A recently released study shows where babies in Wyandotte County are at the highest risk of dying, but figuring out how to prevent infant deaths and help their mothers stay healthy remain unsolved problems.
The study on health disparities in Wyandotte County, sponsored by the Community Health Council, found that residents in some parts of the county were more likely to die prematurely, with residents of the least healthy neighborhoods dying at an average age of 59. While many factors contribute to early deaths, high numbers of infants dying can pull down the average.
Infant mortality rates have been consistently higher in Wyandotte County than the state as a whole in recent years. But the study found that babies in some Wyandotte County neighborhoods were significantly more likely to die before their first birthdays than babies in other neighborhoods.
The study found 11.6 infant deaths for every 1,000 births in predominantly black neighborhoods, more than double the rate in primarily white neighborhoods. The data didn’t specify the race of the infants who died but would be consistent with studies showing black babies die at about twice the rate of white babies nationwide.
While the study illustrates where babies are most likely to be at risk in Wyandotte County, it doesn’t solve the problem of reaching women who need help accessing health services.
Community health workers in Wyandotte County need more partners to connect them with women who would benefit from their services, said Donna Young, a project manager with the Community Health Council.
Young said her coalition is working with church officials and other community leaders that are trusted by black women in Wyandotte County, because word of mouth is one of the most effective ways to reach them. The message is particularly effective if it comes from neighbors and friends, she said.
“These things need to be delivered in the community. They need to be delivered by the community,” she said.
Alyssa Carodine, coordinator of a community action team on infant mortality, said the team has identified several common factors regarding infant deaths in Wyandotte County. Mothers had difficulty accessing care and managing chronic health conditions, she said, and they often didn’t know about safe sleep practices or the need to seek medical care if a fetus stopped moving.
“We would see cases where the mom would have uncontrolled diabetes or uncontrolled hypertension,” she said. “We would see that over and over again.”
‘This is one of the toughest issues’
Targeting clear medical problems may not be enough, however. Traditional prenatal care has been shown to improve maternal health but hasn’t made a dent in infant mortality, said Paula Braveman, director of the Center on Social Disparities in Health at the University of California – San Francisco. Genetics and maternal behavior, such as smoking or using illicit drugs, also don’t appear to explain the gap between black and white infant mortality rates, she said.
“This is one of the toughest issues, and if anyone tells you they know the definitive answer, you can just hang up on them,” she said. “The most likely causes are not easy to address.”
One theory gaining traction is that stress over a lifetime drives inflammation, which is a factor in poor birth outcomes and chronic illnesses, like heart disease. Poverty contributes to stress, as does the fear that others deem a person inferior based on race, Braveman said.
The stress doesn’t go away, even if a person experiences “ambiguous” situations rather than overt discrimination, she said.
“At some level of your consciousness, you know you have to be alert in case there is an experience and you have to decide how to respond,” she said.
Braveman said if the research pointing to chronic stress as a significant factor is correct, the most effective interventions may have little to do with the health care system.
They could include creating jobs in poor communities, increasing access to college and vocational training, building on safety net programs and even reducing the number of men incarcerated, which leaves women trying to raise children without a partner’s financial and emotional support, she said.
Closing the gap
Women with higher incomes generally have better birth outcomes, but decreasing poverty alone won’t close the gap, said Tyan Parker Dominguez, a clinical associate professor at the University of Southern California and member of the U.S. Secretary of Health and Human Services Advisory Committee on Infant Mortality.
While high-income black women have better birth outcomes than poor black women, their infant mortality rates remain higher than those of white women, perhaps due to stress early in life, she said.
Childhood stress affects a developing brain, and babies of chronically stressed mothers are more likely to grow up with unhealthy stress responses, Parker Dominguez said. That can set them up for poor health later in life, even if their achievements allow them to escape a stressful environment, she said.
“If you’re living in chronic stress like a lot of populations do in under-resourced communities, you never get to come up from that threat,” she said. “That’s not something that goes away just because you were able to go to college and get a good job.”
The only method that has shown significant success in reducing infant deaths so far involved offering black women prenatal care and education as a group, Braveman said. Going through pregnancy and the neonatal period together helps women develop support networks and build their confidence as a parent, she said.
“If a woman feels like she can do it, she’s more likely to be able to do it,” she said. “It’s empowering for women to hear other women who are like them.”
Meg Wingerter is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC