This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

For Black infants, racism's impacts begin at birth – and may be deadly.

In 2018 in Michigan, more than three times as many Black babies died before their first birthday as white babies. Black mothers fare even worse, with maternal mortality rates that are 4.5 times higher than non-Hispanic white women. An underlying factor in Black infant mortality is low birth weight (LBW). When LBW babies survive, they face a host of medical problems that often have lifelong consequences.

Amber Bellazaire.

"When we take a long view, maternal and infant mortality across the U.S. has been declining but it is still an issue when the U.S. is compared to other wealthy nations. We are not doing as well," says Amber Bellazaire, policy analyst with the Michigan League for Public Policy (MLPP) and author of its report, "Thriving babies start with strong moms: Right Start 2020." "... When we drill down further, we see those disparities in racial outcomes."

"Racism is oftentimes an underlying value of the disparities seen," adds Dawn Shanafelt, director of Maternal and Infant Health at the Michigan Department of Health and Human Services (MDHHS). "We have systems of care that have been built in this society, which is plagued with structural, systemic racism. The system for medical care continues to perpetuate these. It's been evident in the experiences that have been published by families receiving maternal care. The bias is very clear."

However, the link between racism and health impacts for Black babies is becoming increasingly better understood and acknowledged – and practitioners across Michigan are coming together to address it.

The "weathering" effect of racism

As a Black mother and grandmother, Grand Rapids resident Yvonne Woodard has experienced firsthand the way racial disparities have affected her children and grandchildren's health. Her first baby weighed five pounds, seven ounces. Her fifth and last weighed four pounds, eight ounces.

"They all came to term. My first was overdue," she says. "They just kept getting smaller."

Yvonne Woodard holds a family photo.

Woodard's first grandson weighed one pound, eight ounces. Now nine years old, he has just learned how to say "mama." Woodard's granddaughters weighed three and four pounds.

"It's not a good feeling," she says. "A doctor had told me, 'It's because you are African-American and it's in your family.' I thought, 'I am going to be sick because of my race and background?' It doesn't make sense that it's hereditary."

Woodard's experience reflects the results of "weathering." As retold in Bellazaire's report, University of Michigan professor and researcher Arline Geronimus found that exposure to chronic stress — like the stresses of facing racial discrimination day after day – leads to early health deterioration.

"Continual attempts to cope with cumulative stress — not just one negative experience but a combination over the life course — leads to a high allostatic load or 'wear and tear' on the body," Bellazaire wrote in the MLPP report. "This wear and tear leads to racial health disparities across a range of medical conditions, including disadvantages in pregnancy and childbirth."

As a woman who has deeply researched her own medical conditions, Woodard agrees.

"Stress contributes a lot," she says. "Your nervous system actually has a memory."

Geronimus' research found that in the U.S., non-Hispanic Black women have the highest incidence of weathering. While Black women moving to the U.S. more recently have outcomes similar to white women, those who have lived here all of their lives fare the worst, no matter how much money they have or how advanced their education.

"There are many factors that interact and inform pregnancy-related outcomes. Racial disparity and bias is one," Bellazaire says. "This is borne out in evidence, not just in what people feel, anecdotes, or opinions. Consistent research suggests that when we hold things the same, education, socioeconomic status, and healthy behaviors, we continue to see these disparities by race."

When health care systems operate with racial biases, whether they are recognized or not, that stress can be intensified. Practitioners may assume that Black women have Medicaid insurance coverage, are single mothers, lack education, or are using illegal drugs. According to a 2019 American Progress report, the intersectionality of racism and sexism often results in women of color experiencing bias and discrimination in health care settings, leaving them to feel invisible or unheard when they ask their medical providers for help or try to communicate their symptoms.

"When I had the last baby, I moved from New York to Virginia. I told the new doctor what's going to happen … and of course he didn't believe me," Woodard says. "I was female and Black. He didn't believe that I know my own body."

"If you do not have access to respectful and responsive care, your health is going to be affected," Bellazaire adds. "It's as simple as if you feel unsupported or unheard, you may be less likely to receive care. We know that not receiving consistent prenatal care certainly affects Michigan's outcomes. We want to make sure we are encouraging respectful, responsive care for all Michigan women if we care to improve outcomes."

Respect and response

Although the statistics on racial disparities in infant health are disheartening, awareness of the issue is growing and Michigan is taking steps to address it. Michigan Gov. Gretchen Whitmer's proposed expansion of Michigan's Healthy Moms Healthy Babies program shines a spotlight on racial maternal-infant health disparities and establishes a plan to decrease them. The plan states, "As a part of comprehensive health care for women we will ask a woman what she wants, ensure she can get it in one visit, and provide coverage for it."

Dawn Shanafelt.

In developing the plan, MDHHS staff met with residents across the state in town hall-style meetings to learn about their experiences, needs, and suggestions.

"I think we are transforming the way we are doing things," Shanafelt says. "We made it clear that we don't just want the state to come by and do its thing. We want open communication. We had our team of epidemiologists be a part of meetings so we could share data with communities and really show that we are invested in a partnership."

First and foremost, Healthy Moms Healthy Babies expands health care coverage for low-income new moms to a full year after giving birth. The plan has established nine Regional Perinatal Quality Collaboratives (RPQCs) comprised of health care professionals, community partners, families, faith-based organizations, Great Start Collaboratives, home visiting agencies, and others who will focus on improving birth outcomes through quality improvement projects tailored to the strengths and challenges of each region.

Moving the first postpartum health care visit to within three weeks of birth and adding a comprehensive visit within 12 weeks will better support new mothers with postpartum depression and anxiety, breastfeeding challenges, or substance use disorders. Training in implicit bias will teach health care providers to better listen to women of color. Proven effective, home visiting programs will support women and babies in achieving better health while sharing information that will help them and their partners recognize developmental milestones, gain parenting skills, and access resources for housing, food security, or family planning.

"Really, what Healthy Moms Healthy Babies does is improve systems so we have sustainable change, [with the goal of] zero preventable deaths and zero disparities," Shanafelt says. "Whether you live in Detroit or Traverse City, we want you to have the best possible chance of having a healthy pregnancy and healthy baby wherever you deliver."

While racial disparities in maternal and infant mortality remain a problem, Michigan is actively charting paths towards health equity — with an emphasis on new moms and their babies. But as Woodard emphasizes, the long-term answer will go beyond policy change.

Yvonne Woodard.

"Peoples' hearts have to change," she says. "... We Black women are no different [from white women]. The parts of our body are in the same place. It's about domination. One day, people will realize this. One day, it's going to be so much better."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Yvonne Woodard photos by Kristina Bird. All other photos courtesy of the subjects.