Black Infant Health Program Transforming African American women & their communities to improve health Reggie Caldwell, LCSW Health Equity Analyst California Department of Public Health Maternal, Child and Adolescent Health Division
Thanks California Department of Public Health Maternal, Child and Adolescent Health Division UCSF Center for Social Disparities in Health Steven Bavolek, Nurturing Parenting Tyan Parker-Dominguez, USC School of Social Work Local BIH Staff
Infant Mortality Rates Black:White Comparison in California 35 31.7 Deaths per 1,000 Live Births 30 Infant Mortality Rate 25 19.8 20 Non-Hispanic African American 15 Non-Hispanic White 10.4 10 4.1 5 Ratio 1.6 2.5 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 0 0 0 0 * 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9 0 0 0 0 0 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 9 1 3 5 7 Year Infant Mortality Rate= deaths per 1,000 live singleton births Data source: Birth Cohort Data 1960-2007. *Birth Cohort Data unavailable for 1998. Prepared by the California Department of Public Health, Maternal, Child and Adolescent Health Division • BIH was established in 1989 to address disparities in infant mortality in California • At that time, the prevailing assumption was that increasing access to prenatal care would lead to substantial reductions in infant mortality rates, especially among African Americans.
The BIH Program spans 15 jurisdictions where over 75% of African American live births occur. Source: California Birth Statistical Master Files, 2006- 2008, Non-Hispanic African American resident mothers, age 18 years or older, excluding foreign- born mothers. Analysis by CDPH MCAH EAPD.
The Problem Persists More adverse birth outcomes among African American babies and mothers: African American babies are ~1.5 to 2 times as likely as White babies to have low birth weights or be born preterm, and more than twice as likely to die before their first birthdays African American women are : Nearly 4 times as likely to die from pregnancy complications as White women, taking other factors into account
Why Should We Care About Preterm Births? Being born too early or too small is a powerful predictor of poorer health outcomes throughout life . For example, low birthweight or preterm babies are: Less likely to survive to their first birthdays More likely to have delayed cognitive, behavioral and physical development during childhood More likely to suffer from chronic diseases like hypertension, diabetes and heart disease as adults Sources: Lu & Halfon, 2003; Behrman, 2007; Barker, 2004
Selected BIH Clients Demographics BIH African American Source Clients Mothers in CA Unintended Pregnancy 80% 60% a, b Received Prenatal Care during a, c First Trimester 72% 82% Prenatal Care Paid by Medi-Cal 86% 50% a, c a, d Single Marital Status 85% 64% Education: High School a, b Graduate or Less 63% 34% a, c Age (Average Years Old) 25 27 Sources: [a] BIH Management Information System, Calendar Year 2009, Current Pregnancy Report, Demographics Report., Trimester of Enrollment and Trimester of PNC Initiation Report; Data Set 20100419 [b] Maternal and Infant Health Assessment Survey (2006). California Department of Public Health. [c] California Birth Statistical Master File, 2006, analysis by MCAH staff. [d] Figure 5 (Never married, Separated, Divorced), California Current Population Survey, State of California (2006) Department of Finance, California Current Population Survey Report: March 2005. Sacramento, California. www.dof.ca.gov/HTML/DEMOGRAP/ReportsPapers/documents/CPS_Extended_3-05.pdf Prepared by the California Department of Public Health, Maternal, Child and Adolescent Health Division
Role of Income & Education Among both Blacks and Whites, birth outcomes are better among women with higher levels of income or education But the disparity in birth outcomes between Blacks and Whites is greater among higher-income and more-educated women
Rationale for Revising BIH A 2006 assessment conducted by UCSF found: Great work happening in sites, but was not consistent across sites, but there was a lack of standardization Science governing model was outdated Limited data collected Did not fully consider the other factors that influence health seeking behavior Recommended the development of a single core model for all sites Source: UCSF Center for Social Disparities Health Assessment Report
Social Factors The birth outcome patterns suggest that social factors are involved. Prime suspects include: Stress: Especially chronic, e.g., due to racism and/or economic hardships Lack of social support: Social support may directly improve health, affects health behaviors and buffers stress effects Need for empowerment: Self-efficacy plays key role in health behaviors; key to escaping poverty (lack of control at work strongly linked
The Impact of Racism Racism is a system of advantage based on race. It is the power to not only dislike me, but to impact me. Less access to capital Discriminatory hiring practices Inferior health care Over-representation in the criminal justice system Under-representation in the university system
Racism and Stress Experiences of racial discrimination create chronic stress: Overt incidents Subtle/ambiguous incidents Constant vigilance and self-doubt-- “work twice as hard to get half as far” Chronic stress negatively impacts our health and wellness Consider racism as a health issue Some studies have linked racism (generally, overt incidents) to adverse birth outcomes, others have not
Monique I am generally in good health and in tune with my body. So when I felt a change, I knew I needed to pay attention. Tests were taken. And when the nurse returned, she said, “I’m sorry. You’re pregnant.” As if there was a problem. I asked her if there was something wrong. She seemed to hesitate and then repeated, “You’re pregnant.” To which I responded, “My husband will be so happy.” Seeming surprised, she said, “Oh you have a husband”……
Monique Negative responses hit me hard. Not to mention I was feeling the pregnancy hormones. I felt negatively judged, often heard belittling comments, and felt eyes staring at my ring finger, with a “ tisk, tisk ” teeth smacking response. Birth outcomes are affected by the negative impact of racism over one’s lifetime, not just during pregnancy. A lifetime of exposures to racism can literally get inside the body and affect our health as well as the health of our newborns.
How To Impact Birth Outcomes No definitive scientific evidence The patterns of birth outcome disparities suggest that social factors are involved Strong theoretical basis for believing empowerment-focused group approaches are more effective than individual interactions, and empiric studies with pregnant/postpartum women support group approaches Source: UCSF Center for Social Disparities Health Assessment Report
How can stress influence health? STRESSOR Hypothalamus CRH Pituitary Gland ACTH Adrenal Glands CORTISOL AFFECTS MULTIPLE ORGANS & SYSTEMS Source: Center on Social Disparities in Health, University of California San Francisco
Preconception Health & the Life Course Perspective Excellent Health Exercise Optimal Healthy Education Birth Outcome Relationships Health Care Financial Security Family Planning Planned Pregnancy Safe Neighborhood Nutrition Protective Factors Healthy Relationships Risk Factors Social Support Disparity at Birth Poor Nutrition Obesity Unsafe Neighborhood Poor Education Adverse Poverty Lack of Health Care Childhood Events No Family Planning No Social Support Exposure to Toxins Mistimed Pregnancy Tobacco/Alcohol Drugs Poor Birth Health Poor Outcome Conception Birth Age 5 Puberty Pregnancy Delivery
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