Posted September 30, 2018 in Articles
Author: Brie Zeltner
CLEVELAND, Ohio – Community members and public health officials combating the high rate of infant deaths among black families are celebrating a rare win in one of the hardest hit ZIP codes in Northeast Ohio.
Infant deaths in the 44128 ZIP code, which includes the village of North Randall, and parts of Warrensville Heights, Highland Hills, Garfield Heights, Bedford Heights and Cleveland, dropped to zero last year for the first time in at least 10 years. Most years, between six and eight live-born babies die before reaching a first birthday in this ZIP code, making it one of the most dangerous places to be born in the region.
It’s too soon to tell what caused the drop, or if it will continue, but those on the front lines of the battle to save the lives of babies in this ZIP code are thrilled about the good news. They won’t take credit for the improvement yet, though, and will continue to work until it proves to be a trend.
Members of the group “44128: One Community” have been meeting monthly for the past two years to learn why so many babies have died in their community, and to come up with ways to address the problem. The team is made up of church leaders, public health officials, health care providers, nonprofit leaders, academics and 44128 community members. The team is funded by the Ohio Department of Health’s Ohio Equity Institute in collaboration with City MatCH, a national group devoted to improving maternal and child health outcomes.
The infant mortality rate in Ohio, defined as the number of infant deaths before the age of 1 per 1,000 live births, is among the highest in the nation at 7.4. Compared to any other area in the state, rates in Cleveland and Cuyahoga County place the region among the worst performers in this measure of community health with a shocking and growing gap between the rates for white and black infants.
Last year in Cuyahoga County, the overall infant mortality rate was 8.1, and more than seven black babies died before reaching a first birthday for every one white baby who met the same fate. This disparity is enormous, about three times the size of the gap nationwide and more than double that seen in Ohio.
The grim statistics make a year with no deaths, even in a single ZIP code, stand out.
Engaging the neighborhood
The 44128 team’s goal (along with nine other groups funded in counties across the state) is to develop ways to combat the county’s huge inequity in infant deaths. They chose to work in the ZIP code because it has the highest infant mortality rate in the county and includes both parts of Cleveland and several inner-ring suburbs.
The infant mortality rate for the ZIP code in 2016 was 14.8, twice that of the state. That year, babies born in 44128 were 50 percent more likely to be premature than other babies in the state, the leading cause of infant mortality here.
Erika Hood, community research & dissemination coordinator for Case Western Reserve University and MetroHealth’s Center for Reducing Health Disparities, is leading the community engagement for the 44128 group. When the group first began meeting in January of 2017, community members knew little about the topic and its causes, she said.
It took about five months of meetings to get the 25 to 30 regular attendees up to speed.
“People did not identify with the term ‘infant mortality’,” she said. “They understood that babies were dying in their community, but they had no clue about the disparity.”
Black women of all socioeconomic levels are far more likely (in one recent study four times more likely) to have a baby born very early, between 16 and 22 weeks’ gestation, a primary cause of infant death. And for black women, education is no protection against infant death: College-educated black women are more likely to lose an infant than high school-educated white women. The disparity in infant deaths can’t be accounted for by many of the factors long thought to be explanations, such as poverty, obesity, age of mother and illegal drug use.
Dottie Hendricks, the lay leader at Aldersgate, said the information was a revelation to her, too. Hendricks, 78, of Warrensville Heights, had a miscarriage many years ago that she now attributes to stress.
“You may think you have a great handle on everything, but this hits everybody,” she said.
Hendricks and Bass are two of the many church leaders who have joined the 44128 group. Faith-based organizations have been invaluable in spreading awareness and galvanizing support for the effort, Hood said.
Among other things, Dogba and other church leaders in the neighborhood have committed to providing breastfeeding locations in their churches so that new mothers feel more welcome at services.
Since starting the group, the 44128 team has also been knocking on doors in three areas identified as “hot spots” for infant death in the ZIP code: two apartment buildings in Warrensville Heights and part of the Lee-Harvard neighborhood. They’ve been sharing information on infant death, but also asking community members what kind of supports they have and what’s important to them in their neighborhoods.
Seeing the big picture in the details
Cuyahoga County Board of Health Data Analyst Richard Stacklin identified the hot spots at one of the group’s earliest meetings. “What I found was that in each of those areas an infant died every year for the past 10 years,” Stacklin said.
Stacklin said the hyperlocal data helped people see the big picture in their own neighborhood. “Let’s just say you live on Harvard and 154th Street. How likely are you to know that an infant is dying every year across the ZIP code on Country Lane? Just seeing the totality of it brought it home.”
Once that understanding set in, the group focused in its second year on coming up with ways to make things better. One of their major targets, in addition to outreach and education, is reducing stress.
While researchers have struggled to explain why black women in America, across incomes, are more likely to deliver early and suffer an infant death, a consensus has been building recently that the daily stress of being black in this country takes a real and measurable toll on the body, which can lead to conditions that directly affect infant and maternal health.
The cumulative effects of this stress over time, a phenomenon referred to as “weathering,” may help explain why black women in their 20s, who are in general more highly educated, have worse birth outcomes than black teenagers who give birth, while the reverse is true for white women.
In the 44128 group, addressing stress in everyday life became part of each meeting. Before starting, the group meditates. “If we come to a meeting every month and talk about babies dying, that’s stressful,” Hood said. “We have to set an example for the community in our own sphere.”
“If we can do it for ourselves in our little meetings, we begin to see how to replicate that positive effect on a bigger scale,” said 44128 member Michael Householder, assistant dean of the Case Western Reserve University College of Arts and Sciences.
Next year, the group plans to implement some of its ideas on reducing stress in the community, as well as helping women access existing programs designed to cut down on infant deaths.
And while 44128 members are overjoyed that infant deaths in their neighborhood dropped last year, they remain vigilant.
“It’s good news, but it doesn’t establish a trend yet,” Bass said. “It’s systemic — we’re not going to knock it down completely with a year of meetings.”