Health Programming and Its Impact on Black Infant Mortality

Welcome to the Third Edition of the Black Birth Carnival. Hosted by Darcel of The Mahogany Way Birth Cafe and Nicole of Musings From The Mind of Sista Midwife.   The Topic: Infant Mortality Awareness: Saving OUR Babies. Many birth workers are talking about the alarming infant mortality rates in this country, but none are talking about infant mortality in the Black Community. That’s where this Blog Carnival comes in. We will talk about statistics, try to figure out why, and most importantly what we can do to help lower our infant mortality rates.   This post will be updated with live links by Noon, linking back to the other participants posts.

Below is a Guest Blog Post submitted by Amy Hereford especially for this blog carnival. After reading you can read my article for this carnival HERE.

Blacks babies under age one tend to die at more than two times the rate of white babies. Regardless of the increased educational, socioeconomic, and political power of US blacks, this rate difference has held steady for more than 40 years (http://www.minoritynurse.com/health-care-access/spotlight-infant-mortality-crisis).  Infant mortality data is representative of a country’s overall health and well-being. It is a way to quickly gauge how well a country treats its citizens by reviewing the death rates of its most vulnerable—which are babies under one year of age. Since black babies consistently die at double the rates of white babies, the entities responsible for healthcare in the US are charged with absorbing the message, forging new solutions and building action. However, many federal, state and local authorities are out of answers, stuck on old-world solutions, or simply don’t care.

The general understanding in public health is that health behaviors—what we know and do—have the most immediate impact on our overall health. We saw this with polio: if an individual gets a specific shot, that individual will not get polio. In fact, most of our ideas about public health stem from medical interventions doled out to the masses which end up improving community health. As the world becomes increasingly familiar with healthcare advances and new, life-saving technologies, we get more and more used to fast health improvements: identify a problem; sit down with leaders to come up with a solution; disseminate that solution; chart the impact; see improved health and move on to the next problem. It has not worked this way for those trying to improve rates of black infant deaths.

A lot of the responsibility for what we can do as a country to improve these numbers has fallen on the shoulders of pregnant women, and the nurses and doctors who treat them. Research done in the ‘70s, ‘80s and ‘90s linking infant deaths to maternal behaviors—like smoking, drinking, baby sleep positions—set up a relationship between health programmers and doctors; the health programmers collect information nationally and disseminate life-saving findings to doctors who, in turn, provide these interventions to their patients.While this form of information dissemination has helped to decrease the overall US rate of infant mortality, it has done very little for the rate difference between black and white infant deaths.

This is a hard pill for most health programmers to swallow. Health programmers are the policy and programming wonks that sit at the decision-making tables within federal, national, state and community authorities that make decisions about the services, initiatives and resources within our nation’s cities and counties. How could so much information be disseminated, so many services made more accessible, and still have such disparity between black and white infant death? One researcher, Michael Lu (http://www.arc.org/racewire/030210z_kashef.html), back in the early 2000s, found an answer that not many health entities were expecting. He found that racism, and the stress from racism, contribute to this disparity. Dr. Lu found that regardless of a black woman’s educational level, positive health behaviors, or socioeconomic status her baby still had double the chance of dying before age one compared to white women. Dr. Lu attributed his findings to racism and the mother’s stress associated with racism.

I was working within maternal and child health with a national physician organization as a health programmer. I remember the various cascades of surprise as Dr. Lu’s research on racism and the deathly effects it has on black infants began to be disseminated at conferences, in newsletters and between colleagues. No one knew what to say. In most  professional settings, unless you wanted trouble, racism and prejudice were hardly mentioned (out loud). So, for health programmers to address racism… Well, how were we supposed to do that, especially if the racism Dr. Lu found as life-threatening wasn’t even coming from the doctors or nurses serving the pregnant patients? It was coming from everywhere; where the women worked, where they lived, where they shopped; wherever they encountered racism whether perceived or real.

The research on racism and its effects on birth outcomes has been out for almost 10 years and more and more research has been—and is being—developed that adds to or confirms Dr. Lu’s original research. But, still, there is very little focus from health programmers on how to aim their efforts on racism and reduce its impact on pregnant black women. There are many reasons for this.

First, the people sitting around the decision-making table may be racist themselves and struggling with motivation to move the project in life-saving directions.  As a black woman and in my career as a health programmer, I had one supervisor who—regardless of how nice I tried to be—always questioned me on whether I was angry about this or that, and once even called me “hostile.” This is one man that I would say “is not ready” to provide input into what can save the lives of black infants. However, he was a leader at the office and trusted by his authorities and funders even though my personal experiences with him and my own survival sense pegged him as racist.

Secondly, many health programmers may suffer from inertia, meaning that they are so focused in one direction (say, for instance, smoking cessation) that they no longer know how to think on other solutions for pregnant women. I recently ran across this phenomenon at a local nonprofit that serves pregnant women. There was a befuddled leader who was convinced that the best way to reach young black women was through the church, Afrocentric storytelling, and traditional African garb. This kind of health programming was innovative in the ‘80s and ‘90s and probably not really effective then either. Current research did not interest this leader. She knew what she wanted to do, regardless of what the research was saying about black infant mortality.

Lastly, the general racism that shows up on jobs tends to run counter to establishing the best health programs. For instance, I’ve worked for about eight different agencies over a 15-year span of time; at more than half of them I was placed on the black health committee regardless of whether I was interested in doing that work or not (I was). Others sitting around the table didn’t care about what we were discussing, doing, or planning. At each one of these organizations, leadership did not place these committees as a high priority even though many were being funded to innovate around healthcare solutions for black Americans.

Health programming innovation is not happening at the planning tables, communities, or on the national scene. On top of that, racism is a very powerful force. Many organizations and people struggle with their own issues surrounding this hot-button topic. Decreasing the difference between black and white infant mortality rates is going to take willingness and an ability for health programmers to brave new frontiers in health interventions. Perhaps this frontier, racism and its effects on health, is the scariest for American health programmers to discuss, due to the history of America and our tendency to not talk about it. But just like what is hinted at in the research of Dr. Lu and all of the other researchers finding similar evidence, health interventions directly addressing racism at work, school, and within our own souls is bound to do the most good and have truly lasting impacts on the health of black babies and black communities; which is bound to have totally positive impacts on America as a nation.

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Please take the time to visit the other participants posts. They are very thought-provoking and each woman has written about amazing solutions for lowering the Infant Mortality rate in the Black Community.

Amy: Health Programming and It’s Impact on Black Infant Mortality. Guest Post on Musings From The Mind of Sista Midwife.

Darcel: Black Infant Mortality and Your Responsibility. The Mahogany Way Birth Cafe

Nicole: Stop The Talking… Implement SOLUTIONS! Sista Midwife Productions

Darline Turner-Lee: Standing For Little Brown Babies By Supporting Their Mothers. Mamas on Bedrest & Beyond

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4 responses to “Health Programming and Its Impact on Black Infant Mortality

  1. Thank you guys for giving me the opportunity to think this through :) I was pretty surprised at where I went with it and there really was so much more to say. Like the way, the funding comes top-down, real competitive, evidence-based, and they want quick turnarounds, impact; so this kind of longitudinal, slow stuff like racism prevention/intervention as a major health topic is a not a well-funded pill to sallow. But the research is proving it has real teeth… KHA…

  2. *Stands and claps* THANK YOU so much for sharing this perspective on what is happening in the programming community. This is so valid and its important for us as direct care providers to recognize/remember that one of the reason the disparities continue is that many of those working in programming have their own agendas and as you pointed out those agendas dont usually incorpporate the hard to swallow facts and as evidenced by the data they dont have the best interests of black women and babies involved. Your contribution to this topic is invaluable

  3. This is a fantastic post on ways that our health care system can work to improve infant mortality in the black community. There is so much work to be done and barriers to break through. I think articles like this are small steps to getting where we want and need to be.

  4. Pingback: Black Infant Mortality and Your Responsibility « The Mahogany Way Birth Cafe

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