It Takes a "Village" to Reduce African-American Infant Mortality
Leaders at the community, family and individual levels must pool their talents and resources to help reduce infant mortality among African Americans.
ANN ARBOR, Mich.—Despite federal, state and local efforts to improve the quality and access to prenatal care among African Americans, race-based disparities in infant mortality—driven by poverty, poor access to medical care, environmental hazards, stress and racism—persist in the United States.
A group of researchers from the University of Michigan and the Washtenaw County Health Department suggests that leaders at the community, family and individual levels must mount a concerted effort to address the high mortality rate among African-American infants and to develop and implement creative solutions.
"It takes a 'village' to alleviate the infant-mortality gap between whites and African Americans," said Lynn Perry Wooten, clinical assistant professor of strategy and of management and organizations at Michiganís Ross School of Business. "Public-policy makers, health-care executives and community leaders must adopt a new approach that increases synergies between traditional disciplines and goes beyond simplistic solutions to this complex problem. Their strategy should involve multiple stakeholders and incorporate a diversity of intervention programs aimed at preventing pre-term deliveries and reducing infant deaths."
Currently, non-Hispanic African Americans are more than twice as likely as other racial or ethnic groups to experience early fetal mortality, and African American babies have double the chance of dying within the first year of life. Although federal expansion of Medicaid prenatal coverage in the 1980s and early 1990s was intended to improve access to medical care and birth outcomes for uninsured women, it brought only limited success,
Congressional passage of the Balanced Budget Amendment in 1997 reduced expenditures for Medicaid and Food Stamps, in effect decreasing health care access for low-income citizens. African Americans living in urban areas were particularly affected. In Detroit alone, four hospitals closed within three years of the amendmentís introduction.
To stem this looming crisis, Wooten and her U-M colleagues suggest that leaders must not only utilize traditional prenatal-care systems but also explore interventions that encompass the interpersonal, economic, psychological and socio-cultural attributes of African Americans who are experiencing health-care disparities. This approach, they say, may require a non-traditional view of leadership and the coordination of leaders from different types of organizations.
The Friendly Access Infant Mortality Initiative in Flint, Mich., for example, represents collective leadership, where individuals from various backgrounds work in tandem and organizations pool their talents and resources. The initiative is a partnership of leaders from health care, business, government, social-service agencies and community and faith-based organizations who have joined with community members to find effective ways to close the infant-mortality chasm.
The Centering Pregnancy Program developed by Sharon Schindler Rising, a certified nurse midwife, illustrates the use of kinship leadership. Kinship networks are webs of immediate and extended family, friends, neighbors and church members that historically have been used by African Americans for the exchange of support, goods, services and knowledge, as well as substitutes for or complements to traditional health care channels. The Centering Pregnancy Program recreates a kinship network by bringing expectant mothers together in groups of eight to 12 and building a sense of community. Research indicates this approach leads to increased support, decreased feelings of isolation and higher birth weights, especially for infants delivered pre-term.
Patient-empowerment leadership is a means by which health care providers act as advocates and partners to help women develop a stronger sense of self-consciousness and obtain the resources they need for optimal health care experiences. The Washtenaw County Health Department empowers patients in its prenatal-care program by providing individual attention and mentoring through the health systems. It also strives to remove barriers related to insurance eligibility and transportation to medical appointments.
"Many of these recommended leadership initiatives are cost effective and draw upon a range of resources to reduce the infant-mortality gap," Wooten said. "If the investment is not made, however, there is a potential for this health-disparity crisis to continue to escalate, having a profound impact not only on African Americans but on the greater society."
In addition to Wooten, U-M faculty who contributed to this study include Cameron Shultz (School of Public Health), Briggett Ford (School of Social Work), Lise Anderson (Department of Obstetrics and Gynecology) and Scott Ransom (Obstetrics, Gynecology and Health Management and Policy). Adreanne Waller of the Washtenaw County Health Department's Division of Maternal Child Health also worked on the research project. Their paper, titled "Leadership and Prenatal Health Disparities: It Takes a Village," was published last fall in African American Research Perspectives.
The study is part of a new three-year research initiative at the U-M focusing on health disparities and was supported by a $1.7 million grant from the National Institute of Health. It builds on Wootenís previous research that looks at positive organizing routines in health care organizations.
Written by Claudia Capos
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