Policymakers need to dismantle structural racism with reforms that create equitable access for minorities to housing, jobs, education and quality, less-biased health care, say experts at the Health Policy Institute of Ohio. In the short-term, local groups should continue connecting minority and at-risk moms with assistance services.
But only doing the latter isn’t enough, experts say.
Common denominator: Race
Sydney Beasley and Kortni Alston have both lost infants.
Beasley didn’t attend college, never married, comes from a working class family and is on Medicaid, factors that research indicates put her at a higher risk for losing a child.
Alston has a college degree from Wilberforce University, is married and has a professional career, factors that often reduce risk for child deaths.
Beasley and Alston share a factor, though — both are Black.
In 2009, Beasley went into labor 24 weeks into her pregnancy and gave birth to Keasha — a beautiful but frail girl weighing 1.5 pounds.
Keasha spent four months fighting for her life in three different Dayton hospitals.
Finally, Keasha went home after a breathing tube was inserted and nurse visits were set up. Beasley, then 18, was nervous but looked forward to watching her daughter grow.
“Even though she had the trach, I felt like she was just like everybody else’s baby. She would play, she would laugh, we would just hold her, everything,” Beasley said.
At 11 months, Keasha’s breathing tube accidentally came out. The young mom tried frantically but couldn’t get the tube back in. An ambulance rushed them to the hospital, where staff told Beasley the lack of oxygen had left Keasha brain dead.
Beasley made the difficult decision to take Keasha off life support and the baby died in her mother’s arms.
Beasley became so depressed that she hardly left her bedroom for two years.
In 2013, Beasley gave birth to another girl she named Soraya. Again, the birth came too early — 25 weeks — and the infant weighed 1 pound, 13 ounces.
Soraya stayed in the hospital for four months and has beaten the odds to survive.
In 2019, at 20 weeks into her third pregnancy, Beasley started having contractions so she went to the emergency room. Her daughter, Royalty, was born unresponsive.
“It was hard,” Beasley said of losing two children.
Only in 2019 was Beasley finally diagnosed with an incompetent cervix, a condition that can contribute to premature birth. Black women are at higher risk for the condition.
Now, Beasley is 28 weeks pregnant with a girl due in June and feeling good; she is excited to give Soraya a sister. This time her doctor did a surgery that helps prevent premature births.
Higher risk of SIDS
In 2016, while living in Harrison Twp., Alston gave birth to her fourth child, a healthy girl named Shiloh. Her big brother, 4-year-old Jamison, liked to call her Twinkle.
“He would sing ‘Twinkle, Twinkle Little Star’ to her all the time. And people would ask what’s her name and he would say, ‘Twinkle,’ and we would say, ‘That’s not her name and quit telling people that.’ But we now have come to believe that he knew she would be a twinkle in the sky versus a Shiloh here on Earth,” said Alston, now 41 and living in Tipp City.
Alston, already a mother for 14 years, said Shiloh was happy and healthy. “Everything was wonderful.”
Until one morning, when Shiloh was 3 weeks old, her parents woke up and found her in her crib not breathing.
“And at the moment we kind of thought it was, you know, sleep. You don’t think death, immediately, You kind of go just, ‘Wake up, wake up,’” Alston said.
For reasons that are not well understood, Black and other nonwhite babies are more likely to die from Sudden Infant Death Syndrome, as Shiloh did.
Infant health and maternal health go hand in hand, said Hope Lane, a researcher with the Cleveland-based Center for Community Solutions, a nonpartisan think tank.
“You can’t save babies without taking a real good look at the mother and the mother’s health,” Lane said.
Ohio’s Black mothers are less healthy on average because they have poorer social determinants of health (barriers to jobs, housing, education, etc.), toxic stress from racism that deteriorates their health, lack of access to quality health care and often biased care by medical professionals, experts say.
Of the modifiable factors that affect health, 20% are attributed to clinical care, and 30% to health-related behaviors such as tobacco use and nutrition, according to the Health Policy Institute of Ohio. The remaining 50% are community conditions such as housing, transportation, education and employment.
The Dayton region, like many of Ohio’s major metropolitan areas, remains racially segregated with fewer resources found in majority Black communities.
Much of West Dayton (North and South), an area with a majority Black population, is designated by the U.S. Health Resources and Services Administration as a medically underserved area that lacks primary care providers.
The problem spans income lines. Numerous national studies show that after controlling for education and socioeconomic status, Black women remain at high risk for maternal and infant mortality.
Part of that is due to bias on the part of some medical professionals.
A study of 1.8 million hospital births in Florida between 1992 and 2015 found that when Black newborns were cared for by a Black physician rather than a white physician, their death rate was cut in half.
A 2016 study found that more than half of the 418 University of Virginia medical students surveyed believed at least one myth about biological differences between Black and white people, including the myths that Black people have smaller brains, thicker skin and less sensitive nerve endings.
Ryan Ivory, a social worker who has worked in Dayton hospitals for over a decade and serves as director of the Dayton-area chapter of the National Association of Social Workers, said she often witnesses white providers assume Black patients know less than white patients.
“There are certain things that an African American woman will be offered or told to do during the course of her pregnancy or not do, or when she goes to deliver her child, that is not the same thing that a white woman would experience,” Ivory said.
When Beasley went to the emergency room in 2019 with contractions at 20 weeks along in her pregnancy, the staff did not believe her, she said.
“Every time I go to the hospital, they never believe me,” she said. “I was just sitting there for so long … waiting in the emergency room, just waiting in the lobby, when I was literally trying to tell them I’m in pain. It just happens every time … I feel like sometimes they don’t take us (Black women) serious.”
Racism itself might be playing a role. There is growing consensus among experts that the constant stress of racism leads to premature aging and poor health conditions, Lane said.
“The body of a Black person, a Black mother specifically, weathers at a much faster rate,” Lane said.
Some research even indicates the health impacts of stress can be passed on to children, said Reem Aly, vice president of the Health Policy Institute of Ohio.
“So racism has both an indirect impact and a direct impact on health,” she said.
Ohio’s strategy so far
The Dayton region’s health departments and nonprofits have long provided assistance programs, connected at-risk mothers with services and done educational outreach on topics such as breastfeeding and safe sleep practices. Moms enrolled in these programs have better outcomes.
Ohio Gov. Mike DeWine’s recently proposed two-year state budget would increase funding for existing programs such as home visits, crib distribution, prenatal care, transportation and housing for pregnant moms. In December, DeWine also created a task force focused on eliminating racial disparities in infant mortality by 2030.
But providing services to disadvantaged mothers isn’t enough, said Dr. Karen Mathews, the director of health and psychological services at Central State University.
“If you expect that to fix it, then you’re living in la la land just based on what we know the continued outcomes are,” Mathews said. “I certainly applaud people for supporting people who live in poverty, but we know that that’s not the answer. That’s part of the answer. To help with the infant mortality piece, we have to deal with the overarching institutional racism piece.”
The Health Policy Institute of Ohio recommends continuing to improve access to clinical care, while also advancing meaningful policy changes to improve community conditions.
Solutions: Offer less biased health care
Black medical professionals in the Miami Valley want more people of color in the field. About 2% of doctors in America are Black men.
During a recent panel held by the Greene County Library, Black leaders said schools, nonprofits and hospitals need to do more to encourage people of color to enter the medical field and assist them with earning degrees.
Wright State’s Boonshoft School of Medicine has had success in recent years increasing enrollment of minority students.
Black medical professionals also want more implicit bias training for providers.
Gina McFarlane-El, CEO of Five Rivers Health Centers, applauded Wright State’s obstetrics and gynecology residency program for instituting anti-racism training and would like to see that expanded to hospitals.
Solutions: Improve community conditions
Ohio’s strategy so far isn’t enough to stop Black babies from dying at disproportional rates, Aly said, because it doesn’t address the bigger, underlying issues.
The Health Policy Institute of Ohio has identified over 100 policies, big and small, local and state government could enact to reduce infant mortality.
Those recommendations include:
- Require state and local government leadership and staff to undergo implicit bias and anti-racism training.
- Improve access to housing by increasing timely access to legal representation, rental assistance, landlord-tenant mediation and emergency financial assistance.
- Improve opportunities to obtain self-sufficient income by making Ohio’s state Earned Income Tax Credit refundable and investing in initiatives that increase the number of Ohioans of color who complete high school and obtain higher degrees.
“In order to really see a change in these racial disparities, there needs to be significant investment in policy change that impacts communities and environments,” Aly said. “Once we get to a place where those investments are being made, and they’re being made specific to Black and African American Ohioans … that’s when we’re going to start to see some real change.”