It’s Time Put the “Maternal” Back in Maternal, Child Health

Approximately seven years ago, the issue of infant mortality in Wisconsin took center stage. Of particular concern was the troubling infant mortality disparities that existed in African American communities primarily located in southeast Wisconsin. Our proud state was being called out on horrendous and humiliating statistics showing that Milwaukee’s over all infant mortality rate was worse than 77 other countries, including Libya, Ukraine, and the Czech Republic Thanks to some researchers shining a light on the fact that black infants were three times more likely than white infants to die in Milwaukee, an unprecedented effort was launched to “do something” about the babies dying in Wisconsin.

In 2012, BMO Harris gallantly committed $750,000 to fight infant mortality in Milwaukee. Hundreds of thousands of dollars additionally came pouring in to address the city’s “Empty Cradle” epidemic. Infant mortality became THE public health issue of the day. All eyes were on this campaign to improve birth outcomes through projects like breastfeeding awareness and support work, fatherhood initiatives, home visitation programs, and co-sleeping education. To date, millions of dollars have been spent on this issue in the past decade but frustratingly, we still have a long way to go to take Wisconsin and Milwaukee off the “worst” in America list.

As noted in this report from the Infant Mortality Taskforce Report in Delaware, infant mortality is understood as the product of two major chains of events that begin with a “sequence of socioeconomic and biological forces on the mother’s health that influence the outcome of her pregnancy”. The second major chain of events comes with the adverse outcome of this initial sequence of events that lead to a “delivery of a premature, low birth weight or sick neonate”. As a women’s health advocate, I fear that too many of the efforts around birth outcomes in Wisconsin have been directed “downstream” and have failed to focus on the initial key sequence that begins with the health of a woman. I believe that the hindered results of focusing on downstream solutions indicate that it’s time to equally, if not increasingly, invest in efforts to improve the “coalmine” versus efforts just to resuscitate the “canaries”.

If healthier moms lead to healthier babies, maybe it’s time to ask how we are failing to help Wisconsin women be their healthiest. And if we accept that we still have a black infant mortality crisis in Wisconsin, it only makes sense to examine the status of black women’s health in our state. We especially need to examine the conditions in the places where black women live, learn, work, and play that affect a wide range of health risks and outcomes.

Today, African American women account for roughly 14% percent of the total U.S. population of women, yet are over-represented in all major categories of disease and illness, including hypertension, heart disease, diabetes, cancer, stroke, obesity and reproductive disorders. Black women are more likely than their white peers to die from heart disease, cancer, and stroke; to be obese or overweight; or, to be diagnosed with HIV. Black women are 3-4 times more likely to die from pregnancy-related complications than white women, with a woman in Lebanon having a much greater likelihood of surviving childbirth than a black woman in America. One in four black women are uninsured and black women experience unintended pregnancies at three times the rate of white women. Thousands of local, state, and national reports conclude that the health of African American women is in a state of duress.

Until we, as a state, choose to acknowledge and own up to our system and policy failures that have led to these horrific health disparities that plague black women, I fear we will never improve the maternal conditions that influence birth outcomes.

I don’t deny the value of “downstream” efforts such as medical home and maternity care practices that promote breastfeeding and safe sleep environments, but imagine the greater power we have to improve the determinants that influence maternal health that are directly tied to pregnancy outcomes and infant and child health.

If we, as a state, are serious about actually moving the dial on infant mortality, let’s recognize the severity of the root cause and invest in the evidence-based policies and programs in Wisconsin to improve the health and wellbeing of black women even before they become pregnant. Our legislative leaders can start by:

  • Defending the ACA & Strengthening Medicaid coverage. A healthy baby begins with a healthy woman, and access to affordable health insurance is imperative to ensuring women can reach their optimal preconception health. Starting in 2014, the Affordable Care Act (ACA) expanded access to health coverage for millions of Americans, including up to an estimated 10.6 million women, by expanding eligibility for Medicaid under federal law, providing subsidies for private insurance purchased through the health insurance exchanges, and prohibiting denial of coverage based on health conditions. Undermining the ACA and Medicaid will only lead to decreased access to care and make it harder for women to access the preventive care needed to be their healthiest prior to becoming pregnant. Additionally, any attempts that make it harder to gain health insurance will likely lead to late or no entry into prenatal care for women, which is associated with adverse pregnancy outcomes such as increased risk of low birth weight, premature birth, neonatal mortality and maternal mortality.
  • Supporting Family Planning. Public health experts agree that helping women avoid unintended pregnancy and better time and space the pregnancies have incredible benefits to maternal and child health. Studies have shown a link between closely spaced pregnancies and three key birth outcome measures: low birth weight, preterm birth and small size for gestational age. Recognizing that unwanted and closely spaced pregnancies result in more adverse birth outcomes, our legislative leaders need to stop their persistent efforts to shut down family planning clinics like Planned Parenthood and start investing in them as primary care providers for Wisconsin women. In 1999, the Centers for Disease Control and Prevention identified family planning as one of 10 great public health achievements in the United States during the 20th century – it’s time our elected leaders start honoring this impact and stop politicizing it.
  • Increasing the minimum wage. Income level is a determinant of health. One’s personal finances are strongly linked to her ability to access healthy food and other resources. As a result, there is a direct link between poverty and a series of chronic diseases, including obesity and diabetes. Nearly two-thirds of minimum wage workers in the United States are women ― and the minimum wage falls far short of what it takes to live above the poverty line. Since one of the best protections available against poor birth outcomes is to have a woman effectively plan for pregnancy and enter pregnancy in good health, we must address the direct link between women in poor financial health who are also physically and mentally unwell.
  • Increasing Earned Income Tax Credits. The Earned Income Tax Credit (EITC) is a federal tax credit for low- and moderate-income working people. It reduces poverty and increases income for working families. The EITC is estimated to have lifted 6.5 million Americans out of poverty in 2015. There is a clear link between increasing a woman’s income and improving her physical and mental health.

In recent years, infant mortality has fallen from its perch as the “hot” public health issue in Wisconsin and has since been replaced with a focus on the opioid addiction crisis. As September draws to a close, so does “Infant Mortality Awareness month.” As I reflect on this observance and important issue, I call on the strong cohort of people initially outraged ten years ago to reinvigorate their efforts to once again raise this crisis to a statewide priority. For those still committed to addressing infant mortality in our state, let’s begin to refocus our efforts on the economic and health factors that most affect black women’s health. Healthy birth outcomes in our state require us to ensure that mothers everywhere in Wisconsin have the opportunity to live in communities where they and their families can thrive.

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