Trinamool groups are leading the way in closing Colorado’s infant mortality rate

AURORA, Colo. – This spring Britney Taylor traveled during the grand opening of Mama Bird Maternity Wellness Spa, reflecting on the birth of her first child: a confusing and lonely experience that led to an unplanned cesarean section and an extended postpartum depression.

But here in this suburb of Denver, local families and smiling dudes wander around in a bright place resonating with colorful music where primarily colored women can massage, meet birth professionals and support groups and breastfeed, give birth and baby. May attend care classes. .

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

About 12 miles northeast of Denver, staff members of the Family Forward Resource Center were preparing a room where families who may have difficulty getting to the doctor will be able to easily meet with clinical staff about their medical questions. They were preparing to hire a Dula trainer to help increase the local number of color birth support workers.

One of the main goals of both organizations is to significantly reduce health inequality in Colorado: Black, Hispanic, and American Indian / Alaska Native children die at a higher rate than whites and children in the Asian / Pacific Islands.

“Ethnic / racially segregated, our inequalities are enduring and quite evident,” said Dr. Sunah Susan Hawang, a neonatologist at the University of Colorado School of Medicine.

By various measures, including infant mortality, Colorado is considered one of the healthiest states. For every 1,000 live births, less than five babies die before reaching their first birthday, placing Colorado among the nearly 15 states that have reached a threshold before a national 2030 target.

The Center for Disease Control and Prevention data from 2003 to 2019, the largest range for which comparative data is available, shows that the gap between non-Hispanic black and non-Hispanic white infant mortality rates has narrowed more rapidly nationally than in Colorado. The Colorado gap started wider than the national gap but has now narrowed.

But according to the state health department, only Asian / Pacific islanders and non-Hispanic white children have reached the 2030 target. And while the infant mortality rate has dropped dramatically over the past 20 years, their mortality rate, at about 10 deaths per 1,000 live births in 2020, is much higher than the state average. Hispanic children, meanwhile, are still dying at about the same rate as 20 years ago, with more than six deaths per 1,000 live births. (Data for American Indian / Alaska Native children were not consistently available because the numbers were too low for meaningful rates.)

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

One of the main reasons babies die is because they are born too early. According to the March of Dimes, Colorado was among 22 states where the disparity between the best population and the rest of the population in the last five years has worsened. The state health department is clear about one big reason: 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 in turn can lead to infant mortality,” said Mandy Bakulsky, manager of the Department of Maternal and Child Health.

Infant mortality is a health measure that disproportionately affects Black, Hispanic, and American Indian / Alaska Native Coloradans: compared to other Coloradians, they are more likely to die from kidney disease, diabetes, Covid-19, car accident, and other diseases. According to the state health department.

Bakulsky said that in recent years, state health officials have “reversed” their views 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 said the combination led them to conclude that “finding money in people’s pockets is one way we can 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 a law that, starting in 2024, will give many Colorado parents three months’ partial paid leave to care for new children.

According to the March of Dimes – which tracks state efforts to reduce infant mortality and premature birth – Colorado has achieved four of six policies to improve 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 narrow the racial divide.

“We give Colorado the ‘B’. It’s much better than many states – certainly better than the states around Colorado, “said Edward Bray, senior director of state affairs at the March of Dimes.” But there is room for improvement.

An upcoming change agency hopes it will help: Colorado is in the process of temporarily raising Medicaid eligibility, so that more low-income women will typically receive one-year coverage for childbirth instead of two months. The change is part of a bundle of legislation passed last year that, among other things, promotes maternity treatment abuse into a civil rights issue to be reported to the Colorado Civil Rights Commission.

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

“Studies have shown that doulas help with better overall results for births, reduce preterm births, and reduce both maternal and infant mortality and illness,” said Bra, whose agency identifies doula access as one of Colorado’s major policy flaws.

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 be important. Although Dula plays a key role as a facilitator, a navigator, and a lawyer, he says Doula is “a very low-key solution ৷ it doesn’t really solve the problem.”

Gomez is interested in concrete interventions such as no-string-linked cash transfers to prospective families. In Canada, researchers found that while Indigenous women who were pregnant and poor received a cash benefit of about 60 60 per month, it helped families meet their needs and reduce stress, and children were less likely to give birth early or early.

Gomez is involved in a pilot study, the Lotus Birth Project, which provides about $ 1,000 a month in cash for pregnant women on the Black or Pacific Islands in San Francisco. The goal is to relieve the stress that can cause preterm birth.

Grassroots groups, meanwhile, feel policy gaps are acting as problem solvers in their communities while waiting for policymakers 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 reward Dowles for working with low-income families – one of Colorado’s main gaps marked by the March of Dimes. . In Aurora, where the maternity center is located, less than half the population is white.

“We’re serving women of color,” said Birdie, who goes by one 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 women prone to pregnancy and to train professionals who can help with birth, breastfeeding, and postpartum care.

It is run by people who know for themselves the experience of bias in health care, such as Joy Senia, whose son was born prematurely and died within two days. Her doctors ignored her severe bleeding before birth and after an emergency C-section, they found that she had been isolated from the placenta for several hours.

“Every time I asked, it was rejected: ‘Ma’am, you’re fine,'” said Seniah, who was alone at birth and covered by Medicaid. “When I look at the situation, of course, I think, ‘Yeah, you should have known. You should have raised Hell. ‘

She is now an Outreach Specialist at the Resource Center, working with her colleagues on the goal that kids of color will have the same chance of surviving as other kids in their first year. A big part of this is how families can be supported and given access to their breastfeeding counselors, birth attendants and medical professionals who understand their clients – and are ready to help lift them to hell if needed.

Method

KHN analyzed linked birth / infant mortality record data from the Wonder Database of the Centers for Disease Control and Prevention for the years 2003-2006 and 2017-2019. To identify how the gap between black and white infant mortality rates changed at that time at the national level and in Colorado, a three-year average was calculated for each population group and the 2017-2019 time frame result rate was compared with 2003. 2005 rate.

For state specifications, data from 2000 to 2020 were provided by the Colorado Department of Health and Environment. A moving average of three years was calculated for each demographic group over that period.

To calculate additional deaths from 2018 to 2020, the three-year average infant mortality rate for white children has been subtracted from the three-year average infant mortality rate for black children. As a result, the infant mortality rate was multiplied by the sum of the three years of live birth in that period and divided by 1,000.

Latoa Hill, a senior policy analyst at KFF’s Racial Equity and Health Policy Program, identified the appropriate analysis method, and Tessa Krum, an associate professor of epidemiology at the Colorado School of Public Health, confirmed the decision.

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