Too many babies are dying in Fresno County, and an increase in the black infant mortality rate is so alarming that community leaders plan to release a report on infant deaths Friday at a Children's Summit in Clovis.
Infant mortality is an indicator of the health of a community, and from Fresno County's rates, "it's glaringly obvious something is not right," said Linda Gleason of The Children's Movement, an organizer of the summit.
Several factors could be behind the increase, but health advocates cite budget cuts to Fresno County's Black Infant Health program over the past five years as one.
Infant death rates have declined statewide, but not in Fresno County.
Between 2007 and 2011, the county's infant mortality rate increased from 6.5 deaths per 1,000 births to 7.8 deaths per 1,000. Statewide, the rate decreased from 5.2 in 2007 to 4.7 in 2010, the latest statistics show.
The increase in overall infant mortality rate is disturbing, Gleason said, but it's not what is most startling. "The African-American rate is horrific," she said.
Black infant mortality in the county has increased from 14.3 per 1,000 live births in 2007 to 27.3 in 2011. Statewide, the rate decreased from 11.5 in 2007 to 9.5 per 1,000 in 2010. Fresno County's rate is among the highest in the state.
Infant mortality rates for black infants traditionally have been higher than for other ethnic groups, and local health experts say research points to many factors, including racism, as a reason for the disparity. But they also note that cuts to the Black Infant Health program parallel the nearly two-fold increase in Fresno County's rate.
Deep service cuts
In 2007, the county had a $1.3 million Black Infant Health program with 11 employees. The program provided monthly visits to black pregnant women by public health nurses who monitored conditions and offered support as well as education about pregnancy and parenting.
In 2010, the budget had been cut to a little more than $250,000 and two employees. The cuts have meant fewer home visits to pregnant black women.
John Capitman, executive director of the Central Valley Health Policy Institute at Fresno State, remembers the county's program in 2005, when it was at full staff. It was an "award-winning, large program," he said.
The county started the Black Infant Health program in 1992 to reach pregnant black women. By 2001, it had decreased the black infant mortality rate 69%, from a staggering 37.1% to 11.4%.
"Public health programs really do make a difference," Capitman said. "If we want to address this problem, we have to increase support."
Yolanda Randles, executive director of the West Fresno Family Resource Center, said her organization provides prenatal education classes with March of Dimes support, but the classes haven't made up for cuts to the county program. "There's just a lot of health education that needs to take place in our community," she said.
County health officials say the increase in black infant deaths raises concerns and they're evaluating the numbers, but they stopped short of blaming cuts in the Black Infant Health program.
"I wish I had a true answer," said David Luchini, assistant director of the Fresno County Department of Public Health. "But there's more work we've got to do to dig deeper into these numbers."
Access to doctors doesn't appear to be an issue. County officials say the women get in early for prenatal care, but for unknown reasons many fail to keep follow-up appointments.
Randles said there could be a cultural explanation. In the black community, pregnancy is not seen as a condition needing medical attention, she said.
Capitman said factors, such as the economy, could have affected the black infant mortality rate. The Valley has been among the hardest-hit regions in the state by the economic downturn.
"African-Americans are among the groups most hurt by the economic decline," he said. "And birth outcomes are very sensitive to income differences."
But research also shows that blacks experience more infant deaths than other groups because of stress and anxiety caused by racism, Capitman said. Daily experiences of being treated badly elevates stress levels "and really do produce these outcomes," he said.
Cassandra Joubert, director of the Central California Children's Institute at Fresno State, said infant mortality is "one of the most sensitive indicators of inequality in a region," she said. "I think that's true in this area, but we don't want to have a conversation about racial inequalities and barriers."
Fresno County addresses stresses from poverty to racism in its Black Infant Health program, which brings black pregnant women together weekly in groups called Sista' Talk. The program was revised in 2010 to emphasize social support and empowerment, said coordinator Erica Alexander.
"We talk about how to address certain things and we talk about expressing their experiences," Alexander said. The goal is to help the women see their ancestry as a source of pride and a source of strength, she said.
While the number of black infant deaths will be small — blacks make up only about 6% of Fresno County's population — the rate at which black babies die is more than three times higher than the overall infant mortality rate.
Rose Mary Garrone, manager of public health nursing for the county, said the shift in the Black Infant Health program to peer support groups has allowed the county to do more with less staff. "Where we did more outreach and education, we're now doing more direct service," she said.
More groups could be added and more outreach to get women into the groups could be done, but it would take adding staff, Alexander said.
Luchini, however, questions if restoring the Black Infant Health program to its former staffing level would be the solution. "I think it's going to take a big partnership working together," he said.
That's where the Children's Summit could come into play.
Gleason said the 400 people at the summit will be briefed on three children's issues: infant mortality, children's reading ability by third grade, and high school students' college and career readiness at graduation.
The group will decide which of the three areas to focus on in the coming year, she said.
Capitman said all three issues are important. "My stance is kids need loving, supportive environments all the way through and they need the services and supports and attention of the community."
But black infant mortality would be hard to ignore, he said. "What kind of community do we want … do we value a place where all families have the opportunities to birth healthy children or where some groups and individuals just don't have access to the environments and supports needed for health."
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