma’s mothers smoke before pregnancy, and almost a quarter of pregnant women continue smoking during their pregnancy. Increased access to prenatal care would help curb these rates by informing mothers of the effects of continued tobacco use. The Oklahoma Department of Health and the Tulsa Health Department have both recently enacted laudable programs aid to help smokers, especially mothers and would-be mothers, quit. Similarly, SoonerQuit, an initiative launched to address smoking cessation during or before pregnancy, operates through SoonerCare. Were Medicaid to be extended through acceptance of federal Medicaid expansion funds, like-programs could educate and inform pregnant mothers of the ill effects of tobacco—especially during pregnancy.
Access to and utilization of prenatal care is paramount for improving the health outcomes of infants. Even following the passage of the Patient Protection and Affordable Care Act, Oklahoma ranks among the highest in the country in rates of uninsured, with African Americans and Hispanics disproportionately uninsured. The single biggest determinant of preventive and prenatal health care use is coverage; without health care insurance, pregnant women often lack the resources to pay for prenatal and preventive care.
It is easy to get lost in familiar statistics regarding Oklahoma’s poor state of health, but its painful consequences must be recognized. The health and well being of Oklahomans cannot be delegated to the medical sector and subsequently be forgotten or neglected. Health is influenced by a variety of factors including socioeconomic status, health insurance coverage, and, as evidenced, race. Improved and standardized sex education is necessary to better the health of the next generation and their children. Finally, accepting federal funds to expand health coverage would increase utilization of prenatal care and decrease health disparities present among races.
Oklahoma’s current health crisis may be the product of history, but its future will decidedly be the product of its politics. It is unfortunate that a state that so strongly emphasizes the sanctity of life is unwilling to take serious action to improve the health and financial well-being of its most vulnerable inhabitants.
Well, done, Cassidy. Now, hopefully, the “Powers That Be”, in Oklahoma, will read this excellent paper, listen, think and develop a plan to reduce these numbers. While living there in the ’80’s through 2007, I was appalled at the shocking, irresponsible manner in which the young, indigent and elderly are cared for, or rather, not cared for. Conducting research at OSU while a graduate student, examining the plight of children in The State, made me painfully aware of the neglect and abandonment of these populations. If a parent neglects and abandons a child, the parent is reported to the Department of Human Services and there are consequences for the parent. Is Oklahoma guilty of neglect and abandonment of its most vulnerable? I believe so and your research and conclusions certainly support this. The sad reality is that the plight of this population has not improved but gotten worse since I conducted my research. I eventually counseled adolescents and their families at a private, nonprofit. While there, I also developed and directed a federally-funded program for those teens in Oklahoma, who had aged out of DHS custody, other homeless, whether runaway or throwaway children, pregnant and parenting. At times it was discouraging but I believe we made a difference in lives. The child may be the central, directly affected person, but that ripples out to the family, community, State, Country and ultimately, the World. If we do not pay for it now, we certainly will in the future. I encourage you to be persistent in your work and make a difference at some level, for the “invisible”, in Oklahoma. Respectfully.