Can the United States’ Infant Mortality Crisis be Solved?
For much of the past decade, Cincinnati’s child poverty rate has ranked as the second highest in large cities of the United States. As of 2019’s American Community Survey, over 40.4% (or 2 in 5) children in the city of Cincinnati live below the federal poverty line — an appallingly high value in comparison to the national average of 19.5% (UpSpring, 2021). Although the nationwide rate of child poverty is still rather grim, it has generally been on the decline over the past decade. Cincinnati, however, cannot claim to mirror the behaviour of most large American cities; according to the Cincinnati Enquirer, the Queen City’s child poverty rate has continued to fluctuate since the Great Recession of 2007–2009, increasing by 32.4% between 2008–2013 to reach a staggering 53.1% (Horn & DeMio, 2019). Cincinnati’s slow tackling of child poverty lies in the deeply rooted and systemic impoverishment of African American communities, ignored plights of impoverished women and mothers, and a reluctance for Cincinnati society to address a maternal and infant mortality rate that primarily affects African American women.
It is no secret that the effect of child poverty in Cincinnati is disproportionally skewed by race. Upon examining BestNeighborhood’s interactive maps of the Greater Cincinnati area, it is easily noticeable that areas in which the per capita income and household income is lowest, match up with the areas in which minority populations — particularly the African American community’s population — are highest (BestNeighborhood, 2021).
The story of African American populations being disproportionally impoverished in comparison to white residents of cities is unfortunately a familiar story in America. Richard Rothstein reminds us in his short film, Segregated by Design, that when planning the cities of America, it was “the intention of the federal government to segregate neighbourhoods throughout the nation…” (Rothstein, 2019). President Roosevelt’s New Deal First Civilian Public Housing Program demolished a series of integrated neighbourhoods to create segregated public housing; Lyndon B. Johnson’s Austin Housing Authority forced African Americans into a specifically designated ‘ghetto’; and the Federal Housing Administration subsidized suburban communities on the condition that houses only be sold to white families while prohibiting resale to African Americans (Herriges & Rothstein, 2019). As such, the quality of education in inner-cities in comparison to suburban public school systems mirrors the quality of life in each area. As African Americans historically were forced into low-quality inner city public housing, while white populations were ferried into higher-value suburbs, white populations funded higher quality public schools through taxation that the inner-city African American populations intentionally could not imitate (Herriges & Rothstein, 2019).
But if, sadly, the case of urban vs. suburban segregation of America is synonymous with most of America’s cities, why is Cincinnati’s child poverty rate recovering so poorly compared to the rest of the nation? Researchers of the phenomenon rightfully tackle hunger and education rates, but for Cincinnati’s crisis I would argue that racial biases in medicine — particularly in obstetrics and gynecology — and high frequencies of unwanted teen pregnancies cause Cincinnati’s abysmally high infant and maternal mortality rates’ that contribute immensely to the crisis. Tackling such issues alongside hunger and education quality may remove Cincinnati from its unenviable status.
Ohio’s Hamilton County — which includes the city of Cincinnati and many of its surrounding suburbs — cowers behind its terrible infant and maternal mortality rate which ranks at the second highest in the nation (Stankorb, 2018). While hunger continues to be addressed, I wager that tackling this sub-crisis may be the key to removing Cincinnati from its infinitely increasing child poverty rate. Kathleen Brinkman of The Cincinnati Enquirer references research by the CDC that proves teen pregnancies significantly contribute to female high school dropout rates, and that tackling unwanted pregnancies would naturally reduce the rates of girls ceasing their education and rendering themselves unemployable for higher-paying jobs (Brinkman, 2016). Teens in already impoverished areas of Cincinnati who don’t have access to abortion clinics, or who choose to follow through with pregnancies, would likely struggle to financially support a child, unfortunately perpetuating a status of poverty. Even teens who do not come from poverty may end up impoverished because of unwanted pregnancies if they are not already financially self-sufficient. Unfortunately, for teen girls who grow up in poverty and become pregnant, health is incredibly difficult to maintain, and mortality can easily result.
Brinkman therefore emphasizes the importance of services supplied by Planned Parenthood, which continues to supply low-income areas with birth control units, long-acting reversible contraceptives, access to on-site abortion clinics, and education about gynecological health and pregnancy (Brinkman, 2016). Brinkman’s hypothesis proves worthy: according to Paola Suro of WCPO Cincinnati, “in 2017, the teen pregnancy rate [was] down in Cincinnati [for the first time in decades], and officials say the availability of quality birth control is behind the drop” (Suro, 2017). By democratising contraceptives — particularly long-term ones, such as IUDs — not only can Cincinnati prevent unwanted pregnancies, but with Planned Parenthood’s support, young girls can also have quality gynecological education (Planned Parenthood, 2021). Imparting on vulnerable young women knowledge about the immense life changes that arrive with pregnancy while providing contraceptive material and services would surely reduce occurrences of unwanted teen pregnancies. Making sure that teenage girls are not at risk of becoming pregnant when their life is not ready to handle such financial responsibility may decrease the number of impoverished young mothers and children, and thereby lower the mortality rate of mothers and infants.
Secondarily, to tackle the infant and maternal mortality rate, I feel that it is imperative to focus on Cincinnati’s racial bias in the OBGYN medical industry. The United States has the highest rate of maternal and infant mortality of any developed nation in the world, and to be the county with the second highest rate in the US is appalling. According to Lucy May of WCPO Cincinnati, “African American women [in Cincinnati] are nearly three times more likely to die of a pregnancy-related condition than white women…and 57% of those deaths could be prevented.” (May, 2020). Given that Cincinnati’s areas of poverty coincide with highly concentrated populations of particular races, it is important to understand child poverty’s relation to the high risk of African American maternal mortality in the city. The Ohio Department of Health revealed that 29.5 black mothers vs. 11.5 white mothers per 100,000 live births die, excluding births whose complications led to stillborn babies. Causes of these racially skewed deaths take the form of insurance differences, financial and marital status, and education, but racial biases remain a prominent reason still. Dr. Roosevelt Walker, president of the Cincinnati Medical Association, cements that, “even when exhibited subtly, implicit racial bias is at the root of the racial disparity in maternal deaths” (May, 2020). He continues to assert that, “the danger is that the implicit racial bias affects the way a healthcare provider interacts with the patient, the diagnosis that the healthcare provider assigns, and even treatment options for the patient can be influenced by racial bias.” The United States’ history and continued reality of institutionalized racism, especially in medicine, is no secret. For generations, African American and indigenous communities have been subjected to extraordinarily unethical medical testing and mortality in the hospital due to racial biases held by much of America’s institutions. Dr. Janice Sabin of the University of Washington notes importantly that “half of white medical trainees [in the United States] believe such myths as ‘black people’s nerve endings are less sensitive than white people’s; black people’s skin is thicker than white people’s; black people’s blood coagulates more quickly than white people’s’ that ultimately lead to treatment in practice that shows African American patients are 22% less likely than white patients to receive any pain medication when in need” (Sabin, 2020). The medical industry of the United States is notorious for discounting the needs of black women, especially in comparison to white women, and pregnancies prove to be no exception. The reality is often women’s issues, racial issues, and especially women’s issues based on race take the back burner in tackling any societal problems.
Racially disparate infant mortality rates ultimately lead the United States to cower behind its status as the most dangerous place to be born out of all of the world’s wealthiest nations. Its appalling infant mortality rate of 0.57% is 356% greater than that of Iceland, the safest nation in which to be born, whose infant mortality rate is a mere 0.16% (OurWorldInData, 2017). In fact, four of the world’s top 10 nations with the lowest infant mortality rate are Scandinavian, where the Nordic Model has proven for decades its superiority over much of the world’s healthcare and economic systems. Japan ranks third, after Slovenia, and Norway and Finland tie for fourth place. However admirable the low infant mortality rates for such countries may be, to look internationally for a solution to the United States’ infant mortality struggle, it is premature to compare the Top 4 countries’ approaches to tackling the issue with the United States.
According to Max Fisher of The Washington Post, the populations of the top 8 nations of the world with the lowest infant mortality rate tend towards being ethnically homogeneous, whereas the United States tends towards being more ethnically diverse (Fisher, 2013). Where the United States’ infant mortality rate has proven to be an issue of racial biases held by medical institutions, it is imperative that the US be juxtaposed against a nation whose ethnic diversity index is comparable. Singapore, whose infant mortality rate of 0.22% ranks at fifth lowest in the world, has comparable ethnic fractionalization to the United States: ~40% (World Population Review, 2021). Even in comparison to the rest of the world’s high-income nations, the United States’ rate plateaus, without improvement, while the rest consistently decline OurWorldInData, 2017).
Even with similar ethnic diversity, though, Singapore’s infant mortality rate is still almost 260% less than that of the United States. Some scrutiny must therefore be given to the by-race infant mortality rates of each nation.
The most historically oppressed ethnicities of both Singapore and the United States find themselves with the highest by-race infant mortality rates. Black Americans have a rate over double that of white Americans, and indigenous peoples similarly have almost double the rate of white Americans (National Center for Health Statistics, 2021). Similarly, Singapore’s indigenous Malay population proves to have a significantly higher infant mortality rate than the Indian or Chinese populations of the country:
Noticeably, though, all of the United States’ data by race still ranks with higher mortality rates than any of Singapore’s data. One can therefore find the difference, and the degree of greater success in reducing the infant mortality rate in Singapore, by exploring the nation’s approach to institutionalized racism, especially in and around healthcare.
According to H. B. Wong of the Singapore Paediatric Society, “the mortality rates are higher among the Malays and Indians than the Chinese, likely due to the reluctance of a Malay mother to use modern medicine [and instead prefer a home delivery].” Wong notes that 9.6% of Malay births, 2.3% of Indian births, and only 0.3% of Chinese births are home deliveries (Wong). It seems that most of the motivation to avoid a hospitalized birth stems from cultural birthing traditions in both the Malay and Indian communities that do not coincide with practices used in a hospital, rather than necessarily an institutionalized fear of medical institutions as is present in America for black and indigenous populations (National Heritage Board, 2021). The United States too finds a large portion of black populations tending towards home births again with licensed black midwifes, but largely due to the absolutely rational fear of being ignored and wrongfully treated by American hospitals when requesting help (Jones, 2020). In Singapore, it seems that the healthcare system has not inherently exhibited signs of implicit racial bias in treatment quality that would ultimately lead to the infant mortality rates skyrocketing by race as they do in the United States. Rather, by-race infant mortality seems to originate primarily as a by-product of cultural preference in the birthing process.
Examining racial tensions in Singapore too finds little comparison to the United States despite their comparable ethnic fractionalization. Where there is a multitude of races in a nation, unfortunately it is almost intuitive that there will be racial tensions to some degree; Singapore, however, has sought to rid itself of racial tensions on a constitutional level. According to Walter Sim of The Straits Times, in 2015 Singapore celebrated “50 years of prosperity and relative [racial] peace”, and the government had designated July 21 as “Racial Harmony Day, when young Singaporeans go to school decked in racial garb and are taught the virtues of respecting diversity”. After the nation’s last major racial conflict when the nation was founded in 1965, the then Prime Minister, Lee Kuan Yew “promised to build a multiracial nation [in which] everyone will have his place, equal: language, culture, religion” (Sim, 2015). This is certainly not to say that Singapore is free from racial crimes, tensions, and privileges: Sim reminds readers that many Singaporeans associate themselves primarily with members of their own race, and that there is still a slew of racially driven riots and crimes annually in the nation. It can be said, however, that though members of each population in Singapore may harbour beliefs of racial superiority or inferiority between communities, it appears that Singapore is not inherently institutionally racist — at least, in comparison to the United States. Rather, the government seems to prioritize ameliorating racial tensions until they no longer exist, while the United States still struggles to acknowledge institutional racism exists at all.
Singapore’s healthcare system then gives the United States a goal to which it can aspire, increasing the universality of quality healthcare that is not compromised by income or the United States’ race-based income disparity. Aaron E. Carroll of The New York Times argues that the United States’ Health System has much to learn from that of Singapore. Carroll importantly notes that since the nation’s health system is funded by taxation and is largely universal, “the bottom 20% of Singaporeans in income pay less than 10% of all taxes but receive more than 25% of all benefits. The riches 20% pay more than 50% of taxes and receive 12% of benefits” (Carroll, 2019). Though it is universal, Singapore “stresses personal responsibility and cautions against reliance on either welfare or medical insurance,” and Carroll quotes Dr. Jeremy Lin who reminds readers that “Singaporeans recognize that resources are finite and not every medicine or device can be funded out of the public purse” (Carroll & Lin, 2019). Essentially, Singapore provides universal basic healthcare to anyone, but anything more than that must be individually funded. Singaporeans also primarily lean towards public hospitals, where quality of healthcare is not sacrificed in comparison to private hospitals. All of Singapore’s work in the healthcare sector yields its hospital infant mortality rate to be just shy of 0.18%. If the United States could prioritize the importance of universal quality healthcare — and proper education of healthcare workers to debunk deeply rooted implicit racial biases — the United States may be able to spur the decline of its infant mortality rate. Unfortunately, a lack of attention by the federal government and the local governments of highly impacted cities in the nation has proven that governmental solutions to the issue of racial bias in medicine and infant mortality by race in the United States are unlikely to emerge in the near future, at least until a new generation of legislators who recognize the issue is elected to office. While the United States and Singapore find themselves comparable by ethnic fractionalization, their approaches to tackling racism and achieving adequate healthcare for all citizens, including ethnic minorities, could not be more different. Singapore’s healthcare system and scope on racial tensions are the ideal solution for the United States, but any reality where the two nations are comparable in that aspect is truly far into the future. I struggle to see an America in the near future that has infant mortality rates close to those of Singapore or any of the 36 other wealthy nations that precede the States, unless racial medical biases are addressed and debunked and the healthcare system no longer leaves millions of citizens in debt and uncared for. Until then, solutions must be tackled on the local level of highly impacted cities. We can therefore regain focus on Cincinnati’s processes.
Movements like Cradle Cincinnati, whose mission is to lower the rate of infant mortality in the city, particularly focusing on the plight of African American mothers, have been making significant strides to ameliorate Cincinnati’s crisis. The executive director of Cradle Cincinnati, Ryan Adcock launched initiatives to support black mothers in the city: he kickstarted the introduction of healthcare workers to vulnerable communities, group prenatal care that encouraged black women to attend, strong implicit bias training for healthcare workers, and policy-based legal solutions with Ohio’s legislators advocating for better Medicaid reimbursements (May, 2019). Cradle Cincinnati offers emotional support and the forging of a supportive community for black mothers in need to foster a city in which the upholding of their medical rights, especially in pregnancy, are achieved. In tandem with medical institutions, Cradle Cincinnati could unpack the biases that inhibit black women from receiving appropriate pregnancy care that they need and request. According to Elizabeth Chuck of NBC News, to combat implicit biases in medicine, hospitals have begun to introduce participation in the Harvard Implicit Association Test to determine and combat any and all biases that would negate from uniform quality healthcare based on a person’s belonging to one sect of humanity (Chuck, 2018). Medical institutions must accept the initiatives proposed by NBC and Cradle Cincinnati to understand and eliminate a primary cause of maternal mortality for black women; once they do, we can expect the mortality rate to decline, and with it, the child poverty rate.
To fully combat Cincinnati’s maternal and infant mortality rate, I suggest an organized coalition of Cradle Cincinnati, Cincinnati’s medical institutions, and Planned Parenthood. Cradle Cincinnati and Planned Parenthood have proven their success by advocating for at-risk communities in reintroducing trust in medical institutions for black women, that understandably has faltered in the past. Furthermore, giving democratic access to teen girls to the services of Planned Parenthood — contraceptives, safe abortion clinics, pregnancy education — can only decrease the risks of financial and health complications due to unwanted teen pregnancies. Currently, only three Planned Parenthood locations exist in the Greater Cincinnati area, and only one is in the vicinity of the highly vulnerable downtown Cincinnati area.
I strongly believe that introducing more Planned Parenthoods to downtown Cincinnati, introducing their service to high schools, funding and broadcasting Cradle Cincinnati’s efforts, and having both services collaborate with Cincinnati’s Health Commission and medical institutions would lead to a drop in maternal and infant mortality rates for the city. With all three services in collaboration, Cincinnati could experience effective change with the emotional support for a community that has been so wronged by its institutions. Hopefully, as a result, Cincinnati’s child poverty rate will start to also decrease.
Although opposition to the nationwide amelioration of child poverty would largely seem unethical, Americans who are economically removed from the situation often fail to see the urgency of fixing the crisis. Most of the United States’ legislative efforts to combat child poverty assume the form of tax credits, and the Child Tax Credit and Child and Dependent Care Tax Credit in President Biden’s American Rescue Plan is the latest example. According to Indivar Dutta-Gupta of the Georgetown Centre on Poverty and Inequality, the initiative “will lead to the most substantial one-year reduction to child poverty in US history” (Dutta-Gupta, 2021). Particularly, the bottom 20% of Americans by income would receive an increase in income of 33%; those who have been for generations unable to lift themselves out of poverty, and subsequently lift their children from growing up in a perpetually impoverished state, would have the means by which to begin their escape. To most, or perhaps just to me, the notion of monetarily reducing the plight of child poverty seems a saving grace, but much of America’s legislative bodies, high earning individuals, and those who subscribe unshakingly to the notion of the American Dream may disagree. In any tax credit initiative, funds reallocated from the Federal Government to the American people; as such, the government must reduce budgets for other initiatives, or even eliminate them entirely. The prioritization of child poverty amelioration for many legislators simply does not outweigh the reduction of federal funds, and therefore bills like Biden’s American Rescue Plan always remain opposed to a certain degree. Furthermore, if taxation of the top 1% of America was reallocated to fund America’s bottom 20%, legislators who propose such initiatives may lose the support of their wealthier audience; as such, even if they feel morally connected to the cause, they may not politically advocate for it. Lastly, Dutta-Gupta reminds us of the American Dream notion of picking oneself up by the bootstraps; to strict adherers of the philosophy, tax credits may seem like meritless handouts — a picking-up of others’ bootstraps, perhaps, and a stain on ‘American values’ (Dutta-Gupta, 2021).
To opposers of initiatives that mirror child tax credits, I simply ask, “do America’s values not propose to all the guaranteed rights of life, liberty, and the pursuit of happiness?” Ensuring that everyone be equally able to live without the tarnishes on the quality of life that child poverty perpetuates for generations, to me, seems as American as anything can be. As such, I choose to advocate for the amelioration of Cincinnati’s child poverty crisis, particularly with regards to infant and maternal mortality and unwanted teen pregnancy. Addressing the limitations that Cincinnati individually fails year after year to overcome may only lift the city out of child poverty enough to place it level with the rest of the nation, but that would still be a celebrated 62% decrease. As a community, Cincinnati must begin to prioritise the morally correct and equal treatment of black women and their societal oppression. The nation’s quest against child poverty is another story altogether, albeit one that merits legislative pursuit. If proper federal and local governmental effort pursues the cause effectively and accurately, hopefully child poverty in America will continue on its decline, and child poverty in Cincinnati will too assume a decline.
Generalizing the aforementioned methods by which to tackle Cincinnati’s crisis to the rest of the United States may ultimately help ameliorate the infant mortality rate in America, and thereby ameliorate the child poverty crisis the nation and city also face. Generating grassroots supports for such movements until they are accepted as issues by local and ultimately the federal government would likely give power to the problem and be seen legitimate by legislators in the future. Perhaps when such recognition of the issue at hand takes place, then the United States can redirect its attention to Singapore as a model for ameliorating its crisis on multiple levels.
Sources:
“American Rescue Plan.” The White House, 2021, https://www.whitehouse.gov/american-rescue-plan/. Accessed 30 March 2021.
Brinkman, Kathleen. “Contraceptives Reduce Child Poverty.” Cincinnati Enquirer, 25 April 2016. ProQuest, http://libproxy.usc.edu/login?url=https://www-proquest-com.libproxy1.usc.edu/newspapers/contraceptives-reduce-child-poverty/docview/1783916240/se-2?accountid-14749.
Carroll, Aaron E. “What Can the U.S. Health System Learn From Singapore?” The New York Times, 22 April 2019, https://www.nytimes.com/2019/04/22/upshot/singapore-health-system-lessons.html. Accessed 4 April 2021.
Chuck, Elizabeth. “How Training Doctors in Implicit Bias Could Save the Lives of Black Mothers.” NBC News, 11 May 2018, https://www.nbcnews.com/news/us-news/how-training-doctors-implicit-bias-could-save-lives-black-mothers-n873036. Accessed 30 March 2021.
Demio, Terry and Horn, Dan. “Even as Fewer Cincinnatians Live in Poverty, 2 in 5 Kids Still Do, New Census Data Shows.” Cincinnati Enquirer, 19 December 2019, https://www.cincinnati.com/story/news/2019/12/19/cincinnati-poverty-census-shows-improvement-but-not-everyone/2687022001/. Accessed 30 March 2021.
Dutta-Gupta, Indivar and Shapiro, Ari. “Tax Credit Could Lower Child Poverty More In 2021 Than Any Other Year in U.S. History.” NPR, 8 March 2021, https://www.npr.org/2021/03/08/974941356/tax-credit-could-lower-child-poverty-more-in-2021-than-any-other-year-in-u-s-his#:~:text=We're%20talking%20about%20several,under%20the%20age%20of%206. Accessed 30 March 2021.
Fisher, Max. “A Revealing Map of the World’s Most and Least Ethnically Diverse Countries.” The Washington Post, 16 May 2013, https://www.washingtonpost.com/news/worldviews/wp/2013/05/16/a-revealing-map-of-the-worlds-most-and-least-ethnically-diverse-countries/. Accessed 4 April 2021.
Herriges, Daniel and Rothstein, Richard. “How the Government Segregated America’s Cities By Design.” Strong Towns, 26 September 2019, https://www.strongtowns.org/journal/2019/9/26/how-the-government-segregated-americas-cities-by-design. Accessed 30 March 2021.
“Infant Mortality Rate, 2017.” Our World in Data, 2017, https://ourworldindata.org/grapher/infant-mortality. Accessed 4 April 2021.
“Infant Mortality Rates by Race: United States, 2015–2017 Average.” National Center for Health Statistics, 2017, https://www.marchofdimes.org/peristats/ViewSubtopic.aspx?reg=99&top=6&stop=94&lev=1&slev=1&obj=1&dv=ms. Accessed 4 April 2021.
Jones, Kristin. “For People of Color, Could Home Births be Safer than Hospitals?” The Colorado Trust, 13 February 2020, https://www.coloradotrust.org/content/story/people-color-could-home-births-be-safer-hospitals. Accessed 4 April 2021.
May, Lucy. “Cradle Cincinnati: 2018 Infant Mortality Rate Improves but Remains Far Higher for Black Babies.” WCPO Cincinnati, 25 April 2019, https://www.wcpo.com/news/transportation-development/move-up-cincinnati/cradle-cincinnati-2018-infant-mortality-rate-improves-but-remains-far-higher-for-black-babies. Accessed 30 March 2021.
May, Lucy. “Too Many Black Moms Die of Pregnancy-Related Causes, and a New Effort is Working to Change That.” WCPO Cincinnati, 19 February 2020, https://www.wcpo.com/news/our-community/too-many-black-moms-die-of-pregnancy-related-causes-and-a-new-effort-is-working-to-change-that. Accessed 30 March 2021.
Ministry of Home Affairs — Immigration & Checkpoints Authority. “Infant Deaths by Ethnic Group.” Singapore’s Public Data, 7 April 2016, https://data.gov.sg/dataset/infant-deaths-by-ethnic-group?view_id=68beefc4-9b48-4f2b-b4fb-3f0ac19aafac&resource_id=47de52df-3754-49fb-8c79-eceec5d39f7d. Accessed 4 April 2021.
“Most Racially Diverse Countries 2021.” World Population Review, 2021, https://worldpopulationreview.com/country-rankings/most-racially-diverse-countries. Accessed 4 April 2021.
National Heritage Board. “Birthing Traditions.” National Heritage Board, 27 March 2021, https://www.roots.gov.sg/ich-landing/ich/birthing-traditions. Accessed 4 April 2021.
“OUR CHALLENGE.” UpSpring, https://www.upspring.org/our-challenge-1. Accessed 30 March 2021.
“Race Map for Cincinnati, OH and Racial Diversity Data.” BestNeighborhood, 2021, https://bestneighborhood.org/race-in-cincinnati-oh/. Accessed 30 March 2021.
Sabin, Janice A. “How We Fail Black Patients in Pain.” AAMC, 6 January 2020, https://www.aamc.org/news-insights/how-we-fail-black-patients-pain. Accessed 21 April 2021.
Sim, Walter. “The Race Issue: How Far Has Singapore Come?” The Straits Times, 8 November 2015, https://www.straitstimes.com/politics/the-race-issue-how-far-has-singapore-come. Accessed 4 April 2021.
Stankorb, Sarah. “Growing Up Poor in Cincinnati.” Cincinnati Magazine, 5 December 2019, https://www.cincinnatimagazine.com/features/growing-up-poor-in-cincinnati/. Accessed 30 March 2021.
Suro, Paola. “Teen Pregnancy Rate is Down in Cincinnati.” WCPO Cincinnati, 30 May 2017, https://www.wcpo.com/news/health/teen-pregnancy-rate-is-down-in-cincinnati. Accessed 30 March 2021.
“We’re Here With You — Wherever You Are.” Planned Parenthood, 2021, https://www.plannedparenthood.org/get-care/our-services. Accessed 30 March 2021.
Wong, H B. “The Health of the Singapore Child.” The Journal of Singapore Paediatric Society vol. 23, 3–4 (1981): 123–4, https://pubmed.ncbi.nlm.nih.gov/7052849/. Accessed 4 April 2021.
