Black moms, babies remain at higher risk

April 22--From grassroots organizations working directly with moms to large insurers, health advocates remain increasingly concerned that black mothers and babies continue to die at higher rates than white mothers and babies.

"We know black moms and black babies die more often than other folks," said Toni Hill, founding director of the Northeast Mississippi Birthing Project, which is open to all expectant mothers but focuses its outreach to mothers of color.

Reports published earlier this year from the Mississippi Department of Health and America's Health Rankings, which is compiled by the United Health Foundation, show significant disparities in infant mortality and maternal mortality persisted despite improvements.

By the numbers

Mississippi had an infant mortality rate at 8.6 deaths per 1,000 live births in 2016, second only to Louisiana. That was an improvement from 2015.

The mortality rate is 70 percent higher for black infants than white infants, due in part to higher preterm birth rates, according to a Mississippi State Department of Health report.

Very low weight infants make up 2 percent of births but account for 48 percent of infant deaths. Of the 327 Mississippi infants that died in 2016, 139 were born before 28 weeks gestation. In Mississippi, black infants made up 16.2 percent of babies born preterm in 2016.

The risks for black moms and babies are not just confined to those in poverty. The disparities for black moms cut across income and education.

"It doesn't matter if you are a lawyer," Hill said. "It's not just low resource mommas; it's all mommas."

America's Health Rankings found Mississippi's maternal mortality rate dropped from 26.5 deaths per 100,000 live births between 2010-2014 to 22.6 deaths per 100,000 live births between 2011-2015. For black women in Mississippi, there were 10 more deaths per 100,000 births than for white women between 2011-2015.

Mississippi's maternal mortality rates, both overall and the gap between outcomes for white and black women, were lower than those reported for many other states, like New Jersey and Texas, and half the national average. But it's too soon to say Mississippi moms are doing better. Small numbers of maternal deaths also means it takes longer for definitive trends to emerge.

"I'm really happy to see improvements," in Mississippi's maternal mortality rate, said Tupelo fetal maternal specialist Dr. Justin Brewer. "But I really want to see what happens in the next few years."

Maternal mortality statistics have been shifting as public health officials rework definitions to better capture pregnancy-related deaths. Mississippi State Department of Health expects to have a report out this summer examining the trends using new models that don't rely solely on death certificate reporting.

Solutions

Mississippi State Department of Health has advocated for a number of strategies aimed at decreasing infant and maternal mortality. They include tobacco cessation, progesterone therapy for those with risk factors for preterm birth, long-acting contraception and safe sleep education efforts. Programs through the state health department's perinatal collaborative have established hypertension management guidelines for pregnant women and postpartum hemorrhage, Brewer said.

Mississippi moms in general -- and black moms in particular -- are entering pregnancy with high rates of uncontrolled diabetes, high blood pressure and obesity. It increases the risk to both babies and moms.

"There are a whole host of factors we are concerned about," said Dr. Lionel Fraser, chief medical officer for United Healthcare Community Plan of Mississippi, which offers one of three managed health care networks for the state's Medicaid recipients. "We're trying to develop programs to address health status during pregnancy."

Early access to prenatal care can help manage these factors.

"We know prenatal care can have a positive impact on low birthweight, preterm births and c-section rates," Fraser said. "All these factors are wrapped up in one another. If we help one problem, sometimes we see gain in others."

The hope is that healthy habits developed during pregnancy will linger and boost the health of the entire family in the future, Fraser said.

"Education can carry beyond pregnancy," Fraser said.

Beyond insurance coverage and access to prenatal care, advocates said there's a need to think broadly about education, health literacy, transportation, access to healthy foods and a culture of physical inactivity.

"Attention to issues, including the social determinants of health, potentially have a great impact," Fraser said.

In larger context, Hill sees systemic racism contributing to poor outcomes for women of color.

Expecting moms who rely on Medicaid often don't feel empowered to ask questions.

"Black women in particular are not listened to in the health care system," Hill said.

Some local doctors are doing a really good job reaching across the cultural divide, Hill said. But better systems and structures are needed to address health literacy issues and pregnancy education across the board.

Community resources also need to be more robust, Hill said. The Northeast Mississippi Birthing Project, which relies on volunteers and community donations to deliver evidence-based education on pregnancy and infant care, hasn't received grant funding for two years, Hill said. There currently isn't a Mississippi program to distribute cribs for parents that need a safe place for their babies to sleep.

"Capacity is an issue," Hill said.

michaela.morris@journalinc.com

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