Nearly seven out of every 1,000 babies born in Michigan will not live to their first birthday. That rate is more than double when it comes to African American and Native American infants.
As part of its new effort to move the needle on infant mortality, the state is tailoring solutions to different communities. It recently released a draft of its 2019-2022 Mother Infant Health & Equity Improvement Plan (MIHIEP).
Leseliey Welch is a senior public health lecturer at Wayne State University. She's currently leading the development team for Birth Detroit, a women’s wellness and birth center.
Bethany Brown is a certified nurse midwife and assistant director for the nursing program at Central Michigan University. She's also part of the state's regional infant mortality task force for parts of central Michigan, including Isabella County.
Welch says that in order to address the issue of infant mortality in Detroit — which has a rate of 14.2 deaths per 1,000 infants born — it’s important to talk about racism and the “political and socioeconomic conditions” that women face.
“We know that we need to address the challenges — the larger challenges — that families are having. Whether it be around income levels and poverty, whether it is housing, whether it’s transportation access, those larger factors complicate how women are able to access the care that exists,” Welch said.
Isabella County in central Michigan had an infant mortality rate of 11.7 per 1,000 births in 2017. That makes it the highest in the state, though Wayne County had the highest number of infant deaths. Brown says that implicit bias on the part of health care providers plays a role in the quality of care that different populations in that county receive.
“An implicit bias is when a person has these upbringings and beliefs that they may not be completely aware of, and it shapes how we make decisions and care for people,” Brown said.
Welch says that the current disparities in both infant and maternal mortality are rooted in racism, which impacts the resources and opportunities available to women of color. It also impacts the quality of care that they receive from providers, regardless of socioeconomic status or education level.
Brown says that racial and cultural disparities in Isabella County, which is home to the Saginaw Chippewa Indian Tribe of Michigan, also influences quality of care because providers and patients often come from different backgrounds and may have different priorities.
Both Welch and Brown cite programs that are working to address these issues in their respective communities, including plans for Birth Detroit and for “mobile prenatal care or certified nurse midwives” in Isabella County.
The state of Michigan has set a target to reach zero preventable infant deaths and zero health disparities among its citizens, a goal that Welch and Brown agree is entirely possible. Welch says it will require going beyond healthcare to improve people's economic opportunity, improving housing, ensuring pay equity, and affordable child care.
“Those things in combination with improving our care systems and enforcing or promoting standards of respectful care at birth and really leveraging community-based models of care and meeting families where they are, we can absolutely do that,” Welch said. “There’s no reason to think we can’t.”
This post was written by Stateside production assistant Isabella Isaacs-Thomas.