Next year, Columbus, Ohio, will use 21st century transportation technology to address a health crisis that should belong in the Victorian era: rising rates of infant mortality.
Running from June to November 2019, a pilot program will aim to connect pregnant women with on-demand rides to doctor’s appointments and other daily errands, such as grocery shopping and pharmacy trips. The pilot will include 500 women in the early months of pregnancy who are enrolled in Medicaid, and who live in one of the eight Columbus neighborhoods where the most babies are dying within the first year of life.
In an email to CityLab, Courtney Lynch, a professor of obstetrics at the Ohio State University who is co-leading the evaluation of the pilot, called the program “a completely novel intervention,” designed to research whether lowering barriers to prenatal care and reducing gaps in transportation for low-income women can eventually treat the city’s darkest public health issue. “The long‐term goal is to use the information gathered to reduce infant mortality,” she said.
Access to prenatal medical care is considered essential for preventing preterm births and congenital anomalies, two of the main drivers of infant mortality. Another critical force behind preterm births is stress, which is abundant in the lives in many poor women who may lack stable jobs, housing, and transportation, medical research shows. Black women can also face the added stress of racism in daily life.
Currently, Medicaid subscribers in Ohio can schedules rides on paratransit shuttles to travel to medical appointments, but these services are unreliable and difficult to coordinate, according to users who rely on them.
Under the pilot, participants will be able to book free rides on the Uber-like service via app, text, or call center; the app will also notify healthcare providers when patients are on the way. The service will remain available to mothers in the first two months after they give birth.
The prenatal trip assistance pilot will be funded with part of Columbus’s $50 million Smart City Challenge grant. The 2016 grant competition by the U.S. Department of Transportation was designed to spur local governments to solve big urban problems with cutting-edge transportation technology. Columbus’s winning proposal included a suite of projects, such as a multimodal transportation app, expanded car-sharing, and autonomous vehicles roving around key destination points. (Low-speed, self-driving shuttles debuted at four Columbus tourist attractions earlier this month.) But addressing the plight of Columbus’s vulnerable new mothers through mobility was a focal point of its proposal, and was cited by officials as a primary reason for the city’s victory over competitors like Denver and San Francisco.
As of late last year, however, that key social promise seemed to have slipped off the list of the city’s prioritized projects. A CityLab investigation found that, as plans were moving ahead for other components of the grant, the needs of vulnerable moms were at risk of being left behind. After the investigation was published, the city altered its portfolio of DOT-approved grant projects to include a service for low-income, expectant mothers. Earlier this month, the Columbus city council approved the use of $1 million from the Smart City grant fund to pay for the 2019 pilot.
The United States has higher rates of infant mortality than any other wealthy nation in the world, with 5.8 deaths per every 1,000 live births. The public health crisis disproportionately affects black families, with black babies dying at 2.4 times the rate of white babies nationwide. Ohio has long landed towards the bottom of national rankings, and Franklin County is one of the state’s hotspots, with about 150 infant deaths per year. Although the state’s rate fell slightly in 2017 overall, the disparity between white and black infant mortality rates grew.
Once hidden away by taboo and shame, the conversation around infant mortality is changing in Columbus, said Jessica Roach, the executive director of R.O.O.T.T., a local reproductive and racial justice organization. With more voices like hers calling for radical action, more medical literature identifying stress as a physiological health risk, and a wave of national reporting around the twin issues of maternal and infant mortality, “the needle is moving here,” Roach said.
To her, the fact that the transportation pilot includes trips to grocery shopping and other daily errands signals a greater recognition by city officials that infant mortality is about more than getting moms to doctor’s offices. “You can’t have an impact by just addressing prenatal care,” she said. “You have to look at the overall holistic picture of women’s lives.”