LaToya Gamble watches as Dr. Jerald Purifoy examines Chris'tiana Gamble at the North Oakland Medical Center neonatal intensive care unit. Chris'tiana, who was born three months early, will take her oxygen tube with her when she goes home.Infants At Risk
Suburbs' black babies die at higher rates
The disparity is especially glaring in Oakland County, where death is four times more likely.
Chris'tiana Gamble was born three months early. Her mom, LaToya Gamble of Pontiac, hopes to be able to take her home by New Year's. But doctors say Chris'tiana could have cerebral palsy.
Christopher, 6, wipes away his mom's tears. David and Shellie Peters of Livonia lost Katie five days after she was born. "You can do everything right and the worst can still happen," her dad says.
Sha'Ron Simpson of Pontiac received a hat and booties for her son, Jajuan Daymar Isaiah Senter, who died 17 days after birth. He was born three months early and weighed about a pound.
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Long before he was even born, Jajuan Daymar Isaiah Senter had less of a chance to live until his first birthday than a white baby next door or a black infant in Detroit.
That's because his mother, Sha'Ron Simpson, is African-American and lives in Pontiac. And although Oakland County is one of the nation's wealthiest, it's also a place where being black means it's at least four times more likely your baby won't survive its first year than if you are white.
It is among the most vexing inequities of what many agree is among Michigan's biggest and arguably least-understood child welfare problem -- that babies here die in unusually large numbers, particularly if they are black. In only two other states do black children have worse odds of survival.
Long after those problems have been identified, officials admit too little has been done to fix them, leaving too many families grieving throughout the state.
"It is an atrocity and should not be tolerated," said Dr. Eugene Rogers, a 30-year obstetrician and gynecologist who serves a large number of black patients at practices in Clarkston, Pontiac and Mount Clemens. "It is the worst thing I've seen in the entire time I've been practicing. And people seem to be pushing the issue aside like it will take care of itself. It won't take care of itself."
For every 1,000 black children born in suburban Wayne, Oakland and Macomb counties, 19 will not survive their first year of life, according to a Detroit News analysis of health records from 1998 to 2002, the most recent available. Among white children, just five will die for every 1,000 births. Among black children in Detroit, 17 will not see their first birthday.
The disparities are most glaring in Oakland County, where the mortality rate among black babies is among the worst in the country.
Between 1998 and 2002, the rate was 22 deaths for every 1,000 black babies born to mothers living in the county -- about one of every 46 kids. The rates in suburban Macomb and Wayne counties are roughly equal to Detroit's. The rates are approximations because the number of deaths fluctuates slightly each year.
Jajuan weighed a little more than a pound when he was born July 31, three months early. Doctors whisked the baby away to an incubator in the neonatal section of North Oakland Medical Center in Pontiac. Simpson could not touch him. She could only watch, day after day, his tiny body hooked up to life-support machines in a plastic box, struggling to live.
"I told him I loved him and I was praying for him to live," Simpson said. When a doctor finally placed her son in her hands, 17 days later, he was already dead.
Insured through her mother, Simpson sought prenatal care early and didn't smoke, drink or take drugs during her pregnancy.
But in her fifth month, she was rushed to the emergency room. Her baby was pushing down on her cervix, but since it was too soon to give birth, Simpson was ordered to stay in bed in the hospital. Restless, and believing she would be better off at home, she checked herself out two weeks later.
A week after that, back in the emergency room, she gave birth to Jajuan.
On the 17th day, a doctor gently lifted Jajuan out of the incubator and placed him in his mother's arms. Amid a stream of tears, she said goodbye.
Perpetual issues
For years, babies of all races born in Michigan have been more likely to die before their 1st birthday than those born in most other states. In 2002, eight infants died for every 1,000 Michigan births, a rate worse than in all but nine states and Washington, D.C.
Within those numbers is a pair of issues that have perplexed health officials and speak to just how much work remains.
One is that black babies born in wealthy Oakland County, which has seen a significant increase in its black population over the past decade, die more often than black babies born in Detroit. Only a few large counties nationwide, including Genesee County, have black infant mortality rates as high as Oakland's.
Health officials speculate that the contrast may be caused in part by the stresses of being black in a largely white area, by smaller concentrations of poverty that make problems harder to identify and by a lack of resources focused on the problems faced by the growing minority population.
"You are more likely to be invisible in the community," said Bonnie Daligga of Healthy Families/Healthy Start Oakland, a private nonprofit organization working with mothers facing high-risk pregnancies. "It's harder to be poor in a rich county."
The typical black family in Oakland County, however, isn't poor. Black families had a median income of about $51,000, compared to less than $30,000 in Detroit.
Policymakers admittedly have focused more on reducing infant mortality rates in Detroit, where a quarter of Metro Detroit's African-Americans live. Health officials met last week during a summit on infant mortality that barely mentioned the disparity faced by suburban blacks.
Metro Detroit fits a national pattern of suburban mortality rates for black infants matching or exceeding those in cities such as Chicago, Los Angeles and Philadelphia, an analysis of federal health records shows.
A second continually perplexing issue is that black children still die far more often than whites throughout the state and nation, a fact that has baffled researchers for decades.
Michigan made progress reducing the death rates for all infants through the mid-1990s, but there has been little progress since. The disparity between black and white infant death rates is wider now than it was in the 1970s.
Hispanic and Asian infants also die at rates far lower than black infants.
Underlying the high death rates for black babies is the reality that throughout Metro Detroit, black mothers are more often single, less educated and get less prenatal care than whites, a Detroit News analysis of birth and death records from the U.S. Centers for Disease Control and Prevention shows. All of those factors are linked to higher mortality rates.
Yet black women in Metro Detroit who got adequate care are still far more likely than whites to lose their children.
Researchers and health officials insist many infant deaths could be prevented. And they are beginning to do more: Next year, Michigan plans to set aside $1 million to study infant mortality; the University of Michigan is beginning a $1.7 million study to trace the roots of the gap. But most efforts to erase the gap in mortality rates between blacks and whites have been hobbled by the reality that there's no widespread agreement on what causes it.
Raising awareness
Ultimately, experts say solving both problems hinges on a better understanding of what causes the infant mortality rates among blacks to be so high in the first place.
The March of Dimes launched a national $75 million prematurity awareness campaign in 2003 aimed at women at risk of having a premature baby. The campaign includes television, radio and print materials detailing the signs and symptoms of pre-term labor and the effects it can have on an infant.
To ensure a broader understanding of the dangers of putting infants to sleep with soft bedding, Tomorrow's Child/Michigan SIDS (Sudden Infant Death Syndrome) has distributed millions of brochures in English, Spanish and Arabic on how to safely put infants to sleep in a crib. The hope is to get the information into the hands of everyone who cares for infants, from grandparents to babysitters to the mother herself.
Health departments also began pairing at-risk pregnant women with public health nurses this year to counsel and refer them to medical care and other services to increase the chances of having healthy babies. But they acknowledge those efforts have not brought black mortality rates closer to those of other races.
That's largely because officials don't know what causes the disparities. "When we looked at African-American women who were wealthy, married and well-educated and compared them to white women who were wealthy, married and well-educated, the black women still have a higher rate of pre-term deliveries," said Eve Lackritz, chief of the maternal and infant health branch division of reproductive health at the U.S. Centers for Disease Control and Prevention.
In 2002, 527 infants of all races died in Wayne, Oakland and Macomb counties. Typically, they die either because they are born too small, too soon or from SIDS.
But what goes wrong to cause those conditions is often far from clear. Part of the difficulty is that the explanations usually lie in a jumble of social and medical factors, none of which by themselves can explain why someone died -- or how that death could have been prevented.
Mothers in Pontiac and Southfield, for instance, often face very different circumstances. In Pontiac, a quarter of the population is poor, while black families in Southfield have incomes better than the regional average for all families. But black infants die at high rates in both cities.
"In Pontiac, we have a definite problem with women not getting prenatal care, not paying attention to good nutrition, smoking, substance abuse and lower education," said George Miller, director of the Oakland County Health Division. "But we also have a problem identifying the women at risk. We're working with grass roots organizations, including church groups, to help us find more people" to get them services.
Black women in Southfield face different risk factors.
"We find they are far more educated, financially secure, and they do have access to prenatal care," Miller said.
"But there are new stressors. They may be the sole source of income, they're worrying about their careers, mortgage payments, child care, and they may be smoking more to deal with the stress, which can cause an early delivery."
In suburban Wayne, Oakland and Macomb counties, only about 75 percent of black mothers between 1998-2001 got prenatal care in the first three months of pregnancy, compared to 89 percent of white mothers, birth records show. And nearly 7 percent of blacks don't get adequate care -- because they start too late or don't go often enough -- compared to about 2 percent of white mothers. In Detroit, even fewer black mothers get enough prenatal care.
Records do not indicate whether that's because services don't exist or mothers aren't taking advantage of them.
"In communities where African-Americans feel disenfranchised, they are much less likely to take advantage of services," said Betty Yancey, nurse consultant for the Michigan Nurse Family Partnership, the state's most recent effort to help address disparities and infant health outcomes. "They are less likely to feel comfortable going to certain places.
"The message isn't getting through to them," said Yancey, an African-American woman who lives in Pontiac and has worked on the infant mortality problem for years. "Too many times, it feels like the services are not for them."
Absent a better understanding of why black children die more often, experts say it's proved virtually impossible to devise an effective way to reverse the trend.
"While there has been tremendous effort and a lot of money spent to address the problem, almost nothing has been accomplished with all that investment," said Scott Ransom, a University of Michigan researcher involved in a national study examining racial disparities in infant mortality.
Finding a solution
State and local health officials say they need more help tracking down the women who are most at risk of losing their babies and evaluating which programs will help them.
On top of that, officials who deal directly with pregnant women don't always know which doctors accept Medicaid, the government health program for the poor, said Douglas Paterson, director of the Bureau of Family, Maternal and Child Health at the state Department of Community Health.
The department does not have anyone on staff exclusively dedicated to infant mortality, choosing instead to address the problem through a more broad-based approach of programs such as Women, Infants and Children, which provides health and nutrition for low-income families, and family planning.
"We just haven't been focusing on this," said Michele Strasz, director of community outreach for the Michigan Council for Maternal and Child Health. "We had a lot of efforts into infant mortality into the early '90s but since then (the state) just hasn't focused on it."
By comparison, four staff members work full time fighting lead poisoning, which is widespread and can cause serious health problems but seldom is lethal; another works full time on promoting abstinence.
This also contrasts with the resources the state invested in trying to combat infant mortality between 1986 and 1996, according to Paul Shaheen, executive director of the Michigan Council for Maternal and Child Health, a statewide advocacy group. During those years, there was an expansion of a number of programs, more outreach and easier access to Medicaid for high-risk populations. But when the state moved from a traditional medical plan for Medicaid to an HMO, many of the services were not transferred. And in 1996, the state cut Medicaid dramatically and women had less access to services, Shaheen said. Death rates for all babies -- black or white -- have scarcely changed since.
"We're going backwards," he said. "We're not prioritizing primary care. Instead, we're spending thousands on low birthweight babies in intensive care units. It's penny-wise and pound-foolish."
In 2002, the state eliminated $3.5 million in state and federal funding for county health agencies to provide services to high-risk, low-income women. About $1.6 million was redirected to targeting high-risk pregnancies in Detroit, Pontiac, Flint and Benton Harbor.
Paterson acknowledged the state could do more by addressing the problem more directly to better identify and deliver services to families, as opposed to relying on programs that might indirectly address the problem. But he added: "Infant mortality is the health outcome of a much larger social issue. It's not just a health problem. It's a problem of economics and disparity and access to information and resources. It's in some ways a reflection of how well we're all working together."
Child advocates say that, as a result, mortality rates for all children -- white and black -- remain unacceptably high.
Katie Peters was born March 2. "She was pronounced a healthy, beautiful baby girl at the hospital," said her mother, Shellie Peters, who is white. For nine months, Peters, of Livonia, had done all her doctors told her: She went regularly for prenatal care, took special vitamins and didn't drink or take drugs -- she didn't even take aspirin.
But five days after she was born, Katie started to have trouble breathing and her parents took her to the emergency room. She died, they learned later, of a rare virus in the mother's uterus that led to a heart attack. "You can do everything right and the worst can still happen," said her father, David Peters.
Hopes for change
Chris'tiana Gamble was born three months early, so small and fragile doctors said she had a 25 percent chance of survival. She spent more than a month in an incubator, surrounded by plastic, hooked to a coil of tubes that gave her food and water and air.
"When I finally saw her, I was thinking, she's so little. This is my child. She was in an incubator and I didn't pick her up until 56 days later. I was heartbroken," said Chris'tiana's mother, LaToya Gamble, who lives in Pontiac.
State officials say they are beginning to learn more about where and why black infants face such steep risks so early in their lives. They hope it will help them better allocate their resources -- including the $1 million in tobacco tax money set aside for next year -- to better target areas where the risks are especially disproportionate.
Part of the reason those disparities persisted so long is the state lacked such a focused approach, state Surgeon General Kimberlydawn Wisdom said. "If you use a much more focused approach as opposed to an overall approach, you can anticipate closing the gap."
Advocates say that's a good first step.
"Not addressing the problem is not an option," said Sharon Peters, president and CEO of Michigan's Children, an advocacy group. "We pay too great a price as a society if we allow disparities to continue."
A month ago, doctors summoned Gamble back to the hospital. They told her Chris'tiana was near death.
"They told me she might not make it. That threw a toll on me," Gamble said. "She would get better, then worse."
Chris'tiana is getting better. Gamble hopes to have her home in time for New Year's. That doesn't mean she'll be out of the woods -- even then, Chris'tiana will need an oxygen tube to help her breathe and electronic monitors to watch her condition. Doctors have warned Gamble there's a risk her daughter might have cerebral palsy.
But Gamble is confident. Any step forward is a good one.
You can reach Kim Kozlowski at (313) 222-2024 or kkozlowski@detnews.com.
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