Keeping Black Babies Alive Is A Priority For LA's Top Health Officials
Black babies in Los Angeles County are three times more likely to die before their first birthdays than white babies in Los Angeles County. The majority of infants die after being born too early and too small.
In recent months, the department of public health announced a plan to reduce that disparity by 30 percent over the next five years.
So far, a 12-page document has been produced outlining the areas of focus, and some community meetings have been held. But, turning that into real, tangible steps is a big challenge.
Poverty, education, the behavior of the mothers and access to health care can all be part of the problem, but none of those factors fully explain the gap in birth outcomes that has persisted for decades.
"You can't tell me this can't be fixed," said Dr. Barbara Ferrer, who took over the department of public health last year after working for decades in public health in Boston. A growing body of research points to chronic stress as the culprit. Over time, elevated stress from racism takes a toll on black women's bodies. L.A. County's new plan is focused on averting those chronic stressors and raising awareness of the problem.
The plan aims to reduce the chronic stress in women's lives — by providing implicit bias training for the 100,000 L.A. County employees with whom they might interact — and to address poverty by raising awareness about the Earned Income Tax Credit.
On the health care side, medical providers will be encouraged to regularly ask women about their plans to become pregnant and give them more in-depth information and resources if the answer is yes. The department also wants to provide more funding to community organizations involved in black women's health initiatives.
"You have to start somewhere as a department, put a stake in the sand about what's intolerable - and this is intolerable," Ferrer said.
The gap in mortality rates is also one of the main focus areas of the county's new Center for Health Equity. It's not clear how much money will go along with these efforts, but state Senator Holly Mitchell secured additional $8 million for programs that aim to shrink the gap.
"There's a moral imperative because if we fixed it, we'd have 70 or 80 black children who lived their first year of life who would be contributing members of our community," said Ferrer.
Ferrer and Dr. Deborah Allen, deputy director of the health department, talked to KPCC/LAist about their efforts to close the infant mortality gap when they worked in Boston, the new plan for L.A. County, and what they want black women to know. (Responses have been edited for length.)
There was a Congressional hearing called "Infant Mortality Rates: Failure to Close the Black-White Gap." That hearing was in... 1984. Why is this statistic so persistent?
FERRER: I would say, this is a very blatant example of the impact of racism. And in this country, that's a conversation many people are not willing to have, because it's not just a conversation about oppression and marginalization, it's also a conversation of white privilege. And you really can't talk about dismantling racism without talking about dismantling white privilege. And people in power, which are primarily in the United States people who are white, and some would say still people who are primarily or predominantly male, are threatened by those conversations.
We've tried a lot of things to narrow this gap. Some of it was wrong, because it refused to target money to the people who are most affected.
When the Healthy Start Initiative came out [in 1991], which was meant to improve birth outcomes, we had a huge fight when we decided in Boston, that we were going to target the money just for black women. Latino people were upset, Asian people were upset, white people were upset. You know, we had people are saying, "I'm poor, I need the money, more services, I'm just as much at risk." And I'm Puerto Rican, so I could understand the dilemma here. But Latino babies were doing fine in Boston, their outcomes were very close to white babies.
So for years, we've been saying, just do good things, lift up all boats, and everyone will enjoy good outcomes — provide a really rich set of services that include a lot of prenatal care, get people in early - none of that was addressing the root cause of the lack of opportunities, the lack of economic security, the devastation of families with the racist criminal justice system that disproportionately was putting men of color into jails and prisons and totally destroying families and communities. Nobody was going to talk about that. And I think that's why you have this persistency in this around infant mortality, but also in other health outcomes.
ALLEN: I think in public health, it's always been easier to fall back on, "I'm going to do health education, it's going teach black women how to go through pregnancy, have a baby, raise the baby well." Even in the most loving and concerned way, I think it's still evasion of the reality that that's just not enough, that that's not what explains the difference. But I think it makes for a much more challenging professional life.
I've seen thousands of public health professionals who are willing to sort of allow two mutually contradictory ideas to coexist at the same time. One of which is — yeah, this really is related to racism and the lives that black women lead, and the other is — but if I just think of the perfect curriculum for explaining how to get through pregnancy, I'm going to improve the outcome for her. And I think it's totally understandable, but a total sort of abdication of responsibility. And we've got to be honest.
CALLING OUT RACISM
Not all health departments are being so straightforward in talking about racism and putting that at the core of the literature and action plans. How did you get to that point?
FERRER: I was thrilled to come and actually have permission to actually raise this issue here, and really focus our efforts on an equity agenda and acknowledge that it is time to fight for racial justice and engage in racial healing.
It's not the only thing we all need to do, I mean, we're a service delivery organization, I take that responsibility to heart. But quality services don't necessarily translate to improvements in population outcomes for oppressed people, eliminating sources of oppression is what translates to improved health outcomes. And I feel really blessed that we have a team here that we've been building and a lot of people who have already been here and laid a really strong foundation and a board that says, let's move this forward in a much more visible way. Let's be accountable for actually changing the outcomes, not just talking about it.
FERRER: We're trying to make it real. We need additional resources, and we need to take the resources we have and use them in a different way. We need to work with both our healthcare partners, hospitals, birthing hospitals, providers, and our community partners. And we particularly need to work with black women, so that they're sort of leading the struggle and the solutions to making sure that we eliminate this inequity.
A plan is great - it is an opportunity for people to build trust with each other, come together, identify the things that makes sense in their communities. But that's all it is. Now, it's our job to make sure there are resources that get put behind this plan. And that there are opportunities for there to be leadership amongst the black women, many of whom have been doing this work for ages anyway, and know best.
WHAT'S WORKED BEFORE
In Boston, where you and Dr. Ferrer previously worked, the gap has closed. Between 2000 and 2012, the the black infant mortality rate went from being four times higher to just over double. What made a difference there?
ALLEN: We certainly have tried to spread Centering Pregnancy, the group model of care. There have been efforts to begin to really build One Key Question [where health providers routinely ask about pregnancy plans], although that's very fledgling. We had an investment in what we called women's groups, which were sort of like Black Infant Health here. They weren't in the prenatal care system, but they were opportunities for women to get together outside of healthcare and offer mutual support and talk about their health challenges.
And I think also an effort to really promote uptake of the latest science about what can the medical care system do to avert preterm birth. We don't want to wait until we've overcome racism until we begin to deal with the effects that racism has on people's health, and that includes making sure that women who are at elevated risk don't have to have a preterm birth if we can avert it with either low dose baby aspirin, which seems to be preventively effective, or progesterone. We developed a card for doctors that fit in a white jacket pocket that gave the protocols for use of progesterone - trying to make best practice be standard practice. But you know, Boston has a long way to go, just as Los Angeles does.
Black women in L.A. County should know that this is a real priority.
ALLEN: In addition to telling women that we're working on this is really the notion that this is a shared problem across thousands of women in the United States, you are not alone. It is not what you did or didn't do during the prenatal period that caused this. It's part of a social circumstance that affects many women and you are part of that. And I think that has to be the message and the response has to be in part a mobilizing response - a responsive of not just us saying this is unacceptable. But those women who are most affected, those families, those communities saying we recognize the death of black infants as being as much a question of oppression as the deaths of black young people in the case of gun violence. And that's a next step for us - we're having this conversation, but we're not yet seeing people in the streets saying black babies shouldn't die.
To learn more about what's causing the black-white gap in infant mortality and what's being done to close it, read our earlier coverage.
Read Priska's essay about how she discovered that her family has been affected by this public health crisis:
Do you have a story to tell about how black infant mortality has affected your life? Tell us about it.
This project received support from the Center for Health Journalism's California Fellowship and its Fund for Journalism on Child Well-being.
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