Tag Archive | Black Infant Mortality Michigan

OKT’s Ms. Yvonne Woodard featured in news story

Dec2
As awareness of racism’s role in infant mortality grows,
Michigan takes action
Reposted from SecondWave Media
Grand Rapids resident Yvonne Woodard has had several low birth weight children and grandchildren
This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

For Black infants, racism’s impacts begin at birth – and may be deadly.
 
In 2018 in Michigan, more than three times as many Black babies died before their first birthday as white babies. Black mothers fare even worse, with maternal mortality rates that are 4.5 times higher than non-Hispanic white women. An underlying factor in Black infant mortality is low birth weight (LBW). When LBW babies survive, they face a host of medical problems that often have lifelong consequences.

“When we take a long view, maternal and infant mortality across the U.S. has been declining but it is still an issue when the U.S. is compared to other wealthy nations. We are not doing as well,” says Amber Bellazaire, policy analyst with the Michigan League for Public Policy (MLPP) and author of its report, “Thriving babies start with strong moms: Right Start 2020.” “… When we drill down further, we see those disparities in racial outcomes.”

“Racism is oftentimes an underlying value of the disparities seen,” adds Dawn Shanafelt, director of Maternal and Infant Health at the Michigan Department of Health and Human Services (MDHHS). “We have systems of care that have been built in this society, which is plagued with structural, systemic racism. The system for medical care continues to perpetuate these. It’s been evident in the experiences that have been published by families receiving maternal care. The bias is very clear.”

However, the link between racism and health impacts for Black babies is becoming increasingly better understood and acknowledged – and practitioners across Michigan are coming together to address it.
 The “weathering” effect of racism
 As a Black mother and grandmother, Grand Rapids resident Yvonne Woodard has experienced firsthand the way racial disparities have affected her children and grandchildren’s health. Her first baby weighed five pounds, seven ounces. Her fifth and last weighed four pounds, eight ounces.
 “They all came to term. My first was overdue,” she says. “They just kept getting smaller.”
Yvonne Woodard holds a family photo.Woodard’s first grandson weighed one pound, eight ounces. Now nine years old, he has just learned how to say “mama.” Woodard’s granddaughters weighed three and four pounds.

 “It’s not a good feeling,” she says. “A doctor had told me, ‘It’s because you are African-American and it’s in your family.’ I thought, ‘I am going to be sick because of my race and background?’ It doesn’t make sense that it’s hereditary.”

 Woodard’s experience reflects the results of “weathering.” As retold in Bellazaire’s report, University of Michigan professor and researcher Arline Geronimus found that exposure to chronic stress — like the stresses of facing racial discrimination day after day – leads to early health deterioration.

 “Continual attempts to cope with cumulative stress — not just one negative experience but a combination over the life course — leads to a high allostatic load or ‘wear and tear’ on the body,” Bellazaire wrote in the MLPP report. “This wear and tear leads to racial health disparities across a range of medical conditions, including disadvantages in pregnancy and childbirth.”

 As a woman who has deeply researched her own medical conditions, Woodard agrees. “Stress contributes a lot,” she says. “Your nervous system actually has a memory.”

 Geronimus’ research found that in the U.S., non-Hispanic Black women have the highest incidence of weathering. While Black women moving to the U.S. more recently have outcomes similar to white women, those who have lived here all of their lives fare the worst, no matter how much money they have or how advanced their education.

 “There are many factors that interact and inform pregnancy-related outcomes. Racial disparity and bias is one,” Bellazaire says. “This is borne out in evidence, not just in what people feel, anecdotes, or opinions. Consistent research suggests that when we hold things the same, education, socioeconomic status, and healthy behaviors, we continue to see these disparities by race.”

 When health care systems operate with racial biases, whether they are recognized or not, that stress can be intensified. Practitioners may assume that Black women have Medicaid insurance coverage, are single mothers, lack education, or are using illegal drugs. According to a 2019 American Progress report, the intersectionality of racism and sexism often results in women of color experiencing bias and discrimination in health care settings, leaving them to feel invisible or unheard when they ask their medical providers for help or try to communicate their symptoms.

 “When I had the last baby, I moved from New York to Virginia. I told the new doctor what’s going to happen … and of course he didn’t believe me,” Woodard says. “I was female and Black. He didn’t believe that I know my own body.”

 “If you do not have access to respectful and responsive care, your health is going to be affected,” Bellazaire adds. “It’s as simple as if you feel unsupported or unheard, you may be less likely to receive care. We know that not receiving consistent prenatal care certainly affects Michigan’s outcomes. We want to make sure we are encouraging respectful, responsive care for all Michigan women if we care to improve outcomes.”

 Respect and response
 Although the statistics on racial disparities in infant health are disheartening, awareness of the issue is growing and Michigan is taking steps to address it. Michigan Gov. Gretchen Whitmer’s proposed expansion of Michigan’s Healthy Moms Healthy Babies program shines a spotlight on racial maternal-infant health disparities and establishes a plan to decrease them. The plan states, “As a part of comprehensive health care for women we will ask a woman what she wants, ensure she can get it in one visit, and provide coverage for it.”

Dawn Shanafelt.In developing the plan, MDHHS staff met with residents across the state in town hall-style meetings to learn about their experiences, needs, and suggestions.

 “I think we are transforming the way we are doing things,” Shanafelt says. “We made it clear that we don’t just want the state to come by and do its thing. We want open communication. We had our team of epidemiologists be a part of meetings so we could share data with communities and really show that we are invested in a partnership.”

 First and foremost, Healthy Moms Healthy Babies expands health care coverage for low-income new moms to a full year after giving birth. The plan has established nine Regional Perinatal Quality Collaboratives (RPQCs) comprised of health care professionals, community partners, families, faith-based organizations, Great Start Collaboratives, home visiting agencies, and others who will focus on improving birth outcomes through quality improvement projects tailored to the strengths and challenges of each region.

 Moving the first postpartum health care visit to within three weeks of birth and adding a comprehensive visit within 12 weeks will better support new mothers with postpartum depression and anxiety, breastfeeding challenges, or substance use disorders. Training in implicit bias will teach health care providers to better listen to women of color. Proven effective, home visiting programs will support women and babies in achieving better health while sharing information that will help them and their partners recognize developmental milestones, gain parenting skills, and access resources for housing, food security, or family planning.

 “Really, what Healthy Moms Healthy Babies does is improve systems so we have sustainable change, [with the goal of] zero preventable deaths and zero disparities,” Shanafelt says. “Whether you live in Detroit or Traverse City, we want you to have the best possible chance of having a healthy pregnancy and healthy baby wherever you deliver.”
 While racial disparities in maternal and infant mortality remain a problem, Michigan is actively charting paths towards health equity — with an emphasis on new moms and their babies. But as Woodard emphasizes, the long-term answer will go beyond policy change.
Yvonne Woodard.“Peoples’ hearts have to change,” she says. “… We Black women are no different [from white women]. The parts of our body are in the same place. It’s about domination. One day, people will realize this. One day, it’s going to be so much better.”

 Yvonne Woodard photos by Kristina Bird. All other photos courtesy of the subjects.
  

Do Black Babies Matter?

Dec1

imDuring the first year of life, twice as many black babies die in Kalamazoo and Grand Rapids (11.9 per thousand) than white babies. In Muskegon, the numbers are even higher. To take a look at why these numbers continue to plague infants born to black women of all socio-economic and educational levels, Partners for a Racism-Free Community sponsored a Nov. 30 program, “A Deeper Look at Racism and Infant Mortality.” Breannah Alexander, director of strategic programs, facilitated the dialogue that featured Cathy Brown, from the YWCA Kalamazoo, and Celeste Sanchez-Lloyd, from Strong Beginnings.

Black babies die at double the rate of white babies across the nation. Michigan ranks 40th in terms of good infant outcomes. However, first generation black babies, i.e. babies born to immigrants just coming here from Africa, have the same infant mortality rate as white babies. This leads to the conclusion that the stress of living day to day in a racist environment is a factor in babies dying.

“This has to do with racism, the stress of not belonging, not feeling welcome,” Alexander said. “It’s everywhere in the US, regardless of income. However, poverty is another stress factor for most African Americans. Poverty is the thing we see first; we understand it. It does have an effect but not the only effect. Being black, regardless of income, doubles the risks for infant mortality and low birth weight.”

The YWCA Kalamazoo and Strong Beginnings, in Kent County, are taking intentional steps to keep more black babies alive. Sanchez-Lloyd noted that Strong Beginnings community health workers empower the families they serve by offering in-home mental health support, family planning guidance, a fatherhood program as well as help with housing, transportation and employment. These strategies not only create a healthier environment for pregnant black women but also help alleviate some of the stressors impacting them. “We are looking to save that baby but also to making an intergenerational change,” she said.

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Left to right, Cathy Brown, Celeste Sanchez-Lloyd and Breannah Alexander.

Brown, who works in programs that offer support to victims of domestic violence, notes that black victims who are pregnant face even higher levels of stress. The YWCA Kalamazoo program seeks to meet women where they are at and figure out intentional ways of helping them carry heathy babies to full term.

Both presenters also spoke about the institutional racism pregnant black women face when seeking medical care. Providers routinely ask them about “baby daddies,” illicit drug use or simply assume that the pregnancy was unplanned and that they are not living a healthy lifestyle. Because many black women are using low cost clinic services, they are afraid to report such treatment for fear they may lose all access to medical treatment. Notably, Grand Rapids is the most segregated city in Michigan and among the five most segregated cities in the nation.

OKT’s Lisa Oliver-King was in the audience and related how her white OB-GYN mistreated her when she went in for her initial exam after discovering she was pregnant. “I had just finished my masters’ degree. My husband and I had the very best health insurance. This was our first and planned pregnancy. The doctor spoke down to me in a very condescending manner. He even asked me ‘How many sexual partners do you have?’”

A white, OB-GYN nurse in the audience says she has noticed this treatment of pregnant black women where she works. She is making efforts to raise awareness. She noted that where she worked, 75% of back women were suspected of drug abuse and referred to screening whereas only 25% of white women were. She believes this discrepancy is due to racism. This discrepancy has been noted and new initiatives will require all women to be routinely screened.

OKT believes that other factors impacting infant mortality include diet and environmental toxins. Across the board, women rarely eat a well-balanced diet including 80 grams of protein each day. Physicians don’t often provide sufficient nutritional advice and can tend to stoke fears of weight gain. This may influence women to eat less in the final months of pregnancy when the infant needs the most nutrition. Women of color living in neighborhoods without access to healthy foods face additional barriers.

Recent research has shown that organophosphate pesticides, fire retardants in clothing and furniture, compounds found in most plastics and on every electronic receipt are linked to premature labor and, low birth weight as well as autism, hyperactivity, lower IQ and cerebral palsy in children. Girls exposed in the womb have more risk for emotional illness; boys are more prone to aggression. (Organophosphates were first developed for deadly chemical warfare and later modified for use as pesticides.) Urban neighborhoods with income-challenged residents, most often people of color, have higher incidence of environmental toxins.

Another consideration is the American way of birth. As a nation, we rank 58th in infant mortality. That means, 57 other countries are a safer place to have a baby. (Cuba is one of the safest.) “Other countries recognize the value of health. They offer comprehensive sex education, comprehensive healthcare, lengthy maternal leave,” noted audience member, Peggy Vander Meulen, who is program director at Strong Beginnings. “Here we also have wealth disparities and racism. It’s political will. Are we going to fund wars and tax cuts for the wealthy or are we going to fund health and education?”

Progress has been made in Kent County. Vander Meulen reported that the 2003 Kent County black infant mortality rate was five times higher (22.3 per thousand) than white infants; today it is two times higher.  “We have made a lot of progress,” she said.  “We’re not there until there is no disparity. If we get to Cuba’s rate, I can retire.”

Alexander concluded that stress experienced related to racism is an undervalued part of the conversation. Sanchez-Lloyd agreed. “Black women carry the burden of being black, the weight of it every day, living in the white culture,” she said. “When I was pregnant, I remember the added stress of watching African American men get shot on TV and having to wonder if my husband, who is a police officer, would be shot when not in uniform, just for driving while black.”