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A potentially pathbreaking local effort to unknot the whys of black infant mortality: editorial

August 5, 2018

A potentially pathbreaking local effort to unknot the whys of black infant mortality: editorial

A lot underlies persistently high infant mortality rates in parts of Cleveland and Cuyahoga County. Poor maternal health, lack of health access, inadequate education about safe sleep practices and insufficient breastfeeding support lead the list of usual suspects.

The good news is that preliminary work to tackle this problem by First Year Cleveland -- an unprecedented local public-private coalition of elected officials, hospitals, religious institutions, medical providers, educators and health researchers -- is making inroads. Cuyahoga County’s infant mortality rate fell last year to 8.11 deaths per 1,000 live births, still too high. 

But inside that reduction was an enormously troubling racial disparity.

White infant mortality in Cuyahoga County fell 45 percent over 2016, to 2.54 per last year -- lower than the national average rate for white baby deaths. Black infant mortality in the county climbed, to 15.6 per 1,000 live births.

African-American babies are dying six times more often than white babies in Cuyahoga County. That’s unacceptable. And in Cleveland, the rate of deaths for black babies was even higher -- 18.7.

But layered on top of the high rate of black baby deaths was an even more alarming finding: African-American moms who are middle class and upper middle class, who have resources, education, access to good health care, also lose their babies at higher rates than white mothers. Their babies are being born prematurely, or with low birthweight, or both, at a higher rate than white babies from all income backgrounds. And researchers have few clues to why.

This is not just a Cleveland-area phenomenon, either. Nationwide, the persistently higher infant mortality rate among those of color has defied explanation. The Plain Dealer’s Brie Zeltner has reported that, nationally, efforts to reduce infant mortality also have stalled among blacks while continuing to succeed among whites.

Genetics can be ruled out, according to a number of local researchers affiliated with First Year Cleveland.

So what’s causing the disparity?

Preliminary (limited) testing of local pregnant moms for the stress hormone cortisol points to higher stress levels among black moms in their third trimester than among white moms at the same point in their pregnancies. If First Year Cleveland can raise more money to support such studies, those tests will be, and should be, expanded.

But what’s causing this apparent racial disparity in the first place? It’s a critical question, since the unexplained differences mean efforts to change the trajectory of baby deaths here won’t work until local researchers can untangle the underlying causes of this racial divide.

That’s where First Year Cleveland is planning to take its work to a whole new level that could have national implications -- by tackling head-on one of the most loaded questions not just in health care but in almost all walks of life in this country. They plan to take a methodical look at whether “implicit bias” against black mothers in the health care process -- how they’re treated at every stage of their access to and attempts to access pregnancy and early infant care -- is part of the answer.

They are not starting with an assumption that that is the answer. First Year Cleveland, which is co-led by Dr. Akram Boutros of the MetroHealth System and Patti DePompei of University Hospitals, continues its broad inquiry and efforts across a range of initiatives already known to make a difference. Those include creating new support systems for pregnant moms, widening the message on safe sleep, continuing to improve access to health care and other efforts.

But it’s critical that First Year Cleveland pursue its implicit bias inquiry with as much research rigor as possible, creating within the tricky context of experiential inquiry as many approaches to test against potential research bias as possible, in order to assure that the findings are credible and, ideally, that they can be broadly replicated in other contexts.

Fortunately, the people leading this inquiry are scientists, trained medical professionals and researchers at the city’s great medical institutions.

What they are planning to do has potential national significance. Let’s give them our support.

About our editorials: Editorials express the view of the editorial board of cleveland.com and The Plain Dealer -- the senior leadership and editorial-writing staff. As is traditional, editorials are unsigned and intended to be seen as the voice of the news organization.   

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