As soon as I became The Times' health reporter in October 2014, I started hearing about infant mortality.
The term itself is jargon, but I quickly understood what it meant: Many Indiana babies were dying before their first birthdays.
This didn't seem like a modern concern, I thought, particularly in the Midwest. Didn't vaccinations and sanitation and medical technology solve this problem?
Not completely. The state has perennially had one of the top 10 infant death rates in the nation. In 2013, Indiana's health department and governor made reducing infant mortality a top priority. But how did we get here?
That's the question I tried to answer in my Times series, "What's Killing Indiana's Infants."
Early last year, I applied for a fellowship at the the University of Southern California's Center for Health Journalism. The fellowship provides a week of training, grant money and ongoing mentoring for journalists willing to report on health issues affecting vulnerable children. My proposed project was to explore why Indiana has such a high rate of infant deaths by examining the communities where it's highest.
I was awarded the fellowship in June. The next month, I spent a week at USC's Annenberg School of Journalism. My fellow reporters and I toured a toxic neighborhood where children were getting sick from pollution from a nearby lead smelter. We went to a preschool for kids affected by toxic stress. We heard from experts in the field of childhood health.
When I returned to Indiana, I got to work. I had six months to complete my series.
I'd been writing about infant mortality, on a piecemeal basis, since starting at The Times. But now it was time to get rid of any preconceived notions I had and go where the reporting took me.
I interviewed experts from around the country and state. I did a ton of research online. I traveled to the Indiana cities with the highest rates of infant deaths.
I requested, often through Freedom of Information Act requests, copious amounts of data. Some agencies were more helpful than others. The Indiana State Department of Health denied several of my data requests either because it didn't have the proper data processing software or for privacy reasons. For instance, the state health department refuses to reveal any locality with less than five infant deaths in a year so as not to divulge the people's identities.
The strange thing is, county and city health departments, under an Indiana Supreme Court decision, are required to release death certificates. Those include the names, ages, addresses and causes of death of the deceased. I was only asking the State Department of Health for anonymous data.
Before diving into this project, I remembered hearing from state officials that infant deaths were mostly caused by smoking, unsafe sleep and lack of prenatal care. That made it seem like an easy problem to fix, if moms just behaved better. But the more reporting I did, the more I learned about the social determinants at play.
Poverty, and all that comes with it, plays a huge role in infant mortality, my sources told me. So I spent more time exploring the societal factors that affect the health of mothers and babies: racial discrimination, the stress of living in violent neighborhoods, lack of access to food, health care and education.
Several of my sources also told me pollution is a risk factor for infant mortality, and that Indiana is one of the most polluted states in the country. One of the articles in my series, the one that profiled Daviess County, focused heavily on the impact of the environment on the health of babies.
Finding human faces to put on the series was the hard part. Dying kids is not a subject a lot of people want to talk about. But I knew if I didn't tell the stories of parents who've lost or who were at risk of losing babies, my project wouldn't have the same impact.
I asked my sources if they knew of parents whose infants have died. When I interviewed someone about an initiative to reduce infant mortality, I would ask to attend, to see the program in action and meet moms. From infant death certificates obtained from a local health department, I cold-called moms who had lost babies.
It took me a while, but I found several women with extremely powerful stories. I listened to the heartache of mothers who experienced the unthinkable. I went on home visits and to doctor's appointments with vulnerable moms. The series wouldn't have been the same without these voices, and I appreciate the gracious, courageous people behind them.
Listening to a parent describe what it's like to have a baby die is something you can't quite prepare yourself for. In these types of interviews, you just have to be quiet and let the people talk. Even so, sometimes I was simply shocked into silence by the emotional depths of their revelations. Like when a mother described what it was like to feel her son's heart beat for the last time.
This is the biggest reporting project I've ever taken on. It's one of the largest ones The Times has done in recent memory. A lot of work goes into something like this.
I spent endless hours on the phone interviewing experts. I crunched data from a variety of government and academic sources. I read numerous scientific studies on infant mortality. I was on the road and in hotels for weeks, traveling the state. I even totaled my car when I hit a deer on the way back from southwest Indiana. The series took weeks to write.
But a project like this is bigger than me. My talented Times colleagues assisted in the planning process, took photographs, shot and produced videos, created online and print graphics, designed special web presentations, publicized my stories on social media, edited and gave me feedback on my stories, and corrected my grammatical mistakes. The financial support and mentoring provided by the fellowship also gave me a boost. The series wouldn't have gotten the readership it did without the help of all these people.
And if our hard work can help save the life of just one Indiana baby, it will be more than worth it.