Health & Science

Illinois Group Aims to Trim Maternal Health Gaps

Monday, May 26, 2008

Illinois maternal and infant mortality rates are declining but remain high for African Americans. Health advocates are planning to launch this fall European-style pilot programs that might narrow the gap and improve the city's health profile.

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Robyn Gabel

CHICAGO (WOMENSENEWS)--While the presidential campaigns bat around health-reform proposals, a 70-person steering committee in Illinois is busy designing pilot programs for a blueprint to reduce maternal and infant mortality that could be in place before the next president takes office.

While still working to raise $750,000 from the state government and private foundations, it's a relatively small effort with at least one major goal: cutting in half the mortality gap between blacks and whites by the end of the decade.

To achieve such a thing, organizers say remedies must be sought beyond strictly clinical settings.

"A lot of things in the 10-point plan are not just specific to what we think of as health care," says Peg Dublin, of Chicago health-care provider Access Community Health Network and a participant in the planning meetings. "Things like fighting racism, ensuring equal access to housing and health care, working to get maternity and paternity leave for all families."

In Illinois in 2004, 5.9 white women died as a result of childbirth for every 100,000 live births compared to 14.8 African American women.

The state's overall infant mortality rate of 7.2 for 1,000 live births in 2005 is slightly above the national average of 6.7, but it matches 2002 for the lowest rate in the state's history and reflects a steady declining trend since 1980. In Chicago, the 2005 rate was 8.9 deaths per 1,000 live births.

Illinois' infant mortality rate has stayed between 7.2 and 7.6 deaths per 1,000 live births since 2001, about half what it was in 1980. However, African American babies are 2.7 times as likely to die before reaching their first birthday. Similarly, black women are 2.4 times more likely than white women to die as a result of childbirth in Illinois.

More than half of the state's deaths due to SIDS--sudden infant death syndrome--in 2004 involved African Americans, who represented only 18 percent of live births that year.

Disproportionate Death Rates

If African American infants in Illinois had the same rate of survival as whites, 297 fewer would have died in 2005, says Robyn Gabel, executive director of the Chicago-based Illinois Maternal and Child Health Coalition, who pulled together the committee of activists, health-care professionals, and state and local health department officials.

The coalition is a nonprofit advocacy network linking more than 90 statewide organizations, both private and public.

The steering committee is spending the next few months developing pilot programs based on a 10-point plan generated by two major meetings convened by the Illinois Maternal and Child Health Coalition in October 2007 and this past March.

Tentatively titled the "Campaign to Save Our Babies," the first wave of these programs is scheduled to launch in the fall, assuming the coalition can raise the needed funds.

Developing New Models

In its search for effective approaches, the committee is considering European-style clinical-policy reforms.

One example: Improve prenatal care in underserved communities by first having an obstetrician-gynecologist meet with a group of patients--instead of privately--about nutrition and birth planning. This could free doctors to spend more one-on-one time with mothers-to-be.

Ways to improve access to sex education and family planning and to streamline medical case management are also being studied. Programs will also focus on a broader social agenda, such as fighting discriminatory practices in housing and public education.

The Maternal and Child Health Coalition's Gabel says the push for programs that go beyond clinical settings is key.

"One thing researchers have found is if a mother is stressed during pregnancy, then the baby is born with certain predispositions to stress," Gabel says. "And that can lead to other health problems. So one thing we want to do is to help moms get rid of depression and stress, as those truly affect the fetus in ways people did not previously realize."

Shifting Emphasis

Michael Lu, associate professor of obstetrics and gynecology at the University of California, Los Angeles, and an expert in child health, agrees.

"In explaining the black-white gap in infant mortality, for decades we searched for maternal risk factors during pregnancy rather than looking at the mothers' cumulative life course experiences," Lu told a meeting of clinicians, politicians and women that Gabel's group organized last October. "The danger of focusing solely on risk factors during pregnancy is not only that it doesn't adequately explain the disparities, but more importantly, it can misguide public health interventions and policies."

Lu also co-wrote a paper for last fall's commission on infant mortality from the Joint Center for Political and Economic Studies Health Policy Institute.

In May 2006, Gabel completed a fellowship studying infant mortality and maternity services in France and England looking mainly at how those countries addressed health disparities among different communities. "I realized in the process that they had a much better system for how they deal with women and families in the first place."

European countries with low infant mortality rates tend to offer extensive paid leave for parents before and after childbirth, government allowances for parents to pay for child-care necessities, and subsidized or free child care. The plan incorporates all these ideas along with the goals of organizing activists to push for government action on these fronts.

"A big part of reducing mortality is going to be improving overall health," Gabel says. "Some of the feedback we heard from women in our focus groups is that it's hard to get health care in their communities. There are long waits, receptionists or doctors are mean to them, there's a lack of transportation to get to appointments, the cleanliness of clinics is poor. Those are all things we want to work on."

Jeff Fleischer is a Chicago-based journalist. He has written regularly for publications such as Mother Jones, the Sydney Morning Herald, Mental Floss and Chicago magazine. He is a 2008 Alicia Patterson Foundation fellow in Oceania.

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