How programs in Kent County and Detroit are reducing Black infant mortality
WYOMING—As she lifted her toddler into her arms, Ronnise Eubanks-Chambliss looked into his eyes, and broke into a smile.
“He is doing so awesome,” she said, standing with her 2-year-old son in late April outside her duplex in this Grand Rapids suburb.
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This is one in a series of reports focusing on health disparities in Michigan. The project was made possible by a grant from the nonpartisan, Washington-based National Institute for Health Care Management (NIHCM) Foundation. If you have suggestions for future coverage please contact Robin Erb at firstname.lastname@example.org
But Eubanks-Chambliss said things could have gone another way back in October 2019, as she counted down the final days of her pregnancy, and sensed something wasn’t right.
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“My hands and feet were swollen. I was tired. I was just very uncomfortable,” she recalled.
Eubanks-Chambliss was enrolled at the time in a Kent County program called Strong Beginnings, aimed at reducing Black infant mortality — which in Michigan stands at nearly three times the death rate for white infants.
A community health worker assigned to keep in regular touch with Eubanks-Chambliss through the program prodded her to see her doctor. She took her counsel and was diagnosed quickly: preeclampsia, a pregnancy complication that can lead to serious, even fatal, results for mother and baby.
“My doctor looked at me and said, ‘You’re going to the hospital,’” Eubanks-Chambliss said.
The next day, in a medically-induced delivery to protect her and her child, Eubanks-Chambliss gave birth to the infant she named Marcello. He arrived three weeks early and underweight at 5 pounds, 3 ounces.
But he was otherwise perfectly healthy.
The work of this group, and those like it in Detroit and elsewhere involving a robust and well-funded community support network for Black mothers and infants, can pay real dividends.
According to Great Beginnings’ internal tracking of mothers — most of whom are Black — enrolled in the program over the past 16 years, it has averaged 5.0 infant deaths per 1,000 live births. That’s about one-third the mortality rate for Black infants across the state.
“The results show that this really does work,” said Peggy Vander Meulen, who has directed the program since its start in 2004. “It speaks to the value of strong community partnerships.”
She cautioned that the organization’s data is imperfect. Strong Beginnings is not limited to Black mothers: 30 percent of participants in 2021 were Latino and 10 percent white or other races. She estimated that African American births account for at least 75 percent of all births in the program’s history. The numbers also don’t include mothers who left the program before their child was one year old.
Even so, Vander Meulen said, the benefits are readily apparent. The program employs more than two dozen community health workers and mental health therapists to form a critical bridge of support for women during pregnancy and in the months after birth. That can be everything from furnishing help with housing, managing stress, offering advice on breastfeeding, referring families to physical and mental-health resources, or arranging transportation when a car won’t start.
Its clients are all enrolled in Medicaid, the federal health care program for low-income individuals and families. But they receive support that most other women in their position do not.
While Black infant mortality has dropped considerably over the decades, the disparity between white and Black infant mortality remains broad.
In 1970, Black infant mortality in Michigan stood at 30.6 deaths per 1,000 live births, compared to 18.5 white infant deaths per 1,000 live births. The rate for Black infants has since declined, to 14 deaths per 1,000 in 2020. But the rate for whites fell to 5 deaths per 1,000.
According to KFF, a San Francisco-based nonprofit health research organization, Michigan had the sixth highest rate of Black infant mortality in the nation in 2019.
To put the issue in global perspective, Michigan’s Black infant death rate would rank worse than overall infant mortality rates in Brazil, Jordan and Mongolia. Detroit’s Black infant mortality rate of 15.8 deaths per 1,000 live births from 2018 to 2020 is barely better than rates in Egypt and Vietnam.
“That’s not at all comforting,” Dawn Shanafelt, who directs the Division of Maternal and Infant Health at Michigan’s Department of Health and Human Services, said of the comparisons.
There is also growing concern over the rising number of African American mothers in the U.S. who die from pregnancy complications. In 2018, 206 Black women died in the U.S. from issues related to their pregnancy, with the numbers rising to 241 and 293 in the next two years, according to the U.S. Centers for Disease Control and Prevention. The maternal death rate for U.S. Black women was 2.9 times the rate for white women in 2020. In Michigan, Black women were 2.8 times more likely to die than white women from pregnancy-related causes from 2014 to 2018, according to MDHHS, which recorded 61 overall pregnancy-related deaths during that period.
Shanafelt acknowledged it’s been an uphill fight to close the racial gap in infant and maternal mortality in Michigan.
“We are making strides, but we hit a wall for decades in improving disparities,” Shanafelt said.
According to the CDC, low birthweight and pre-term delivery are among key causes of infant mortality — traits found far more often in Black infants in Michigan. Premature birth is linked to an array of factors including diabetes, high blood pressure and poor nutrition, as well as risk factors including smoking or alcohol use.
Nearly 15 percent of Black infants born in Michigan from 2018-2020 were delivered at fewer than 37 weeks, compared to 9 percent of white infants. The same is true for low birthweight infants, with 14.8 percent of Black infants born from 2018-2020 weighed less than 5.5 pounds, while 7.1 percent of white infants were under that weight.
Shanafelt said the numbers reflect a wider disparity in health outcomes for Michigan African Americans that’s been evident for decades — underscored over the past two years by the higher COVID-19 death rate for Black Michigan residents.
“We see Black families impacted across the board, whether you are looking at cancer rates, asthma rates, infant mortality, length of life or more recently, COVID-19 case rates and deaths,” Shanafelt said.
Still, Shanafelt said, the state is pushing to close the Black infant mortality gap, pointing to Gov. Gretchen Whitmer’s Healthy Moms Healthy Babies initiative that funneled $11.4 million in the 2021-2022 state budget to programs that support low-income expectant mothers and babies. That includes $7.4 million to expand home visits to 1,000 parents with infants at-risk due to substance exposure, along with funds to help parents find home visiting programs and mental health support.
The budget also adds $5.1 million to extend Medicaid coverage for pregnant women from 60 days to 365 days postpartum. The months after birth can be critical to the survival of some infants, as about a third of infant deaths occur a month after birth up to an infant’s first year.
“We know that when we look at our maternal mortality data, that’s a critical time. A pregnancy doesn’t end when a child is delivered. That postpartum period is extremely important in the health of a mother and her infant,” Shanafelt said.
She noted the state also backs additional home-visiting programs — funded in fiscal 2020 by $16.5 million in state funds and $21.6 million in federal funds — that reach out to pregnant mothers before and after they give birth, serving over 23,000 low-income families. Nearly 40 percent of the mothers served were Black.
Researchers have spent decades probing why Black women are so more vulnerable to losing their babies at birth and in the first year of life. It’s long been assumed these health disparities stem from risk factors that include poverty, limited access to prenatal care and poor physical and mental health.
But there’s emerging evidence Black women’s persistent exposure to socioeconomic disadvantage — and the stresses it causes — may at least help to explain earlier deterioration in physical health and disparate rates in infant deaths.
The racial component of that stress can’t be ignored when looking at health data, said one expert.
“I think it’s tremendously important. We have looked at other things, but we haven’t really looked at this,” said Dr. Dawn Misra, a professor of epidemiology and biostatistics at Michigan State University, who studies infant mortality among African Americans.
“This can be everything from getting turned down for a loan, someone following you around in a store, someone speaking down to you in a medical setting,” Misra told Bridge.
“These are all about perceptions. If you perceive something is happening to you, that’s affecting stress hormones.”
Stress attacks the body in multiple ways, raising blood pressure, elevating hormones like cortisol, triggering inflammation and suppressing the immune system, all of which may be linked to adverse fetal development.
In 2004, a pair of researchers published a study in the American Journal of Public Health in which they asked African American women with very low birthweight infants about their housing, income, health habits and discrimination.
Researcher Richard David, then a neonatologist at the University of Illinois Chicago, told NPR of its findings: “It turned out that as a predictor of a very low birth weight outcome, these racial discrimination questions were more powerful than asking a woman whether or not she smoked cigarettes.”
In 2008, major health systems in and around Detroit convened a group to study persistently high infant-mortality rates among Black children. One outcome of the group’s work was a program called the Women-Inspired Neighborhood (WIN) Network: Detroit, backed by Henry Ford Health.
Much like Kent County’s Strong Beginnings, the Detroit program was built on the shoulders of community health workers who often form close bonds with mothers-to-be both before and after birth.
“They become family to these women,” Courtney Latimer, program manager for WIN Network, told Bridge. “They are the mom, the sister, the aunt, the best friend some of these women ever had.”
From late 2016 through this April 1, mothers enrolled in the WIN Network program gave birth to 321 babies, with one infant death. Delivered at an average of 38.5 weeks, barely short of full term, their average birth weight was nearly 7 pounds.
To be sure, this program is no panacea for the area’s needs, as it reaches just a small fraction of Detroit mothers, who gave birth to nearly 9,000 babies in 2020 alone.
In Kent County, Strong Beginnings relies on a web of community partners that includes Spectrum Health, nonprofit mental health agency Arbor Circle, the Kent County Health Department, Cherry Health, a non-profit community health center, Michigan State University, Mercy Health Saint Mary’s and Metro Health Community Clinic.
It receives about $1.4 million in annual federal Healthy Start funds directed at community infant and maternal mortality reduction programs across the country, as well as $800,000 a year from a Kent County early childhood millage. Across its partner agencies, it fields a staff of 46 full- and part-time workers, including 26 community health workers and four mental health therapists.
Strong Beginnings has also profited from sizable backing by the W.K. Kellogg Foundation, which has poured $9.7 million into the program since 2011 and is committed to $2.1 million more through 2025. (Disclosure: Kellogg is also a donor to The Center for Michigan, which includes Bridge Michigan and BridgeDetroit.)
“We are certainly encouraged by the results,” Kellogg Foundation senior program officer Yazeed Moore told Bridge.
The program’s outcomes appear especially notable in light of the challenges many of the program’s mothers face. A preliminary study by Michigan State University found these women are more likely to be homeless, worried about housing or food and in need of mental-health support than Medicaid clients not enrolled in the program.
Moore noted that Kellogg’s commitment to Strong Beginnings extends beyond its typical three-year grant cycle, adding: “We have to look at what’s the long game here. It’s definitely an all-hands-on-deck strategy.”
Mindful of the key role fathers play in maternal and infant health, Strong Beginnings is also focused on encouraging their active involvement before and after the birth process. In 2019, 73 percent of Black Michigan children lived in single-parent homes, compared to 25 percent of white children.
Program director Vander Meulen said it serves 85 to 120 male clients a year with support similar to that it offers women. Through an arrangement with Kent County Friend of the Court, it offers some men alternatives to jail time so they can remain with their families. It also connects fathers to jobs through arrangements with four area employers.
As for former client, Eubanks-Chambliss, she’s proud to take her own mother-infant story full circle. About a year after the birth of Marcello, she was hired as a Strong Beginnings community health worker by the Kent County Health Department.
“This program made such a big impact on me that I wanted to be able to do this for other moms,” she said.
Eubanks-Chambliss said she hears a litany of concerns as she juggles remote and in-person visits with a client group of about 30 women, ranging from anxiety about their impending delivery to worry over making rent or paying for groceries. She connects some to food pantries or mental health assistance. She advises others on breast-feeding. She helped another woman figure out housing after a water leak in her apartment forced her into a motel.
She recently visited a single Black woman in her early 20s, about 30 weeks pregnant with her first child. She needed step-by-step reassurance on what to expect.
“This is a first-time Mom with all kinds of questions: ‘How do I know if this is a contraction?’ ‘How do I know if the baby is hungry?’
“So we basically had to come up with a birth plan. What are your options for medications? Who is going to be your support in the room? We talked about preparing for the hospital, how to time your contractions and when to go to the hospital, all of that.”
Looking back at how the birth of her own son, Eubanks-Chambliss said she’s driven to deliver the same kind of support she received.
“I guess this is kind of my calling,” she said. “We’re doing what we’re supposed to, making sure we have positive outcomes for our families.”
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