Dane County suffers from racial disparities in birth outcomes and infant mortality. A recent public engagement campaign looking for solutions wanted to hear directly from those most affected: African-American women.
“The strong message was, it’s not just what a mother is eating, or how she’s behaving, or whether she's getting prenatal care or timely care that may be affecting the health of babies,” but also many external pressures, said Lisa Peyton-Caire, founder and president of the Foundation for Black Women’s Wellness.
One major factor, the report said, is that participants experienced "a looming state of stress in ‘living while Black’ in Dane County."
Last spring, Dane County Health Council announced it was taking a new tack to find solutions to the frequency of babies born at low birth weights, asking African-American women in-depth questions about their lived experiences, treating them as the “primary experts and key informants.”
A nine-month community engagement campaign, led by the Foundation for Black Women’s Wellness and EQT By Design, held over 20 sessions to gather input from African-American women, their partners, their communities, and health and service professionals.
In Dane County, African-American mothers are twice as likely to give birth to infants with low birth weights, the report said. That can lead to health problems later in life and put them at higher risk for infant mortality. Public Health Madison & Dane County data shows that in 2016, black mothers in Dane County were 2.8 times more likely than white women to have a child die in the first year of life.
The finished report, “Saving Our Babies,” released Monday, reported firsthand experience of these alarming statistics. At one session, a local pastor said that her congregation members had experienced the deaths of eight babies in the past seven years, some from premature birth complications. Ten of the women surveyed had experienced infant mortality and 43 had experienced a miscarriage.
The over 200 participants were a self-selected “sample of convenience,” the study said, but even so, included significant diversity in age, education, income and other factors. Along with facilitated group discussion at these sessions, there was a participant survey and questionnaire.
The report identified 10 themes driving low birth weights and black disparities in child and maternal health in Dane County, including chronic stress, economic insecurity, and racism and institutional bias.
The three are related, the report says: racism and economic insecurity have “created a toxic cycle of stress and pressure that is driving Black infant low birthweight and other health disparities.”
There’s “nothing inherently flawed about a black woman’s ability to have healthy babies,” Peyton-Caire said, but there are many external factors that contribute to poorer health outcomes, especially stress.
The report dove into some of these external factors. Participants said they experienced an “overall negative perception” of black populations, the report said. Asked if they felt they were “treated with dignity and respect” and “welcomed by staff” when they visited their healthcare provider, a third of respondents said “No/Sometimes” to both questions.
“Nurse assumed I was a single mother without asking, though I am married to the father of my children and indicated this on intake forms,” one participant wrote.
And then there are economic pressures: 66% of respondents said they were “living paycheck to paycheck” or that “money was a major stressor.” While the majority of participants said their housing situation was stable, they still listed high living and housing costs as a “hurdle for their families and families in general.”
“I cannot tell you how many times housing insecurity came up: the threat of homelessness, how many people are struggling to afford rent, struggling to become homeowners,” Peyton-Caire said.
And Peyton-Caire was surprised to hear that so many women, including those with a college degree, were working two or three jobs to make ends meet. That points back to a need to solve educational disparities, which affect access the post-secondary education or training needed to “secure family-sustaining work,” she said.
There needs to be more support and education before and after pregnancy, the report said. Almost three quarters of female respondents said no doctor talked to them about “preparing for a healthy pregnancy,” the report said.
And tragically, 17% of respondents with prior pregnancies said they had experienced domestic violence during pregnancy. That means better screenings during patient intakes and other supports, the report said.
These broad causes of poor health outcomes call for broad solutions “within and beyond healthcare,” the report said.
“To truly make progress on improving the birth outcomes of Black women and babies, we must move upstream to intentionally address root causes … If we don’t, we will continue to swim against the current and recycle the same patterns of disparity at the ultimate cost of losing the lives of Black babies,” the report said.
The fact that black families face significant disparities in Dane County is not new information, Peyton-Caire said, “but now the solution really has to be broad and systematic.” An important initial issue for city and county leaders to address is income and housing security, she said.
The report ends with many “multi-year” recommendations, including increasing access to African-American doulas, establishing a Black Maternal and Child Health Task Force and an Annual Wisconsin Black Maternal and Child Health Summit and increasing workforce diversity among midwives and in programs like prenatal education classes. A coming July press conference will outline “specific next steps,” a press release said.
Peyton-Caire noted she was happy to hear that generally, participants said they “see Madison as a place of opportunity,” though they want more equal access to that opportunity. Participants were also generally satisfied with their experience in local health care, though many of them had at least one experience of racial bias in the health system.
And most satisfying of all: the community was glad they were asked.
“The community was very appreciative that this project was specifically aimed at collecting their thoughts and experiences, because they said, ‘Nobody ever asks us that,’” Peyton-Caire said.