Combatting Infant Mortality Means First Having the Uncomfortable Conversation About RaceNovember 30, 2017 2:43 pm Lauren Sega
“Combatting infant mortality locally means folks are going to have to get uncomfortable.”
Jessica Roach will tell you herself: her plans to combat Columbus’ infant mortality rate aren’t revolutionary. Longstanding and commonsensical, they’re founded in the historical context, lived experiences, and quantitative research that describe the state of quality of life for people of color.
But, they are new to Columbus.
The city’s own taskforce on infant mortality, CelebrateOne, kicked off in 2014 with a focus on the social determinants of health: economic stability, education, housing and environment, healthcare, and social context. The initiative places heavy emphasis on the ABCs of safe infant sleep (Alone, on their Back, in a Crib) and addresses those social determinants through its Connector Corps program.
Celebrating its first graduating class in December 2016, Connector Corps puts classes of community health workers into high-risk communities, connecting expecting or new mothers with vital resources. The program’s 24 graduates will enter the eight identified high-risk neighborhoods and address issues like preterm and low-weight births, sleep-related deaths, tobacco exposure and health disparities.
Roach asserts that there’s another, more foundational layer to examine. Her black women-led reproductive justice organization, Restoring Our Own Through Transformation (ROOTT), is looking beyond social determinants and to the structural determinants of health, or the racially discriminatory policies and social constructs that have created an environment where black mothers are three times more likely to lose their babies than white mothers.
“It’s easy to talk about the social determinants, to talk about poverty as an issue, to talk about unstable housing as an issue,” Roach says, “but we never get to the core of how those things were actually created, or how a timeline of 400 years of history has created a massive issue in all categories of health and economics, especially when we’re talking about infant mortality issues.”
Where ROOTT comes in is at a number of levels. At its core are the doulas.
For a pay-what-you-can price, expecting moms can receive conception-to-postpartum support from one of ROOTT’s doulas.
“We work as full-spectrum doulas,” says Laurel Gourrier, a certified doula and former special education teacher. “We do discuss abortion, adoption, and surrogacy. We discuss if you are giving your baby up for adoption. As a full spectrum doula, whatever that looks like for you, that’s how I’m going to support you.”
Through ROOTT, Gourrier supports one or two families — called birth clients — at a time. The typical support timeline will include prenatal guidance, education, processing past births and how they contribute to the current pregnancy, and formulating and following through on a birth plan. Those who request postpartum services can call on Gourrier for at least a year after birth.
Involved in the doula network, Central Ohio Doulas, Gourrier still checks in on clients from two or three years ago.
“After you survive year one, you finally have gotten to this routine. What do we do to continue all the developmental growth that will now take place?” Gourrier proposes. “— to really build our children up to be successful and strong and loving and all those great things?”
Advocacy, education and choice are Gourrier’s priorities when working with a birth client. In her own experience, Gourrier has perceived a cultural negativity toward pregnancy and a tendency toward anxiety and fear. She largely blames the medicalization of pregnancy and birth, and the implicit and explicit racial biases of medical professionals.
Currently pregnant with her second child in a state with an entirely different birthing culture (no birth centers, no hospital midwives), Gourrier’s first prenatal appointment was a stark contrast to that of her first pregnancy in Maryland.
Gourrier says her doctor was impersonal and uninformative. Rather than a standard ultrasound, the doctor recommended a transvaginal exam, but offered, “Let’s just do it this way” as a reason why. During the first glimpse of her baby, Gourrier said it was so rushed she couldn’t concentrate.
“That might not have been racism, but it was also just the business of birth,” Gourrier says, “and it caused stress. If i’m going to have to see you almost every month, let’s actually have a conversation. Like, why don’t you get to know me?”
During her work with birth clients, a common narrative she hears is of the helplessness felt when seeing an obstetrician. Because black individuals are more impacted by infant mortality, they’re likely to be told what steps they need to take to avoid losing their baby, or what risks are out there that might affect their pregnancy.
As certified doulas, Gourrier and her colleagues go on a case-by-case basis to understand and address what their clients say they need before issuing expert advice.
“We genuinely believe and honestly know from our own inherent experiences that the key to having a healthy mom and healthy baby is having the support system in order to do so,” Roach says, “and having the level of validation to be able to say, ‘I know that you’re having this experience. How can we address this in order to decrease some of the burden?’ versus telling us, ‘If you don’t do X, Y, and Z, your baby is going to die.’”
Roach is a public health professional, a former nurse and home birth midwife assistant, and a mother of a pre-term infant. She’s further connected to the cause through genealogy, as her great grandmother was catching babies before women of color were allowed in hospitals.
Roach describes a tradition of communal birthing practices that’s rooted deeply in black history. It’s revived within ROOTT. Meetings, focus groups, and workshops all take place within neighborhood spaces. If they’re in Linden, they meet at the Linden library, and they provide food and childcare as incentives for people to show up.
“And then it becomes a word of mouth kind of situation — ‘Oh, there’s this great group out here,’ and then people are more invested and willing to come to you,’” Gourrier says.
As ROOTT expands, more doulas will enter the fold. They’re part of Roach’s model of community economic stability and sustainability. Rather than relying on external “saviors” to come in and establish neighborhood needs and goals, ROOTT pays its doulas for doing the work, and “that’s revolving the money inside of the community,” Roach says.
Community self-investment is a key part of ROOTT’s work as it combats infant mortality. It intends to reverse the effects of racist home loaning policies that date back to the 1930s, when black urban neighborhoods were “redlined,” or disqualified from receiving a bank loan. Forced to rent their homes from outsiders to the community, residents have, over the years, been continuously pumping money out of their own neighborhoods.
Those communities are now recognized as those with the least number of resources and the highest infant mortality rates: Northeast, Southeast, Morse Road & 161, Franklinton, Hilltop, Near East, Near South and Linden.
ROOTT’s economic model keeps its dollars and uses them to further invest in its target communities. While its effects aren’t far-reaching enough to address unstable housing, poor educational opportunities or food insecurity, ROOTT is simultaneously working to affect policy changes that could address these issues.
Dorian Wingard, policy and strategic analysis advisory council to ROOTT, works with local and state leaders to bring structural determinants into infant mortality discourse. He critiques the city’s taskforce on infant mortality for its focus on safe sleep and its superficial approach to lowering mortality rates. Ultimately, he doesn’t believe the city is actually prioritizing communities of color or adopting their ideas and perspectives.
“It’s about priorities,” he says. “It’s back to that phrase: social value propositions — where they place their interest, who’s valued and who’s not.
There are parts of this city that look exactly the same in 2017 as they did in 2000 when Michael Coleman was elected. In 20 years, nothing was done to change it, yet Downtown looks like a brand new place. It’s about where priorities are placed.”
He refers to the all-in city effort to #SaveTheCrew as an example. Within a month of the announcement that the Columbus Crew SC would be moving to Austin unless a new stadium was constructed, the Columbus Foundation, the Columbus Partnership, City Council and Mayor Andrew Ginther were all collaborating on ways to keep the Crew here. Yet, it took two years for city government to come up with a new Comprehensive Neighborhood Safety Strategy that somewhat addresses residents’ concerns about police brutality within the Columbus Division of Police.
“The way we elect our officials, where housing developments are built, the way police patrol patterns are determined — it’s all connected,” Wingard says. “And we, again, know for a fact that those in positions of leadership know these facts, because I’ve been in the room having these conversations. We don’t need another study or task force. If you know these facts, why are you not doing things to address these issues?”
Part of the reason seems to be the unpopularity of discussing race issues in politics. Mayor Andrew Ginther held a half-hour long press conference about the changes he plans to make to public safety initiatives, but never used the words “race” or “racism” in his speech.
“It’s always the politically correct thing to do to stay away from structural racism,” says Jason Reece, a former member of the state’s Greater Infant Mortality Task Force and an Assistant Professor at The Ohio State University. “Think about efforts across the state of Ohio. It’s really not uncommon that we’ll have this really deep and rich analysis, but our solutions bank toward the things that are easy and the things that aren’t really helping address those structural issues.”
For true policy change, public discourse on infant mortality will need to shift first, Reece says, and that means centering the voices of people and groups like ROOTT.
“The U.S. has never done a great job in addressing issues of race, and we have much more work to do,” Reece continues. “We have to acknowledge a lot of our problems in the past and things that, from a policy perspective, have deliberately contributed to this problem. I do think that through that illumination and through that discomfort, we’ll see growth.”