Tag Archives: perinatal disparities

Infant Mortality – Its Far Too Early to Celebrate

Last week, I got an email that made me really pause and take a deep breath.  It started like this…

“FOR IMMEDIATE RELEASE:

 AMCHP Celebrates 12 Percent Decline in U.S. Infant Mortality Rate Since 2005 – Calls for Continued Funding to Accelerate a Promising Trend

Washington, DC, April 17, 2013 – Today, the Centers for Disease Control and Prevention (CDC) released new data showing that following a plateau from 2000 through 2005, the U.S. infant mortality rate declined 12 percent from 2005 through 2011. A copy of the data brief entitled Recent Declines in Infant Mortality in the United States, 2005–2011 is available here. 

Michael Fraser, PhD, CAE, Chief Executive Officer for the Association of Maternal & Child Health Programs, highlighted this progress with the following statement:”

Now… Before I get to the statement… In case you don’t know, AMCHP is the Association of Maternal and Child Health Programs.  Their mission “is to support state maternal and child health programs and provide national leadership on issues affecting women and children.” You can learn more about them and what they do by visiting their website.

Below is the statement from Michael Fraser.  I have included the statement here in its entirety along with some commentary from yours truly… My comments are in green :-)

“The recent decline in infant mortality is a public health success story deserving national recognition and celebration. In short, we are helping more babies reach their first birthday than ever before and this is great news. (Sure its good news that the rates are declining but is this REALLY a time for celebration? I believe it’s far too early to celebrate.  Our Infant mortality rate remains high and our international standing remains embarrassingly low. This may be a time for reflection on what is working so progress can continue but celebration… I think it’s too soon for that.) The decline is also a strong indication that public health efforts supported by the Title V Maternal and Child Health Services Block Grant – along with other critical programs including Medicaid, the Children’s Health Insurance Program, WIC, Healthy Start, Community Health Centers, and critical efforts of the CDC and the National Institutes of Health are making a difference in saving babies lives.  The work of dedicated public practitioners and health care providers is definitely paying off and, for that, AMCHP and its members are extremely thankful. (Interesting how this statement speaks to “critical programs” that nationwide are currently facing budget cuts. In Louisiana, where I live as an example, Healthy Start recently received a huge budget reduction (a  near 50% reduction from what I have been told) and the monies going to our state’s Nurse Family Partnership program were also cut.  Healthy Start across the country is facing budget cuts and many programs may not even continue to receive funding.  What’s going to happen as these programs are reduced further or cut out entirely? What will the numbers say in a few more years? I bet they will be begin to creep up especially if we take time to celebrate instead of continuing the fight.)  Perhaps most encouraging is that the infant mortality rate declined the most (16 percent) for non-Hispanic black women. This may be an indication that deliberate efforts to promote health equity are beginning to create progress in reducing the alarming disparities between whites and blacks, but despite improvement these gaps are still unacceptable and need heightened attention and investment to accelerate progress.   (Not only are the gaps still unacceptable, the disparity remains virtually unchanged. The infant mortality rate for black babies continues to be TWICE the rate of white babies… Are we celebrating too soon? I think so.) Furthermore, improvements realized in the last five years reflect investments policymakers made years and even decades before. While this improvement is welcome news, budget cuts coinciding with the economic downturn and the current sequestration cuts will undoubtedly create major challenges to sustain this success. (EXACTLY. That’s what I’m saying.  These budget cuts he speaks of will reduce this “progress”  so ummmmm riiiight…. Like I said… its far too early to celebrate.)  Accordingly, AMCHP calls on the administration and Congress to reverse years of eroded public health funding, agree on a balanced approach to deficit reduction, and sustain critical investments in the health of women, children, and families.”  (End of Statement)

And they do. In fact last month, Dr Christopher A. Kus, MD, MPH, testified on behalf of the Association of Maternal & Child Health Programs (AMCHP) before the House of Representatives about stopping budget cuts and allocating $640 million to 2014 funding budge for the Title V Maternal and Child Health (MCH) Services Block Grant. But the reality is, the budgets are getting cut and programs are being lost all across the country.  So as far as I’m concerned… Its definitely to early to celebrate. 

I will celebrate when the rates of infant mortality in ALL communities is at a minimum and there are no longer racial disparities.  I will celebrate when we have equal distribution of health services and resources across all boundaries. When access is not tied to race or socio-economic status and when all women have equal access and ability to create and nurture a healthy pregnancy.  I will celebrate when women, without fear or coercion, without jumping through managed care hoops, and regardless of her insurance carrier can easily choose the provider and location for HER birth.  Then and only then will I celebrate. When I see this reality, I will happily pop a bottle, light a candle, hire a second line band, shout from the roof tops and I might even “Drop it like its hot!!” Until then… The fight continues. #FistUP… Do you think its too early to celebrate?

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

Mothers & Babies in Louisiana Need Doulas

The mothers and babies of Louisiana deserve and need more doulas.  The state of Louisiana has some of the worst perinatal outcomes in the nation.  Louisiana has the highest cesarean section rate in the country with nearly 4 out of every 10 women in the state give birth by major surgery1.  Every year, in our state, approximately 600 babies die before reaching their first birthday2. 

Premature birth is the second cause of infant death nationwide.  Mississippi and Alabama are the only two states with premature birth and infant mortality rates higher than Louisiana.  Together they are the only three states that received an F on the March of Dimes Premature Birth Report Cards. Prematurity is the leading cause of infant death in the African American community and in Louisiana, African American babies are more than twice as likely to die as Asian, Latino, and Caucasian babies2.  

 A Doula is a trained birth companion who provides physical, emotional and informational support to a mother and her family during pregnancy, labor, and after birth.  “Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily3  Additionally, the use of Doulas has been shown to decrease the numbers of unnecessary medical interventions, decrease the numbers of cesarean sections and decrease the rate of premature births.  Now more than ever, every pregnant woman, including those in Louisiana, deserves and needs a Doula.

The International Center for Traditional Childbearing (ICTC) is an infant mortality prevention, breastfeeding promotion, and doula/midwife training non-profit organization.  ICTC sponsors the Full Circle Doula Training Program to empower women, increase positive birth outcomes, and reduce infant mortality in African American community.  The Louisiana Friends of ICTC is seeking individuals who are interested in learning more about becoming a doula.  From the ICTC website:  The Full Circle Doula training is perfect for students interested in learning doula skills from multicultural, historical, and traditional perspectives.   In its doula training, ICTC teaches the history of midwifery as a model of care, infant mortality prevention, medical terminology, anatomy and physiology of pregnancy and labor, nutrition and herbs, labor comfort measures, breastfeeding technique and much more. 

An ICTC Full Circle Doula Training will be held in New Orleans May 17 – 20, 2012.  If you, or someone you know is interested in learning more about empowering women during pregnancy and birth and starting a new career as a doula we want to hear from you.  You can learn more about the ICTC Full Circle Doula Training here or contact me for more information about the New Orleans training:  nicole at sistamidwife dot com.  Together we can make sure the women in Louisiana have an opportunity to truly Birth Something Beautiful™

References:
1.  National Vital Statistic Reports, Volume 59 Number 3, December 2010
2.
 
www.marchofdimes.com/peristats
3.
  DONA International
www.DONA.org

Monday Musing: Erykah… Ebony… And a Missed Opportunity…

A couple of weeks ago I was standing in line at the grocery store and picked up the March issue of Ebony Magazine. I picked it up initially because of the cover. It featured Samuel L. Jackson as the “King of Hollywood” looking fine as ever wit his bad ass…. But I digress…

As I flipped the pages, I noticed there was an article about Erykah Badu and her road to midwifery.  Suddenly I was “forced” to purchase the issue. I’m always happy to see anything positive about midwives in mainstream media, especially outlets that are widely read by black women. I was surprised to see the article and wondered why no one in my birth circles had talked about it…Or… I thought to myself, maybe they did, and I was simply under a rock. Regardless, I made the purchase and decided I would read the article later that day… which ultimately jus became later… Two weeks later.

Once I read the article, I  was truly disappointed.  The article did not speak at all about the benefits of midwifery care, or the benefits of hiring a doula. It said nothing of perinatal disparities and the need for black women to get more involved and to take more control over their birth experiences. The article gave information that could easily be misunderstood/misinterpreted. And aside from the fact that the article featured Erykah Badu, who is a wonderful role model and spokesperson for normal birth… the article did a disservice to birth professionals, to black women and to #BlackBirth in general IMHO.

It is well known that back babies and black mammas nationwide have the worst perinatal outcomes, yet somehow when Ebony decided to write an article about midwifery they left these facts out.  We have heard the statistic before. The national infant mortality rate is approximately 6.42 infant deaths per 1,000 live births. The rate for caucasian babies is less than the national average at around 5.3 deaths per 1,000 births while the rate for black babies is DOUBLE the national average with greater than 12 black babies dying per 1,000 births. In some states as many as 16 black babies die!!  Prematurity is the leading cause of infant mortality for black babies.  There are a host of reasons black women find themselves at increased risk for premature birth.  Ebony didn’t mention any of that.

Ebony left out information about the benefits of midwifery care and doulas.  They didn’t mention that research has shown repeatedly that Midwifery care with its attention to detail and focus on people and families not just bellies and babies, can turn birth disparities around.  Check out the work of one of my Midwife Sheroes Jennie Joseph for proof.   They left out advice about choosing a better doctor and getting better outcomes. Yep…. They left all of this out, all while doing things like calling a fetoscope a “maternity stethoscope”

I mentioned my annoyance to a couple of folk and their take on it was… “Well… This was an article about Erykah Badu not midwifery and pregnancy.” My thought… It was an article about Erykah and her path to midwifery… The two cannot be separated.   I thought to myself, maybe if they had covered these topics else where in the issue it would have been better.

Not five pages after the article on Erykah there was the “Wellness /Spirituality” section. Personally I can think of nothing that matches these two categories simultaneously more than midwifery. Yet… As I flipped through this section there is no word of pregnancy, birth, doulas, or midwives.

There was an article about Vitamin D.  Not a word about the research surrounding vitamin d deficiency and pre eclampsia; A serious pregnancy issue that disproportionately affects black women. There was even a blurb about clean teeth and heart attacks.  Again no mention of pregnancy, birth and the VERY STRONG link between dental hygiene and pre term labor.  Remember… preterm birth is the number one reason for infant mortality for black babies.

I was disappointed that Ebony fell short…waaaayyyy short.

They missed an opportunity to educate not only black women of child-bearing age but black families everywhere. And for that I say shame on you Ebony. Here was an opportunity to really serve the women who read your magazine and it was missed. I hope next time it will be different.

Did you read the Ebony Article? Do you feel like they missed an opportunity to help women Birth Something Beautiful™?  I sure do.

Welp… that’s my musing for this week…. Make it a GREAT one!
Don’t forget to follow me on twitter I’m @SistaMidiwfe

All Women Deserve Adequate Labor Support…

Recently read a wonderful interview with Penny Simpkin as she answers questions from Mother’s Advocate about the many benefits of Labor Support.  IMO, one of  the most pertinent quotes from the interview…

“I think what we find is that a woman has great emotional needs during labor. If those are not met, she’s depleted. She may become depressed — we’ve found that there’s more depression in women who have not had adequate labor support. So this can have ramifications that go far beyond the birth experience. When she feels well supported, valued, respected, cared for, nurtured, guided — she feels empowered. And after a birth like that, she’ll say, “I did it.” She knows that she has that strength. I would hope for every woman, however she chooses to give birth, that she comes out of it feeling the sense of power, capability — accomplishment.” (emphasis mine)

That’s what I would hope for too!!!  To me this is a perfect follow up to the birth story I shared yesterday.  And while I know Ms. Simpkin speaks about “every woman” I am painfully reminded, as I work across this country that women of color are less valued, receive less support, are less respected and are devalued during their labor experiences. This is increasingly true if the woman of color is using Medicaid… as if a method of payment is a statement about your humanity.  It’s no wonder women of color, specifically African American women, are more likely to experience post partum depression, among other things.

In FACT…. I just had a conversation with a  woman who had such an experience. Wanted an un-medicated birth. Arrived to hospital at 5/6 cm dilated. Had no one there to support her. Received an epidural. HATED it and now is having a rough time processing her birth experience. Makes me VERY sad I was unable to be there for her.  She is now considering becoming a doula!!!  Are you a woman of color with ANY interest in childbirth and labor support? Let me know. We DESPERATELY need you in our ranks to educate, to support and to help spread the information needed to create a better birthing environment for our girls and women.  But I digress….

Read Penny Simpkin’s entire interview about labor support HERE. It’s a great interview!

In Birth and Love,
Nicole ~
Follow me On Twitter @SistaMidwife