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First Year Cleveland takes community approach to narrow infant mortality gap

Posted October 10, 2021 in Articles

Author: Judy Stringer

If there is a proverbial canary in the coal mine when it comes to black women’s wellness, it might be infant mortality.

In Cuyahoga County, the board of health recorded its lowest infant mortality rate in 30 years in 2020. The number of babies who died before their first birthday last year dropped to 7.65 per 1,000 live births.

Gains, however, are not evenly spread.

Over the last five years, while white infant mortality has plummeted by 39%, black infant mortality has fallen by only 19%, according to First Year Cleveland, a public-private coalition focused on decreasing the county’s infant mortality rate.

In 2020, three black infants died for every one white infant.

“Infant mortality is an indicator of the health and wellbeing of our community,” said First Year Cleveland interim executive director Katrice Cain. “When we really look at the fact that more of our black babies are dying, what does that say about our community?”

The short answer, according to Cain and other First Year Cleveland leaders, is that black mothers need more support. The long answer involves entrenched systems of racism, discrimination and oppression – and even unrealistic expectations – that contribute to the accumulation of “toxic” levels of stress.

“Studies show cortisol levels are significantly higher in black women than white women,” said Mitchell Balk, president at The Mt. Sinai Health Care Foundation and a member of First Year Cleveland’s executive team. “So, we know that black women are walking around with significantly more toxic stress than their white counterparts.”

High levels of stress hormones, in turn, increase the incidence of pre-term labor among black women. And pre-term birth is the leading cause of infant death, Balk said.

Beyond prenatal care

To that end, First Year Cleveland’s future, the leaders say, will be as much about targeting the social and economic determinants that lead to infant mortality as its first five years have been about offering interventions for at-risk mothers.

Cain said First Year Cleveland’s group prenatal care clinics and in-home doula and nursing services, for example, have contributed to declining infant death rates locally, as have external programs like Cuyahoga County’s Fatherhood Initiative. There is potential to build on that progress by scaling those types of interventions, she said.

“But this is not solely about poverty or a lack of education or prenatal care in our community,” Cain explained. “Black women who are well educated with advanced degrees are experiencing [infant] losses at higher rates than white women with less than a GED.”

“There’s nothing biologically different between a black woman and a white woman,” she added. “There is a difference in the black woman’s experience.”

That experience often involves being ignored, discounted and overlooked in and outside of health care settings, said India Pierce Lee, senior vice president of program at the Cleveland Foundation and co-chair of First Year Cleveland’s executive committee.

Her fellow co-chair, Cleveland City Councilman Blaine Griffin, describes this kind of perfect storm where black women bear mistreatment while simultaneously trying to live up to a societal image of being a “strong black woman.”

“This idea exists that, somehow, black women handle more pain and stress and all the other things because they're always seen as such strong figures and leaders in our community, which is a good thing, but often they don’t have the support that they need,” he said.

Community-based model

Changing how society treats black women won’t happen overnight, Lee said, and will require “deconstructing” racial biases across institutions and systems.

First Year Cleveland plans to be part of that deconstruction movement, starting from “the ground up,” according to Cain. The coalition will go into Cleveland neighborhoods, talk to black mothers – and fathers – about their experiences, invest in grassroots organizations already on the frontlines of socioeconomic equality and “engage new stakeholders in this important work,” she said.

“Saving babies” is not only about the clinical care, Cain said. It’s also about housing, transportation, economic opportunity and the many other factors that affect health inequities and disparities.

“I think that we have to be very clear that this approach will require a lot of work,” she said. “It will require a lot of transparency, and a commitment to doing things differently. But we can’t do business as usual.”

Original Article: View Online

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