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Can systemic racism impact infant mortality?


Even when controlling for poverty, education level, and tobacco use of a mother, maternal and infant health outcomes are far worse for minority populations than European-American women. What's causing the continued disparities? And what can West Michigan do to ensure all babies born here have the best chance of reaching their potential? Zinta Aistars reports on Strong Beginnings, one local program working to give all families a fair start.
 When life first stirs inside a woman’s womb, her dreams have already begun to unfold around her child’s future. A nursery lovingly prepared, a first step taken, the ringing of school bells, the proud march for diplomas, weddings and future generations. For an alarming number of Latina and African-American women, however, those dreams darken to nightmares—a child’s death.

The infant mortality rate, or IMR, refers to the number of babies who die before their first birthday. “Rate” refers to the number of babies who die for every 1,000 babies born alive. The IMR reflects the physical, social and economic health of a community.
According to Peggy Vander Meulen, RN, MSN, program director of Strong Beginnings in Grand Rapids, a black baby is 2.9 times more likely to die than a white baby.

“That’s down from 5.2 in 2005,” she says. “The rate in Grand Rapids was very high back in 2003—the worst in Michigan. But we’ve made inroads; our totals are now close to statewide averages.”

Strong Beginnings is a Grand Rapids-based program formed in 2001 to address the glaring disparities in birth outcomes between African-Americans and European-Americans. “We are a partnership of six community agencies,” says Vander Meulen. “Traditionally, we began with a focus on African-Americans, but we have opened our program to all who meet the criteria of being underserved, because any loss of an infant is tragic.”

In 2004, Strong Beginnings applied for federal funding and received it. As the program grew, its financial needs grew along with it. The W.K. Kellogg Foundation awarded the program a grant in 2011 to expand its services to all of Kent County, add a fatherhood component, and to work toward promoting racial equity. A second grant in 2013 allowed Strong Beginnings to engage the Latino community to improve maternal-child health. 

And, this past May, Strong Beginnings was awarded more than $9 million in grants to expand outreach to African-American and Latino communities. The program will receive $4.3 million over five years from the W.K. Kellogg Foundation to improve maternal and child health among Latinos in Kent County through its program, Familias Fuertes y Saludables. The grant will provide services during pregnancy and two years after the baby’s birth.

Partnering with Strong Beginnings are Spectrum Health’s Healthier Communities, Arbor Circle, Breton Health Center, Cherry Health, Family Futures, the Grand Rapids African American Health Institute, the Healthy Kent Infant Health Team, the Kent County Health Department and the Salvation Army Booth Clinic.

Ken Fawcett, right, and Peggy Vander MeulenKen Fawcett, MD, has been vice president at Spectrum Health’s Healthier Communities for about six months, but it’s been time enough to impress him with the difference the Strong Beginnings program has made, even as he understands the need for the program to do more.

“When we look at the incidence of infant mortality, it’s a reflection on our society,” he says. “This is not a matter of genetics, but a societal issue.”

“When the first generation of Latinos came to Grand Rapids, they were strong and the infant mortality rate was low,” Vander Meulen adds. “With the next generation, the rates worsened. We haven’t been able to determine all the causes, but we attribute it in great part to the loss of community. They also experience diet changes in Western civilization, and, let’s face it, our diets are not always healthy.”

Stress, Vander Meulen says, is one of the greatest determinants of infant mortality and maternal health outcomes, causing physiological changes in the body.

“It’s a cascading effect,” she says. “Racism is still very real; we’ve seen that in recent media. Grand Rapids is still a hyper-segregated city. We rate high as a desirable place for whites to live, but are still one of the worst for people of color.”
Encountering racism on a daily basis in all its subtle nuances wears down a person’s physical, emotional and mental health, Vander Meulen explains.

“We know that smoking is bad, that it contributes to low birth weight,” she says. “Yet when we compare rates for women of color and white women, non-smoking black and Latina women still have higher infant mortality rates. Poverty is a factor, but when we compare women of color with higher incomes than white women, their infant mortality rates are still higher. Same with education. Black women with degrees have worse maternal health outcomes than white women with GEDs. These are disparities that can’t be explained by any other factor than the stress of lifelong exposure to racism.”

“There are other determinants to health other than health care,” Fawcett says. “Health systems today are addressing food insecurity, health literacy, violence and safety, job skill training, transportation. We are empowering individuals with the information to make informed decisions about their own health and the health of their family members.”

The main cause of infant death is low birth weight or prematurity, followed by congenital anomalies and suffocation from unsafe sleep. Low birth weights (less than 5.5 pounds) can lead to life-long physical, cognitive and behavioral impairments such as cerebral palsy, mental retardation, chronic lung disease, growth retardation, blindness, deafness and speech/language disorders, ADHD, behavioral problems, and learning disabilities.

“Problems associated with low birth weights can cost billions of dollars a year,” says Vander Meulen. “It becomes a matter of priorities, how a community spends its money.”

All services offered by Strong Beginnings are free, including transportation, child care and client assistance items.
“We’ve made great progress and have seen great improvements among vulnerable populations,” says Fawcett. “We haven’t had a single death in the past three or four years among those enrolled in Strong Beginnings. But until we eliminate racial inequities, we will continue to see racial health disparities.”
 
 
Zinta Aistars is creative director for Z Word, LLC. She also hosts the weekly radio show about books and writers, Between the Lines, at WMUK 102.1 FM.
 
 This story is part of a series of solutions-focused stories and profiles about the programs and people that are positively impacting the lives of Michigan kids. The series is produced by Michigan Nightlight and is made possible with funding from the W.K. Kellogg Foundation. Read other stories in this series here.
  
Photography by Adam Bird
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