Strides are being made to combat maternal and infant health disparities in the First State
On April 12th, Delaware lawmakers passed a bill recognizing April 11-17 as "Black Maternal Health Awareness Week" in the First State, just four days after the White House made a proclamation on Black Maternal Health Week to reinvigorate efforts to close the disparity gap faced by Black mothers and infants.
According to the Center of Disease Control (CDC), every year in the United States, about 700 people die during pregnancy or in the year after giving birth, and about 50,000 people each year have unexpected outcomes of labor and delivery with serious health consequences. These numbers reflect all people who give birth, but the crisis particularly impacts Black women, who are three times more likely to die from a pregnancy related cause than white women.
And the trends are similar for Delaware, affecting both mothers and infants.
The Delaware Healthy Mother and Infant Consortium (DHMIC) was created in 2005 to combat the state’s rising infant mortality rate. Its predecessor, the Governor’s Infant Mortality Task Force issued a report on Delaware’s high infant mortality rate, including twenty recommendations to reduce the number of Delaware babies who die before their first birthday, and eliminate the racial disparity that exists between the affected babies. In the report, it was concluded that healthy women have healthy babies, highlighting the need to increase focus on maternal health in the First State.
Dr. David Paul is one of the nation’s leading neonatologists, chair of Pediatrics with ChristianaCare, and chair of the DHMIC. He says that since 2005, the infant mortality rate in Delaware has improved by over 20%. According to the CDC, in 2020 there were 5.53 infant deaths per 1,000 live births in the state of Delaware, and in 2005, the rate was 9.02 per 1,000 live births. But despite this success, the disparity ratio has yet to decrease.
“We’ve seen a widening gap in the Black to White infant mortality disparity ratio in Delaware. Black babies are about three times more likely to die before their first birthday than white babies in the state of Delaware,” explained Paul. “So what that means is that as that infant mortality rate has reduced, it's been reduced in both Black and White babies, but the reduction has been proportionally greater in White babies, in so that we have a high and even widening disparity ratio in that outcome.”
The leading cause of infant mortality is premature birth (a birth that takes place before 37 weeks of pregnancy), and Black women are two times more likely to have a premature baby. Risk of premature birth, Paul says, is related to maternal health.
“When you look at maternal health there are really a lot of upstream factors, meaning factors in the neighborhood and outside of the hospital system that are driving health. And those are factors that influence women throughout their life course, before they’re pregnant, they’re really based on, you know, probably a history of legacy and racism and policy decisions nationally and in the state that have kind of driven the systems in our neighborhood and in our state that adversely affect health,” said Paul. “Things like the education system, things like pollution, things like transportation. All of those social determinants of health, which again affect upstream health, and subsequently lead to a premature birth.”
The DHMIC takes a data driven approach to combat adverse birth outcomes in the state and close the disparity gaps faced by both Black mothers and infants.
Susan Noyes is a registered nurse, and co-chair of the Healthy Mother and Infant Consortium. She says that a key part of the solution to reduce adverse birth outcomes is helping women improve their health before pregnancy.
“It’s not all about that short window when you’re getting care. It’s about so much more. And it’s where you live, work, play, and pray, and how other factors are impacting that,” said Noyes.
In 2019, the DHMIC launched Healthy Mothers Healthy Babies 2.0, a strategic initiative that looks to improve birth outcomes across the state, with an emphasis on looking at the social determinants of health. This initiative is currently in partnership with seven healthcare organizations across the state to provide wraparound services to women, especially those deemed as high-risk for adverse birth outcomes.
The DHMIC recognizes the impact of structural racism in the social disparities faced by many women in the state, and Tiffany Chalk, chair of the Black Maternal Health Workgroup and co-chair of the Well-Women Committee within the DHMIC, says that it extends beyond the social determinants of health.
Chalk joined the DHMIC 14 years ago, after her own birthing experience. She says she’ll never forget the day that she went to ChristianaCare, 23 weeks into her pregnancy, after noticing that something didn’t feel right. She waited for 5 hours to be treated, was not properly communicated with, and was not taken seriously. She ended up giving birth to her son that day, who did not survive.
“From that day forward, I said I never want a family, especially a Black family, to experience what my family experienced. So whatever voice, whatever advocate, whatever work I need to do, I am here for it,” said Chalk.
She says that she never wants a woman to have the adverse outcome that she experienced.
Structural racism within the healthcare system is not new, but more recently it has become a topic of conversation, and more and more women, such as Chalk, have been speaking out about their own experiences.
In the White House's 2022 proclamation on Black Maternal health week, it was stated: “The Biden-Harris Administration remains fully committed to ameliorating these unacceptable disparities and building a healthcare system that is equitable and safe for Black families. The inequities that Black mothers face are not isolated incidents but, rather, the byproduct of systemic racism in our society that has festered for far too long.”
It has been recognized both nationally and locally that healthcare systems are not always equitable and safe for Black families. One way the DHMIC aims to combat that is by working with local organizations, such as Black Mothers In Power, to connect women with doulas.
Doulas advocate for women throughout the entire birthing process, and work to help Black women feel more comfortable in medical settings.
“Black women lack trust within the healthcare systems. So, home births and doulas and midwives have really been on the rise because they need that additional support,” said Chalk.
She says there's a certain level of fear that Black women face going into the hospital, especially considering the maternal mortality rates, and having an advocate with them helps to curb that fear.
The DHMIC is currently working on looking at Medicaid reimbursement for doulas in Delaware.
Noyes adds that the normalization of birth workers, such as doulas and midwives, in healthcare is a great sign.
“I think services are getting broader and more robust for women, and I think it’s really important for women to select what's best for them,” said Noyes.
She says that she believes healthcare should be a menu, where one can pick services based on their individual needs and values.
And Paul says it’s important to note that there’s no evidence of a lack of care in Delaware. A lot of the work of the DHMIC and healthcare organizations throughout the state includes increasing access to and improving systems of care that already exist.
“One great example at ChristianaCare is we recently were able to reduce postpartum readmissions by giving women blood pressure cuffs to take home,” said Paul.
He says one of the main leading causes of maternal mortality is high blood pressure, something that often goes unrecognized. By giving mothers blood pressure cuffs and having them report back their numbers, ChristianaCare has not only been able to reduce readmissions overall, but also help reduce the disparity ratio of readmissions.
ChristianaCare hopes to use grant funding to implement this across the state.
The DHMIC, in partnership with healthcare systems such as ChristianaCare and organizations across the state focused on maternal and infant health and wellness, continue to work to identify factors leading to adverse birth outcomes in the First State.
More of the DHMIC’s work can be found on the DE Thrives website, and at their annual summit on April 26th, 2022.
The theme of this year’s summit is “Listening. Connecting. Inspiring Change.” The event will feature both local and national speakers, and will cover a variety of topics related to maternal and infant health. The event is online and open to the public, more information can be found on their website.