Time to Recognize Role of Racism in Infant Mortality The Columbus Dispatch

(www.dispatch.com) – The mid-December news from the Ohio Department of Health was discouraging: Following years of effort to reduce the rate of infant mortality, new numbers showed that not only did the overall rate remain unchanged, the rate at which Black babies died before their first birthdays actually rose. 

In fact, if one considers only white babies, says Democratic State Rep. Emilia Sykes of Akron, the state long ago surpassed the widely shared goal of, by 2020, losing no more than six babies per 1,000 live births in a year. But the mortality rate for Black babies in Ohio in 2019 was 14.3 per 1,000 live births – up from 13.9 in 2018 and nearly triple the 5.1 rate for white babies. The overall rate for 2019 is 6.9, the same as 2018.

Zahra Younous, holds her two month old daughter, Sujud Adam, while her other daughter, Sadan Adam, 2, gives her new sister a kiss. Thursday, August 16, 2018. Younous participates in a program to help reduce infant mortality.   (Dispatch photo by Courtney Hergesheimer)It’s time for policymakers to consider what many researchers have found: Racism itself, as much as poverty or any other factor, is part of why Black babies are more likely to die.

Sykes, who has a master’s degree in public health and who has worked for years on the infant mortality issue, was unimpressed that Republican Gov. Mike DeWine reacted to the health department report by announcing formation of a new task force, charged with developing a plan to reduce infant mortality overall and eliminate racial disparities by 2030. She took to Twitter, declaring: “We already know the strategies to end disparities in infant mortality. We don’t need another ‘task force.’ We need actions.”

Rep. Erica Crawley, a Columbus Democrat, tweeted similar thoughts: “We KNOW why babies, especially Black babies, are dying. This is yet another attempt to continue to kick the can down the road.”

The frustration is understandable; the goals outlined by DeWine are essentially the same that were set for Franklin County in 2014 by CelebrateOne, an initiative that grew out of Mayor Andrew J. Ginther’s Infant Mortality Task Force. It resolved to reduce infant mortality overall by 40% and end the racial disparity by 2020.

On the first goal, CelebrateOne has had more success than the state overall: Since its inception in mid-2014, the infant mortality rate in Franklin County fell from 8.1 to 6.9. In a group of Columbus neighborhoods targeted by the initiative, it went from 11.7 to 10.

But the racial disparities have proven to be what Ginther calls “stubborn numbers”: Countywide, the difference between the general rate and that of Black babies grew from a factor of 2.4 to 2.7, and in the targeted neighborhoods from 1.6 to 2.2. The target is 1:1 – no difference.

CelebrateOne has attacked the problem with educational campaigns and advocacy in specific areas. Because a significant number of infant deaths result from unsafe sleep conditions – often being smothered while in a bed with a parent – the organization stresses a safe-sleep message of “ABC”: When sleeping, a baby should be Alone, on its Back, and in a Crib. The organization and its partners have made portable cribs available to mothers who don’t have them.

Other CelebrateOne partners work to connect expectant mothers with pre- and postnatal care, housing and all the other supports that help a mom and baby remain healthy.

But Sykes and others point out that the stark disparity between outcomes for white and Black babies involves more than just the persistent effects of poverty. Multiple studies have shown that simply being Black – even if you’re wealthy, well educated and generally healthy – can harm your chances of having a healthy baby.

Studies by the Harvard T.H. Chan School of Public Health, the American Psychological Association and others have shown that racism – not just race – can influence interactions with health care providers, as well as physiological effects in women, that harm babies’ prospects. A primary health consequence of racism, even for the most successful and privileged of Black and brown people, is constant, chronic stress.

Sykes is no stranger to such stress; in 2018, she spoke of repeatedly being challenged when she tried to enter the Statehouse. In one instance, a security guard said she “didn’t look like a legislator.” For even the most outwardly successful Black people, Sykes said, the possibility of such a confrontation is a constant anxiety.

Such stress has a physiological effect that a University of Michigan public health professor calls “weathering”: cellular changes that can make Black people more vulnerable to health problems, including in pregnancy.

Consider a Black pregnant woman, faced by doctors and nurses who assume she has poor health habits and make her feel humiliated and insulted. Such interactions drive some women away from prenatal care. Anecdotal stories abound of Black women whose concerns about pain or other problems are dismissed. Doctors too often assume any health problems experienced by Black women must be due to drug or alcohol use or other unhealthy habits.

Racism underlies most of the challenges faced by poor Black families: poor housing, education and job prospects. CelebrateOne and other efforts seek to address all those challenges, but it will take broader community efforts to truly change them.

Sykes has suggestions: Doctors, nurses and other health care professionals should have “cultural competency” training to help them better understand and respect patients who are culturally different from themselves. Years ago she backed a bill requiring such training in Ohio medical schools. Some schools have added such training on their own initiative, but state policy should enshrine it as priority nonetheless.

Preventing infant mortality obviously means care for the women carrying the babies. That points to measures such as allowing Medicaid to cover a prescription of progesterone, which can help maintain a fragile uterine lining, as well as birth control so women can space their pregnancies better. Anyone familiar with the extreme social conservatism of Ohio’s Republican lawmakers can imagine how difficult such policies might be to enact.

But if Ohio’s leaders are serious about saving all babies from untimely and unnecessary death, they’ll have to accept certain realities: Racism is baked into American society in ways that challenge Black and brown people every day; bias, implicit or otherwise, often affects how health-care providers, who largely are white, view and treat their patients.

Until political and health-care leaders adopt laws and policies that recognize the role of racism, Black babies will remain the tragic subjects of a “stubborn number.”

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