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.

Five Michigan organizations will receive federal support of about $1 million each to improve maternal and infant health in the state.

On April 29, 2024, the U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), announced more than $5 million in total Healthy Start funding for the Detroit-based Institute For Population Health, Genesee County, Grand Rapids-based Corewell Health, Kalamazoo County, and the Sault Ste. Marie-based Inter-Tribal Council of Michigan (ITCMI). The HRSA-funded Healthy Start program focuses on improving the well-being of expectant mothers and those who have just given birth in communities with infant mortality rates that are at least 1.5 times higher than the national average. The programs support clinics and a full range of providers as well as culturally responsive health care services, food assistance, emergency supplies, transportation to care, housing navigation, and other critical social supports.

"Each of those Michigan awardees had to demonstrate that their outcomes for infants are worse than the national average," says Dr. Michael Warren, associate administrator for the HRSA Maternal and Child Health Bureau. "These community organizations are coming together to work to make a difference. They put together compelling applications."

The funding will help improve access to health care and community resources for Michigan moms and babies in high-need communities. The goal is to decrease the racial disparities in maternal and infant health outcomes in Michigan, where Black and Indigenous babies are over three times likelier to die before their first birthday than white babies. Maternal mortality rates reflect similar disparities.

"Not all states have any Healthy Start awardees, and some states just have one or two. The fact that Michigan has five means that there are worthy projects and folks who are committed to move this work forward," Warren says. "You've also got other state investments in place that are working to make a difference."

We chatted with two of Michigan's Healthy Start funding recipients about how the funds will help advance their work.

A Healthy Start for tribal moms and babies

Devin Smith, Healthy Start program manager for ITCMI, says systemic challenges as well as individual, family, and community struggles contribute to compromised maternal and child health within Michigan’s Tribal communities. Post-neonatal deaths and sudden unexpected infant death syndrome (SUIDS) are two to four times higher in these communities than they are for white infants.
Devin Smith.
"American Indian communities have been significantly impacted by the profound effects of racism, intergenerational grief, and historical trauma," says Smith, who is a member of the Sault Ste. Marie tribe of Chippewa Indians. "High rates of smoking, substance abuse, domestic violence, and chronic diseases such as diabetes, obesity, and cancer coincide with insufficient access to quality, responsive health care and the social services needed to impact the social determinants of health."

ITCMI has adapted Healthy Start’s framework to develop culturally relevant approaches with feedback from community members. Nurses, health educators, and outreach workers at 10 sites across the state provide coordinated care. Partnerships across multiple programs and agencies help address families’ health and social needs. This strong foundation of relationships between clients and staff has helped the program grow.

However, challenges like housing, transportation, and access to healthy food multiply for tribal members living in the U.P., where services are spread thinly across a large region. As smaller hospitals quit offering obstetric services and some larger systems prohibit family practice doctors from delivering babies, prenatal and birthing care become tough.

"Our Indigenous people are so dispersed across the whole of Michigan," Smith says. "We have tribes out to the west of the U.P, the Keweenaw. If all of our 12 tribes were going to meet in Detroit, it would take the Keweenaw [Bay Indian Community] as long as it would take me to travel to Washington, D.C."

"Transportation is very difficult for our people," she adds. "We have islands around here that require a ferry. We have a bridge with a toll. If you have a child or a mother that needs to be brought down to a bigger hospital, say Grand Rapids, that's five hours away from Sault Ste. Marie."

HRSA recognizes transportation as a barrier to maternal/infant care and encourages grantees to use funds to meet those transportation needs.

Federal-state-county collaboration keeps moms and babies alive

According to Derek Miller, Kalamazoo County Healthy Babies Healthy Start & 4Dad Fatherhood Program supervisor, Kalamazoo County has slightly lower maternal and infant mortality rates than the state average. He credits Cradle Kalamazoo, an initiative that brings together community leaders and organizations to implement evidence-based, holistic interventions that reduce infant deaths and promote respect for families and children.
Derek Miller with a Pack 'n Play playpen, which Kalamazoo County has given away to families.
"We really have a problem with the rate not being zero," he says. "Thanks to that Health Resources and Services Administration grant in combination with community partners, that allowed us to continue to make strides in driving these rates down."

Miller says lack of access to basic needs – such as quality health care, transportation to that care, safe and affordable housing, and other social determinants of health – is one root cause of maternal and infant mortality in the county. Another is institutional racism. Not only do women of color face implicit biases in the health care system, but they also suffer physical reactions to the daily stressors that discrimination creates. These stressors can increase risk for preterm births and low birth weights.

"There is more to it than just social determinants of health," Miller says. "Even high-income families of color are still twice as likely to experience maternal and infant mortality."

The HRSA grant funding will support Kalamazoo County and the other four Michigan grant recipients as they work to dismantle racism in both medical care and mental health care, and work to improve outcomes for Michigan moms and babies facing increased risks of death.
Kalamazoo County staff use these materials in parent trainings.
"Nationally, we know that maternal mental health conditions are a leading cause of maternal deaths," Warren says. "One resource we have here at HRSA is our toll-free National Mental Health Hotline, 833-TLC-MAMA. It’s available 24/7. Folks can call [or] text and speak to someone on the other end who is eager to talk to them and help them connect with resources in their own community. Since we launched it a couple years ago, we've had over 33,000 calls."

"We could prevent the vast majority of these deaths"

Warren says Healthy Start funding helps to address the alarming state of maternal and infant mortality in Michigan and throughout the U.S.

"Whether you look at maternal or infant health outcomes, our rates of deaths are higher for both mothers and infants compared to other similar countries across the world," he says. "If you look at maternal deaths, there are about 800 of them a year in the United States. In addition to that overall number that none of us is happy with, there are marked disparities. Black women and American Indian/Alaskan Native women are more likely to die during pregnancy or during that first year after childbirth than other women. Similarly, if we look at the rate of infant deaths, we lose about 20,000 babies a year before their first birthday."

In Michigan, the top three causes of infant mortality are prematurity, birth defects, and accidents and injuries.

"Those causes may look different from state to state," Warren says. "Partners in public health departments, whether that's the state health department, local health departments, partners or community-based organizations, take that data and use it to inform their work."

Warren shares that in Michigan, maternal mortality reviews systematically examine why mothers die. The three leading causes are infection, blood clots, and substance use disorders. Looking closer, reviews identify that 75% of the deaths were preventable.

"Why are mothers dying? You really need to look at why those deaths are occurring — and that's one of the things that we do in public health. That really helps to move toward prevention," Warren says. "For all of us, that ought to really ignite a passion to move on these. We could prevent the vast majority of these deaths."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Derek Miller/Kalamazoo County photos by John Grap. Devin Smith photo courtesy of Devin Smith.