Fresno County vowed a year ago to make black babies’ lives matter.
Research showed black infants here were three times more likely to die in their first year than white and Hispanic infants.
And black mothers in a Fresno State study offered reasons why so many babies die before they can crawl or walk: The mothers had little or no social support and little or no information before their pregnancy about the risks of infant death. They had negative experiences at clinics and high levels of stress. They lacked access to culturally appropriate health-care services.
And race was an issue.
Obstacles to a healthy pregnancy remain for black women in Fresno County, but in the past year the community has united to reduce the infant mortality. Funding has increased for a longtime Black Infant Health program while new programs are taking shape. And for the first time, black women and men are being asked to help guide the effort.
“Based on what people said they wanted and needed to address infant mortality, that’s happening,” said John Capitman, executive director of the Central Valley Health Policy Institute at California State University, Fresno. “There’s evidence that the systems are listening and really jumping on doing what they can.”
And despite the racially charged climate in the country, Capitman said so far there has been a consensus around reducing black infant mortality.
“It’s much easier for us to come together around the need to solve that problem than it is for people to come around to issues of criminal justice or environmental justice,” he said.
Fresno County one-time leader
At one time, Fresno County was a leader in Black Infant Health.
The county was one of the first places in the country to have a program for black mothers.
In 2007, the county program had a budget of $1.3 million and a staff of 11. Fresno County’s black infant death rate was 10 per 1,000 births.
But by 2013, the program’s budget had fallen to $234,208 and there was a staff of three. The black infant death rate had climbed to 25 per 1,000 births.
Alarmed by the increased death rate, health advocates statewide pushed for a restoration of funding for Black Infant Health, and this year the county’s program got $790,065 from the state, doubling the $388,345 it got in 2014-15.
The county now has funding for a coordinator, a community outreach liaison, a part-time nurse and social worker, and three full-time family health advocates who facilitate group meetings that provide support for black women to have healthy pregnancies and deliveries.
“I can’t even speak, I’m so happy that we have been able to hire,” said Erica Alexander, the public health nurse for the county’s Black Infant Health program.
The funding will allow the county to serve more women and to augment services to them, Alexander said. This past year, ending June 30, it had enrolled 68 women. The goal is to serve 96.
The women get support for reaching goals, whether it’s for schooling, careers or just having a healthy pregnancy. Meeting as a group, they also have a place where they can talk about the risk of being African Americans in the United States, Alexander said. “It’s a powerful group.”
Zorporia Battle, 22, just completed the program. The meetings helped reduce stress during her pregnancy, she said. She delivered her daughter, Zoe Williams, at full term four months ago.
Her obstetrician suggested the program, but Battle said at first she was reluctant to enroll. She’s shy and worried about talking in a group. “But when I got there, it was just a really cool, comfortable environment,” she said. “We all clicked instantly.”
Members of the group were there for her during a time of grief – her father died in her eighth month of pregnancy. “The group helped me a lot with the social support I needed to keep going,” she said.
Parents involved in creating programs
First 5 Fresno County, which commissioned the Central Valley Health Policy Institute at Fresno State to study black infant deaths, has taken the lead in the effort to develop new programs.
The agency, which has a budget of $10.6 million for programs to improve the lives of babies and young children, has dedicated $300,000 to reducing black infant mortality.
The most ambitious goal: Establish a Centering Pregnancy Care program for black women. The program is similar to the county’s Black Infant Health program – pregnant women meet as a group – but Centering Pregnancy adds a health provider to the mix.
A health provider assigned to lead discussions with the group is critical, said Lilith Assadourian, program and evaluation director for First 5. “What came out from the study, loud and clear … African American women had a disconnect with their health care providers.”
Capitman said Centering Pregnancy is a better approach to prenatal care. “We’re just very excited that it is moving forward.”
The Centering Pregnancy program would be based at the Lighthouse for Children in downtown Fresno, which is operated by First 5. The program could be up and running this year, Assadourian said, but First 5 needs state certification for an examination room so that women in the group can have individual checkups by the health provider. The women will be seen one-on-one by medical providers before or after the group meets.
UCSF Fresno has shown interest in providing doctors for the program, she said.
First 5 needs partners to reduce black infant deaths. “This issue is so deep and so large in scale, Fresno County cannot do it alone,” Assadourian said. “We had to identify key partners that really make sense and have resources to bring along with our resources.”
Besides UCSF Fresno, the UC San Francisco Preterm Birth Initiative has offered to help. The initiative is a $100 million, 10-year effort to improve birth outcomes in Fresno County, San Francisco, Oakland and three sub-Saharan African countries. The March of Dimes also is supportive, and the county’s public health department is a partner.
But key to the efforts being spearheaded by First 5 is involvement by black mothers and fathers, Assadourian said.
The First 5 Fresno County Commission wants to establish a Parents Council composed of mothers and fathers who have had preterm births and whose babies have died. The council would guide the community in developing programs and services to address parents’ needs, Assadourian said.
“It’s creating a direct access for parents to be involved and be part of the decision-making process that will directly impact their lives and the care they receive themselves.”
The council also would be a supportive place for parents who have lost babies, Assadourian said. “It would be a space and place for voicing their experiences.”
The First 5 Commission also is working to develop a blue-ribbon panel that would focus on culturally appropriate health care for black women and families.
From the Fresno State study, it was clear that black women receive disrespectful care, and not just from doctors and nurse practitioners, but while making appointments and waiting to be seen, Capitman said.
A multigenerational group of black women, from teenagers to grandmothers, would be enlisted to recommend who should serve on the blue-ribbon panel, Assadourian said. The panel will be charged with developing a culturally competent health care plan for the community.
Capitman is encouraged by the First 5 decision to have parents take a lead in setting goals and developing programs so black babies can see many birthdays. “It’s central to the success of all these efforts.”
By the numbers
Fresno County infant deaths in 2013
▪ Hispanic: 82; 8.7 per 1,000 live births
▪ White: 25; 8.2 per 1,000 live births
▪ Black: 21; 25 per 1,000 live births
▪ Asian: 14; 7.9 per 1,000 live births
Fresno County Department of Public Health