After Black infant mortality surged in Kansas, birth workers jumped into action
Peggy Jones-Foxx knows what it takes to raise a baby.
“It’s the hardest work I’ve ever done,” she said. “And I have a master’s degree.”
At the Dellrose United Methodist Church in Wichita, Kansas, Jones-Foxx teaches pregnant women, particularly Black women, about that work — with the understanding that, statistically, their babies are less likely to live to see their first birthday than White children.
So she coaches them on how to stay healthy during pregnancy: Are they taking their prenatal vitamins? Do they have strategies for managing stress? Do they know what resources exist if they need help buying healthy food?
During a recent class, Jones-Foxx, who is president of the Wichita Black Nurses Association, lingered on a slide about the importance of communicating with their doctors. She told the women to write down any questions they might have ahead of a checkup, and insisted that they get answers. After all, she said, it can make a big difference when it comes to keeping Black mothers and their children alive.
“Sometimes that can be pretty intimidating because we’re all a little shy when it comes to professionals,” Jones-Foxx told her class. “They ask if you have any questions as they’re already walking out the door — but that’s your time to ask those questions that may be weighing on you.”
These “Baby Talk” prenatal education classes represent a new partnership between the nurses association and the University of Kansas School of Medicine-Wichita’s Center for Research for Infant and Birth Survival, or CRIBS.
The impetus? New data revealing that Black infant mortality in Kansas surged 58 percent in 2020.
While the U.S infant mortality rate declined from 2019 to hit a record low in 2020, some states are starting to see the reverse trend — with the rate of Black infant deaths far outpacing that of White infants. In Kansas, 17 Black babies out of every thousand die before their first birthday — over three and a half times the rate of White babies. Of the 2,369 Black babies born in the state in 2020, 40 died in their first year.
“I hope to be able to, one by one, shift those numbers for young mothers in the state of Kansas,” Jones-Foxx said.
‘We clearly haven’t done everything we can do’
The classes Jones-Foxx teaches are part of a multi-pronged effort by CRIBS in response to the increase in infant mortality. The center also runs an in-home visitation program for young families. Director Cari Schmidt said she and her staff are trying to secure funding for research that would help the center better understand the causes of sudden unexpected infant death.
“As long as there is a disparity” between White and Black infant mortality, she said, “we clearly haven’t done everything we can do.”
Public health experts are still trying to understand why Kansas saw so many babies die during the first year of the pandemic. Most suspect the virus has something to do with it — whether from direct impacts to fetal development or stress from job loss and isolation.
Both of those experiences were more common in Black communities, said Sharla Smith, a KU Medical Center professor who directs the Kansas Birth Equity Network: Black people were more likely to catch the coronavirus and they tended to feel the pandemic’s vast economic fallout more acutely.
“All of this has just contributed to the stress on the Black body,” Smith said.
What’s causing babies to die
Focusing on the health of Black mothers will be crucial to addressing Black infant mortality going forward because of racial differences in why babies die in Kansas, Smith said.
While White and Hispanic infant mortality is most commonly caused by birth defects, Black infant deaths more frequently stem from complications related to being born too early and underweight.
Premature birth can be caused by a host of factors, including a pregnant person’s preexisting health issues and challenges accessing prenatal care.
Smith said both can stem from bias and systemic racism within the medical field. Research shows doctors are less likely to diagnose Black women with endometriosis or refer them for cardiac treatment, and are more likely to ignore their pain.
“This is not just about getting an appointment,” she said. “Black women are just not heard.”
Infant mortality disparities transcend socioeconomic lines. A 1992 study found that a stark infant mortality gap existed between babies born to Black and White parents even when both were college-educated. Among that group, Black babies were nearly twice as likely to die as White babies.
So it’s a mistake to focus on poverty as the only driver of these outcomes, said Michelle Redmond, a KU School of Medicine-Wichita professor and Smith’s collaborator at the Kansas Birth Equity Network.
“You really have to look at what we define as social determinants of health — it’s social, environmental, economic, educational,” she said.
A holistic approach to improving outcomes for moms and babies
A few miles away in North Wichita, Sapphire Garcia-Lies is trying to tackle those non-medical factors that contribute to poor health outcomes, through the Kansas Birth Justice Society, a nonprofit that serves Black, Latino and Native American families.
The group’s approach is holistic, focused on improving both maternal and infant health.
“We can’t separate the two,” said Garcia-Lies, who founded the center during the pandemic. “They’re two sides of the exact same coin.”
That means providing supplies that low-income families might struggle to buy. The building houses a room stacked floor-to-ceiling with free diapers and baby clothes, a community fridge, and a lending library full of books about the birthing experiences of women and queer people of color. There’s also a meditation room and a meeting area for parent support circles.
And the organization is recruiting and training lactation consultants of color — a first for Wichita.
“People need culturally affirming care,” Garcia-Lies said. “They need to feel like they belong.”
The goal is to help Black, Native American and Latino families, who breastfeed at lower rates than White and Asian families, continue breastfeeding past the newborn stage — which research indicates is correlated with a lower risk of infant death.
“It provides protection from infectious diseases and sudden infant death syndrome,” said Lisette Jacobson, a KU School of Medicine-Wichita professor who studies the relationship between breastfeeding and infant health. “To optimize those benefits, you want to be exclusively breastfeeding for at least six months.”
For families of color, meeting that target often involves navigating more roadblocks than White families do.
“Lots of times, the biggest obstacle is that they have to go back to work really early,” Garcia-Lies said. “For some of them, it’s two weeks or less after they give birth.”
This year, the Kansas Birth Justice Society will pair around 75 families with doulas who’ll support them throughout pregnancy, birth and infancy. That can involve advocating for patients during doctor’s visits and ensuring they aren’t pressured into medical interventions in the delivery room, like labor induction or C-sections.
It’s an issue close to Garcia-Lies’ heart. She lost her second daughter to miscarriage in 2013 after, she said, a doctor brushed aside red flags she’d brought up about the pregnancy.
“By the time I went for a second opinion, she had passed away,” Garcia-Lies said. “I was full-term. We were days from her due date. And it didn’t just happen to me — it’s continuing to happen all the time.”
Now, she works so that fewer families have to go through that heartbreak.
Reducing racial disparities around infant mortality, she said, requires community-driven support for Black and Brown families in a world that’s hostile to them.
“We know that as soon as they walk outside these four walls, they’re going to face all the same things that they walked in with,” Garcia-Lies said. “But when they're here, we love on them and we nurture them. And we try to make sure that everyone who walks through those doors understands that they matter.”
Rose Conlon reports on health for KMUW and the Kansas News Service. You can follow her on Twitter at @rosebconlon or email her at firstname.lastname@example.org. Side Effects Public Media is a public health news initiative based at WFYI.