Tiny casualties: What infant mortality means in Oakland County
Roughly 16 of every 1,000 black infants born in Pontiac won’t live to see their first birthday.
It’s a striking statistic, but not an uncommon one, as researchers and public health officials have grappled for decades with disproportionate infant mortality rates between communities of color and whites.
In Pontiac, the mortality rate for black babies is 16 for every 1,000 live births, more than twice the 6.8 per 1,000 live births for white babies born in the city, the county seat.
Data from the Michigan Department of Community Health shows that the infant mortality rate for a black child is 2.9-times higher in Michigan than that of a white baby.
In Oakland County, the infant mortality rate is 3.5-times higher, standing at 13.5 per 1,000 live births for black children and 3.8 per 1,000 live births for white children. The study followed three-year moving averages per 1000 live births from 2006 to 2017.
Like a tree with many deep and historic roots, the disparity between infant mortality rates in blacks and whites is a symptom of multiple systemic causes. There’s no golden root that could be cut to bring the tree down, only a tangled weave of questions about poverty and access to health care.
Preterm births and low birth weights are two of the leading causes of infant mortality across all races, according to the Centers for Disease Control and Prevention in Atlanta. A healthy pregnancy is often the best defense against those complications.
But what makes a population more susceptible to preterm births isn’t an easy answer, said Dr. Anissa Mattison, residency program director for obstetrics and gynecology at St. Joseph Mercy Oakland Hospital in Pontiac.
There’s several risk-factors that affect all pregnant women’s chances for a preterm birth. Including:
Age, teen pregnancies and those 35-years or older,
Weight, obesity or lack of nutrition during pregnancy,
Substance use such as drugs or tobacco,
Access to health care.
But for many predominantly black communities, such as Pontiac and Southfield, those risk factors are amplified by lack of socio-economic equality, unreliable transportation, less access to fresh fruits and vegetables, and misinformation about available resources for pregnant women.
“When you look at the medical literature, just being black, like so many other health issues, puts you at a high risk. I think one part of it is chronic stress, and that’s not just something we see with teen pregnancies,” Mattison said.
Perceived discrimination, especially over the course of a lifetime, has been linked to causing chronic stress, according to a 2018 report from Duke University’s Samuel DuBois Cook Center on Social Equity and the Insight Center for Community Economic Development. Chronic stress can lead to a host of health complications, including high blood pressure and levels of inflammation.
“In my opinion, if you look at life course theory and social determinants of health, the health of the mom affects the baby, and not just in the sense of if she has diabetes or not. When there are high stress levels in their life, the theory holds it can affect the health of the infant she’s carrying,” Mattison said.
Trust Over Substances
Sometimes, it’s mistrust of the medical system itself that can stop a woman from seeking out prenatal care. For those trapped in a substance use disorder with drugs like opiates, or alcoholism, or even being unable to quit smoking cigarettes, that doctor’s appointment becomes more of a fear than a safety net against infant mortality.
“It’s a tie between misinformation and fear that a woman might have about her situation that keeps her away from care,” Erika Alexander, director of quality assurance for Oakland Family Services, said. “If she smokes or has used marijuana, a woman might think it’s better if no one even finds out she’s pregnant. It tends to keep them away from care.”
Oakland Family Services is one of the agencies the Oakland County Health Department partners with to provide prenatal resources to at-risk women. For eight years, Alexander ran the agency’s Project Recovery Intensive Services for Mothers program, known as PRISM. The program specializes in helping pregnant women overcome their substance use disorders and receive prenatal care, regardless of their insurance status.
“We work with a couple different providers that are willing to take women when they’re still pending for Medicaid or insurance. A lot of people think they can’t get prenatal care without it, but we can link them with providers,” Alexander said.
It’s a common enough issue that she calls it a major barrier to a healthy pregnancy, from her more than 19 years working with Oakland Family Services. There’s just not enough information spotlighted on things like Federally Qualified Health Centers, such as Honor Community Health in the Pontiac area, which assist with providing affordable care in at-risk communities.
“It’s both an actual and believed barrier that women don’t have access to this kind of prenatal care, but I do think because it’s believed, women don’t even reach out to find out if someone would accept them. There’s this automatic assumption that they won’t be able to afford it,” Alexander said.
Access & Education
Access to prenatal care for at-risk and black communities is a constant concern for county health officials, according to Shane Bies, county administrator for public health nursing services.
Even with a myriad of educational services and community partnerships to increase access to affordable health care, 45 public health nurses making at-home visits and an estimated $1 to $2 million spent each year in the county on programs that affect infant mortality rates, Infant mortality is still a difficult issue to address through the typical avenues of providing public funding for local programs.
“It’s so difficult (to close the disparity gap) because you’re talking about a population change. We have close to 13,000 live-births each year in the county and we’ve dedicated a lot of our resources to Pontiac and Southfield,” Shane Bies, county administrator for public health nursing services, said.
“We work with the African American population as much as we can and oftentimes, we’re seeing multi-generational issues. We do see the gap closing, but not as fast as we would like.”
From 2008 to 2017, Michigan saw only a one percent decrease in the infant mortality rate for black children. For whites, it dropped by 0.7 percent. Oakland County saw a 1.9 percent decrease for black children and a 1.1 percent decrease for white children. Michigan is currently in the process of transitioning from its 2016-2019 Infant Mortality Reduction Plan to the new Mother Infant Health & Equity Improvement Plan.
“We’re always implementing and changing and as this new state level plan is phased in, we’re going to see a big change. Instead of equity being one emphasis of the plan, it’s going to be interwoven throughout all our efforts,” Bies said.
One of the county’s most prominent programs is a nurse-family partnership program, a nationally recognized initiative, with about 45 home visiting public health nurses.
Sue Martinez, a public health nurse of 25-years, has worked with the nurse-family partnership programfor nine years.
“Getting to and from their doctor’s appointments is the biggest barrier. Often our transportation system isn’t reliable, so they’re missing their prenatal visits,” she said.
Nearly a third of Pontiac residents live without access to reliable transportation.
Information on how to access all county programs, partnerships and resources pertaining to prenatal care and pregnancy can be found by calling a nurse on call at the county health department’s helpline: 1-800-848-5533.
For decades, the disproportionate rate of infant mortality between black and white populations was attributed most solely to poverty, without much consideration to other factors. There’s more awareness today, both among the medical community and local governments, about cultural and systemic issues experienced by the black community.
And for Mattison at St. Joe’s Hospital, that means it all comes down to one thing:
“Education,” she said. “If we don’t go beyond the walls of the hospital and into the community, then we are only reacting to these infant mortality numbers and not being proactive. You have to build trust through education, especially when you’re talking about minority populations. Without that, everything else is less impactful.”
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