The grassroots groups are leading the way in closing the child mortality gap

DAWN, Colo. – Brittany Taylor traveled during the opening of Mama Bird Maternity Wellness Spa this spring, she thought of giving birth to her first child: a confusing and lonely experience resulting in an unplanned c-section and a long period of postpartum depression.

But here in this suburb of Denver, local families and smiling Doulas (who provide emotional support during pregnancy and childbirth, but do not provide medical care) wander through a bright spot with colorful music, where most of the colorful women can massage, meet. . Join professional and support groups, and attend breastfeeding, childbirth, and childcare classes.

“It’s perfect,” Taylor said. His next delivery, he said, would be “completely different.”

About 12 miles northeast of Denver, staff at the Family Forward Resource Center were setting up a room where families who may have difficulty accessing a doctor can easily meet with clinical staff to find answers to their questions. Treatment.

They were also preparing to hire a Dula trainer to help increase the number of black birth support workers locally.

A central goal of both organizations is to reduce a significant health inequality in Colorado: Non-Hispanic black, Hispanic, and American Indian / Alaska Native children die at a higher rate than non-Hispanic whites and Asian / Pacific island children.

Dr. Sunah Susan Hawang, a neonatologist at the University of Colorado School of Medicine, said, “Apart from race / ethnicity, our differences are permanent and quite obvious.”

Colorado is considered one of the healthiest states, according to various indicators, including infant mortality. For every 1,000 live births, less than five babies die before their first birthday, placing Colorado among the nearly 15 states that are well ahead of the national target for 2030.

Data from the Center for Disease Control and Prevention (CDC) from 2003 to 2019, the largest range for which comparative data is available, shows that the gap between infant mortality rates for non-Hispanic blacks and whites has fallen sharply in Colorado. Started bigger than, but has now shrunk.

But according to the state health department, only Asian / Pacific islanders and non-Hispanic white children have reached the 2030 target. And despite a dramatic decline in the infant mortality rate of non-Hispanic in the last 20 years, its mortality rate in 2020 is about 10 deaths per 1,000 live births, much higher than the state average.

Hispanic children, meanwhile, are dying at about the same rate as 20 years ago, with more than six deaths per 1,000 live births. (Data for Native American / Alaska Native children were not consistently available because the numbers were too small to make meaningful rates.)

If the infant mortality rate in non-Hispanic black and Hispanic children states were the same as in non-Hispanic white children, about 200 children could be saved between 2018 and 2020, according to KHN analysis of the data.

One of the major causes of infant mortality is premature birth. According to the March of Dimes, Colorado was among 22 states where the disparity between the top-editor population and the rest of the population in previous births has worsened over the past five years. The state health department is clear on one important issue: racism.

“We know that racism and structural racism are among the main factors that can contribute to the chronic stress in human life that can contribute to premature death, which can lead to infant mortality later on,” said Mandy Bakulsky, mother and child manager. Welfare Department of the State Health Department.

Infant mortality is one of the health systems that affects non-Hispanic blacks, Hispanics and Colorado Native Americans / Alaska Natives: they are more likely to die from kidney disease, diabetes, Covid-19, than residents of other states. Car accidents and other illnesses, by category.

Bakulsky said that in recent years, state health officials have “changed” their approach in response to the community’s response to the state’s infant mortality gap and a multistate project that has studied a wide range of possible interventions. Bakulsky’s team says the combination led them to conclude that “keeping money in people’s pockets is a way to improve health outcomes.”

So, the department is emphasizing the benefits of child tax credits that allow families to keep more of their income, and is preparing to introduce a law that, starting in 2024, will give many Colorado parents three months of partial paid leave to care for a new child.

According to the March of Dimes, which tracks state efforts to reduce infant mortality and premature birth, Colorado has achieved four of the six policy initiatives aimed at improving maternal and child health, which are closely linked. Most importantly, it expanded to Medicaid in 2013, which researchers say helps reduce infant mortality, although it is unclear whether it has helped reduce the racial divide.

Shawn Taylor, Joy Senia and Alice Hardy of Family Forward Resource Center are seen smiling and posing for a photo.
From left to right, Shawn Taylor, Joy Seniah and Alice Hardy lead the program and outreach at the Family Forward Resource Center. The center receives federal funding to provide services such as breastfeeding assistance, baby delivery and mental health care to high-risk pregnancies.(Roy Ellen Beechel / KHN)

“We give Colorado the ‘B’. It’s much better than many states, of course, better than the states surrounding Colorado, “said Edward Bray, senior director of state affairs at the March of Dimes. But there is a “place of improvement”.

An upcoming change is expected to help the company: Colorado is in the process of temporarily raising Medicaid qualifications so that more low-income women typically receive coverage for one year after giving birth instead of two months.

The change is part of a set of legislation passed last year that, among other things, promotes the abuse of antenatal care in a civil rights issue that must be reported to the Colorado Commission on Civil Rights.

Yet lawyers, researchers and professionals who work with color families say the state can and should do more. First, they say, create a workforce of culturally skilled caregivers, including Doula.

“Studies have shown that doulas contribute to better overall birth results, reduce premature births and reduce both maternal and infant mortality and morbidity,” said Bray, whose organization identifies doulas access as one of the major flaws in Colorado policies.

However, Anu Manchikanti Gomez, a health equity researcher at the University of California-Berkeley who studied interventions including Dula Care designed to improve birth outcomes, said other options could also be critical. He said that while Dula plays a key role as a facilitator, navigator and advocate, he is “an over-the-top solution. It’s not really solving the root of the problem.”

Gomez is interested in concrete interventions such as no-string-linked cash transfers to prospective families. In Canada, researchers found that when poor pregnant Indigenous women received about $ 60 a month in cash, it helped meet household needs and reduce stress, and children were less likely to be born prematurely or underweight.

Gomez is taking part in a pilot study in San Francisco, the Lotus Birth Project, which provides a monthly cash compensation of about $ 1,000 for pregnant black and Pacific island women. The goal is to break free from the forms of stress that can lead to premature labor.

Meanwhile, grassroots groups are closing policy gaps, taking steps to address issues in their communities while waiting for policymakers to catch up.

For example, Birdie, owner of Mama Bird Maternity Wellness Spa, works with Colorado Access, one of the state’s Medicaid providers, to see if they can pay dowels to work with low-income families, one of Colorado’s main gaps, by the March of Dimes. Marked In Aurora, where the birth center is located, less than half the population is non-Hispanic white.

“We’re serving women of color,” said Birdie, who goes by a single name “The measure of our success is happy mothers, happy children.”

Nearby, the Family Forward Resource Center has received federal funding to support high-risk pregnant women and to train professionals who can help with childbirth, breastfeeding and postpartum care.

It is run by people who seem to feel biased in health care, such as Joy Seniah, whose son was born prematurely and died less than two days after birth. Her doctors ignored her heavy bleeding before birth and after an emergency C-section discovered that the baby had been isolated from the placenta for several hours.

“Every time I asked, I was fired: ‘Ma’am, that’s fine,'” said Seniah, who was alone at the time of delivery and covered by Medicaid. “When I look back at the situation, of course I say, ‘Yes, you should have known. You should have complained louder. ‘

She is now a resource center outreach specialist, working with her colleagues to achieve the goal that kids of color have the same chance of surviving their first year as other kids.

A big part of this is how families can be supported and given access to their breastfeeding counselors, labor and delivery staff and medical professionals who understand their clients and are ready to help if needed.

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