Grassroots groups are leading the way to closing Colorado’s infant mortality gap

AURORA, Colo. – As Britney Taylor visited the Mama Bird Maternity Wellness Spa during its grand opening this spring, she reflected on the birth of her first child: a confusing and lonely experience that resulted in an unplanned C-section and a long period of postpartum depression.

But here in this Denver-adjoining town, local families and smiling doulas wandered amidst a bright space echoing with upbeat music where mostly women of color can get massages, meet birth professionals and support groups, and attend classes on breastfeeding, childbirth and infant care. .

“It’s perfect,” Taylor said. Her next birth, she says, “will be completely different.”

About 12 miles away in northeast Denver, staff members at the Families Forward Resource Center were preparing a room where families who might have trouble getting to the doctor can easily meet with clinical staff about their medical questions. They were also preparing to hire a doula trainer to help increase the local number of birth support workers of color.

A primary goal of the two organizations is to reduce a significant health disparity in Colorado: Black, Hispanic, and Native American/Alaskan babies are dying at a higher rate than white and Asian/Islander babies. of the Pacific.

“Separated by race/ethnicity, our disparities are persistent and quite stark,” said Dr. Sunah Susan Hwang, a neonatologist at the University of Colorado School of Medicine.

By several measures, including infant mortality, Colorado is considered one of the healthiest states. For every 1,000 live births, fewer than five babies die before they reach their first birthday, putting Colorado among about 15 states that have reached a threshold well ahead of the national 2030 goal.

Data from the Centers for Disease Control and Prevention from 2003 to 2019, the largest range for which comparable data is available, shows the gap between infant mortality rates for non-Hispanic blacks and non-Hispanic whites has narrowed faster in Colorado than nationally. Colorado’s gap started wider than the national gap, but is now narrower.

But according to state health department data, only Asian/Pacific Islander and non-Hispanic white babies have met the 2030 goal. And despite a dramatic drop in mortality among black babies over the past 20 In recent years, their mortality rate, at around 10 deaths per 1,000 live births in 2020, remains well above the state average. Hispanic babies, meanwhile, are still dying at about the same rate as 20 years ago, with more than six deaths per 1,000 live births. (Data on Native American/Alaska Native babies were not always available because the numbers were too small to give meaningful rates.)

If black and Hispanic infants had the same infant mortality rate as non-Hispanic white infants in the state, about 200 babies would have been spared from 2018 to 2020 alone, according to an analysis of KHN data.

One of the main reasons babies die is because they are born too early. According to data from March of Dimes, Colorado was among 22 states where the disparity in preterm births between the most prosperous demographic groups and the rest of the population has worsened over the past five years. The state health department is clear on one important factor: racism.

“We know that racism and structural racism is one of the root causes that can contribute to this chronic stress in people’s lives that can contribute to prematurity, which can then lead to infant mortality,” said Mandy Bakulski. , responsible for the maternal and child welfare section. for the state health department.

Infant mortality is just one measure of health that disproportionately affects Black, Hispanic, and Native American/Alaska Native Coloradans: compared to other Coloradans, they are more likely to die of kidney disease, diabetes, covid-19, car accidents and other illnesses, according to the state health department.

Bakulski said that in recent years, state health officials have “reversed” their approach in response to community feedback on state infant mortality discrepancies and a multi-state project that studied a wide range of possible interventions. Bakulski’s team said the combination led them to conclude that “putting money in people’s pockets is a way to improve health outcomes.”

So the department has pushed the benefit of child tax credits that allow families to keep more of their income and is preparing to promote legislation that, starting in 2024, will give many Colorado parents three month of partially paid leave to care for a new child.

According to the March of Dimes — which tracks state efforts to reduce infant mortality and preterm birth — Colorado has achieved four of six policy actions supposed to improve maternal and child health, which are closely related. More importantly, he expanded Medicaid in 2013, which researchers say helps reduce infant mortality, though it’s unclear whether it helped narrow racial gaps.

“We give Colorado a ‘B.’ It’s much better than a lot of states — certainly better than the states that surround Colorado,” said Edward Bray, senior director of state affairs for March of Dimes. But there’s “room for improvement.” .

The organization expects an imminent change that will help: Colorado is temporarily expanding Medicaid eligibility, so more low-income women will have coverage for a year after giving birth, rather than the usual two months. The change is part of a package of laws passed last year that, among other things, elevated medical abuse during the perinatal period to a civil rights issue to be reported to the Colorado Civil Rights Commission.

However, advocates, researchers and professionals who work with families of color say the state can and should do more. First, they say, create a workforce of culturally competent health care providers, including doulas.

“Research has supported that doulas help achieve better overall birth outcomes, reduce preterm births, and reduce maternal and child mortality and morbidity,” said Bray, whose organization identified the access to doulas as one of Colorado’s major policy shortcomings.

However, Anu Manchikanti Gómez, a health equity researcher at the University of California, Berkeley who studies interventions, including doula care, designed to improve birth outcomes, said other options could also be crucial. While a doula plays an important role as a support person, navigator and advocate, she said, the doula is “a very downstream solution. It doesn’t really get to the root of the problem.

Gómez is interested in concrete interventions such as unconditional cash transfers to pregnant families. In Canada, researchers found that when impoverished pregnant Aboriginal women received a cash benefit of around $60 a month, it helped families meet their needs and reduced stress, and babies were less likely to born early or small.

Gómez is participating in a pilot study, the Abundant Birth Project, which pays a monthly cash supplement of about $1,000 to pregnant women in San Francisco who are black or Pacific Islander. The goal is to relieve the types of stress that can lead to premature birth.

Grassroots groups, on the other hand, address gaps in policy, acting as problem solvers in their communities while they wait for policy makers to catch up.

For example, Birdie, owner of Mama Bird Maternity Wellness Spa, is working with Colorado Access, one of the state’s Medicaid providers, to see if they can get doulas reimbursed for working with low-income families — one of Colorado’s major gaps. identified by March of Dimes. In Aurora, where the maternity ward is located, less than half of the residents are white.

“We serve women of color,” said Birdie, who goes by a name. “Our measure of success is happy mom, happy baby.”

Nearby, the Families Forward Resource Center received federal funding to support women prone to high-risk pregnancies and to train professionals who can assist with childbirth, breastfeeding, and postpartum care.

It’s run by people who know firsthand what it’s like to experience prejudice in healthcare, like Joy Senyah, whose son was born early and died within two days. His doctors ignored his heavy bleeding before birth, and after an emergency caesarean found he had been detached from the placenta for hours.

“Every time I asked he was turned down, ‘Ma’am, you’re fine,'” said Senyah, who was alone during the birth and covered by Medicaid. “When I look at the situation in hindsight, of course, I’m like, ‘Yeah, you should have known that. You should have raised hell.

She is now an outreach specialist for the resource center, working with her colleagues to ensure that babies of color have the same chance of surviving their first year as other babies. A big part of that is figuring out how to support families and give them access to lactation consultants, birth attendants and healthcare professionals who understand their clients – and are willing to help bring hell to them if necessary.

Methodology

KHN analyzed data from linked birth/infant death records from the Centers for Disease Control and Prevention’s WONDER database for the years 2003-2006 and 2017-2019. To characterize the evolution of the gaps in infant mortality rates between blacks and whites during this period at the national level and in Colorado, three-year averages were calculated for each demographic group and the resulting rate for the period 2017-2019 was compared to the 2003-2005 rate.

For state specifics, data from 2000 to 2020 was provided by the Colorado Department of Health and Environment. Three-year rolling averages were calculated over this period for each demographic group.

To calculate excess mortality from 2018 to 2020, the three-year average infant mortality rate for white babies was subtracted from the three-year average infant mortality rate for black babies. The resulting excess infant mortality rate was multiplied by the sum of the three-year live births over that period and divided by 1,000.

Latoya Hill, senior policy analyst with KFF’s Racial Equity and Health Policy Program, identified appropriate analytical methods, and Tessa Crume, associate professor of epidemiology at the Colorado School of Public Health, confirmed the findings.

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