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Black Infants in the East Bay Are Experiencing Higher Negative Health Outcomes

Here's why — and what's being done about it.

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Her son was in the NICU for two and a half weeks. Though he was breathing fine, he had trouble eating because he hadn't yet developed his sucking reflex, Foreman said.

According to Dr. Amanda Williams Calhoun, physician maternity director at Kaiser Oakland, the most common problems for preterm babies during their first month of life are with breathing and digestion.

In early childhood, "the risks are around chronic lung disease, asthma, some learning difficulty, cerebral palsy" and vision problems, Calhoun said. In general, most of these problems resolve as children grow into adults.

Today, Foreman and her two pre-term sons, now ages 6 and 19 months, are healthy. "This kid is off the charts," Foreman said of her second son. "With weight, with height — he's been pretty amazing, actually."

In the Bay Area, two groups are trying to understand why these disparate health outcomes exist, to help mothers understand the resources available to them and teach them how to advocate for themselves. A third is working to address the social determinants that affect mothers' health.

The Preterm Birth Initiative, a UC San Francisco program that brings together researchers from disciplines across the university, has been holding focus groups in San Francisco, Oakland, and Fresno. With these groups, the researchers were "really trying to get at, what are women's experiences of their care," said Oakland nurse Monica McLemore, a principal investigator for the initiative. They wanted to know what questions mothers had when they were pregnant "that were never answered or that they really wanted to be able to ask," she said.

During her work with the Preterm Birth Initiative, McLemore heard from African-American women about interactions with health care providers who were disrespectful, neglectful, or didn't believe their patients — things, she said, "that we probably would not accept in any other domain of health services provision."

Because the paper about these focus groups is under peer review, McLemore didn't feel comfortable discussing specific examples of the issues mentioned above, but said that, generally, the neglect and disrespect manifested themselves in situations such as mothers "having birth plans and having them be ignored," hospital staff "policing who could and could not be with laboring people," and a "disregard for symptoms — when people say epidurals aren't working or something just doesn't feel right."

McLemore thinks that part of this problem stems from a lack of coordinated care by health care providers — part of what Malin called the "fragmentation of care." McLemore said that, "to ask pregnant people to navigate those discordant systems is also really problematic."

Add to these negative experiences an automatic assumption by some providers that their African- American patients are high-risk, "when they may or may not be," said McLemore, "because there are still clinicians who actually believe that it is the Black race that is exclusively associated with these poor outcomes," said McLemore. "Race only overexposes you to racism, but there is nothing inherent about black skin that makes pregnancy any more dangerous than it is for any other pregnant person." This assumption sometimes means that Black pregnant women undergo unwanted procedures or tests, McLemore said.

In an effort to provide respectful care, McLemore listens to her patients and doesn't assume authority over them, she said. "First of all, I start from a place of not believing I know everything, despite the fact that I have tons of degrees and I've been a nurse in women's health for 26 years, mostly all focused on reproductive health. I walk into my clinical care environment trying to determine what are my patients supposed to teach me that day," she said.

Like many health experts, she strives for "cultural competency" — not only literally speaking the patients' language but creating space for the patients themselves in making decisions about their care. "It is about an intentional effort to understand where women are coming from when they come in the door of your health care system or your clinic," said Bryant, who endorses similar goals.

Another group, called Black Women Birthing Justice, is working to educate women about their options when pregnant and giving birth. Based in Oakland, the collective of academic researchers, midwives, doulas, breastfeeding educators, and students put out a report in October called "Battling Over Birth," which included suggestions for improvements in the health care system and birth stories collected from Black mothers around California.

From 2011 to 2015, members of the group and a team of co-researchers collected narratives and questionnaires from 100 Black women who gave birth in 11 California cities and towns. The women included in the small study were 17 to 46 years old. Each woman — cited only by first name — shared her experiences with giving birth either at a hospital or at home assisted by a midwife or doula.

The researchers found that, for the women they surveyed, the health care system itself was a source of stress. A woman named Zanthia, who birthed four of her eight children before she turned 20 and used the health care system in Oakland for two decades, told the researchers that she had many negative experiences within the system, but that prenatal care was the worst. At her prenatal visits, she felt routinely disrespected and, as a result, stopped going. "They would talk about me," she said. She recalled nurses pushing birth control on her — "not even the kind I'm scheduled for" — and that she had doctors tell her, "Just go ahead and get an abortion."


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