Maternal health race gap stirs concern
Kimberly Streater was pregnant with the third of her six children when the New Haven resident called her friend for a ride to the hospital after sustaining a hit to her stomach by her then- husband.
When she reached the hospital, Streater, not yet 28 weeks pregnant, alerted personnel that her baby was coming — now.
“They said, ‘ No, no, he’s not coming,’ after I told them he was,” she recalled. Minutes later, Howie was
born at 3 pounds and 1.5 ounces in the admitting area of the hospital, just as Streater had predicted.
Statistically, the preterm birth of Streater’s baby does not come as a surprise. In Connecticut and nationwide, black women and their infants suffer disproportionately worse pregnancy- related health outcomes than white women.
The March of Dimes’ 2017 Premature Birth Report Card for Connecticut revealed that between 2013 and 2015, 8.4 percent of all infants born to white women were premature, compared with 12.4 percent of infants born to black women. Statewide, after a complication- free delivery, black women are twice as likely as white women to be readmitted to a hospital within 30 days, according to a 2015 study published in the journal Obstetrics and Gynecology, which drew from statistics maintained by the Connecticut Department of Public Health.
These racially disparate outcomes mirror persistent racial gaps nationwide. Babies born to black women are more than twice as likely to die in the first year of life than babies born to white women, and black women are 243 percent more likely than white women to die from pregnancyrelated complications, according to the Centers for Disease Control and Prevention.
These statistics aren’t new. What’s new is how some professionals throughout Connecticut — from psychiatric researchers to community activists to medical doctors and progressive health centers — are reframing the way racial disparities are addressed, by re- examining their root causes and coming up with new solutions. This close examination of racial disparities in pregnancyrelated outcomes coincides with a recent push to address the nation’s discouraging overall maternal death rates, which increased by more than 25 percent between 2000 and 2014, while those in other developed countries declined, according to a study published in the journal Obstetrics and Gynecology.
Targeting racism
At Southwest Community Health Center in Bridgeport, about 80 percent of the patients that advanced practice midwife Janet Spinner sees are women of color. She’s pleased about the decisions the center makes to accommodate its patient population’s health needs. For instance, instead of waiting to see patients at the typical six- week postnatal visit, Spinner has new mothers come for a checkup between one and two weeks after delivery, then again at the sixweek mark.
“That’s when scary post- preeclampsia can rear its ugly head,” Spinner said of the dangerous medical condition that occurs more frequently among black women and can happen during or shortly after pregnancy. Spinner also uses the initial postnatal visit to check in with patients about breastfeeding, social support, and intimate partner violence, which she refers to as “the elephant in the room.”
And, Spinner said, the Bridgeport health center provides strong diversity training to its employees, a trend she sees becoming more prevalent throughout the state.
“We really need to talk about this as a community,” she said.
New Haven Healthy Start, a community- based program, has been working for three decades to identify and eliminate racial disparities in birth outcomes. The organization has examined several factors as possible culprits in the racial divide, including poverty, health insurance, and access to prenatal care. Ultimately, they homed in on one factor.
“Racism. Discriminatory practices based on race. That’s what we’ve been focusing on,” said Kenn Harris, president of the board of directors of the National Healthy Start Association and project director at NHHS. In response, offer a program aimed at making women, regardless of their race, feel truly supported throughout their pregnancy.
Mental health component
At the heart of NHHS’s strategy is its care coordination service model. They do outreach at strategically located places where pregnant women in the program’s target population are likely to visit, including community health centers and agencies that serve the homeless. Every participant is assigned a care coordinator, who provides an array of support — from helping them sign up for state Medicaid to arranging transportation and child care to reaching out to them if they miss a doctor appointment.
Another program making a difference in the health of black moms is The New Haven MotherS ( MOMS) Partnership. This community/ academic partnership, founded in 2011 by Yale associate professor of psychiatry Megan Smith, seeks to improve maternal mental health among low- income women through a community- driven approach.
Smith said she started the MOMS partnership because of increasing racial inequities she observed related to mental health care among New Haven residents.
“They’re more likely to drop out of mental health care programs, and less likely to receive high quality mental health care,” Smith said of the women targeted by the MOMS partnership. Since its inception, the program has reached more than 500 low- income moms and pregnant women from New Haven, about 70 percent of whom are women of color.
The program seeks out mothers and pregnant women in targeted neighborhoods of New Haven, requesting that they complete mental health assessments. Those who demonstrate need receive cognitive behavioral therapy in familiar settings. The treatment setting is non- threatening; so too are the community mental health ambassadors, mothers from the local community who work alongside traditional mental health clinicians.
Smith attributes the program’s success largely to the ambassadors and the community settings where they serve women. To date, more than 70 percent of participants registered for cognitive behavioral therapy through the partnership have adhered to treatment, and more than 50 percent report decreased depressive symptoms.
Streater, who gave birth prematurely to two of her six children, is a community mental health ambassador. She learned about the job when taking a free stress management class about five years ago. Streater says she didn’t have much of a support network as a pregnant or new mom. “It was pretty much me,” she said.