In Baltimore, the infant mortality rate for black babies is an alarming 27 deaths per 1,000 live births – three times the rate for white babies in the city. Nationwide, the disparity in infant mortality rates between African Americans and whites is two to one. Although our nation’s overall infant mortality rate has declined in recent years, the pronounced racial disparity in rates persists.
“We must address this racial disparity head-on,” says Chad Abresch, executive director of CityMatCH, the national membership organization of urban maternal and child health programs. “Some have called inequities in birth outcomes intractable,” says Abresch, “but we believe real change is possible, not someday but right now.”
Abresch’s optimism infuses the latest CityMatCH initiative, the Institute for Equity in Birth Outcomes (Equity Institute), launched this year with funding from the W.K. Kellogg Foundation.
The Equity Institute brings together local public health departments and community partners to implement evidence-based strategies that directly address racial inequities in birth outcomes. The institute provides local teams with extensive training on racism and disparities in birth outcomes in the U.S.; evidence-based interventions; and evaluation.
Although many maternal and child health programs are in place in cities across the country, very few have risen to the level of evidence-based practices, and few of those have been proven to actually reduce inequities. By bringing a rigorous, scientific focus to addressing racial disparities in birth outcomes, Abresch believes the Equity Institute can achieve measureable results in a short amount of time.
The initial teams are from Baltimore, Md.; Dayton, Ohio; San Francisco, Calif.; and West Palm Beach, Fla. In addition, with funding of their own, 11 public health departments in Ohio have partnered with CityMatCH to form an additional Equity Institute.
Abresch recognizes that closing the racial gap in birth outcomes ultimately requires social equality. “We won’t have lasting health equity until we have broad social equality,” he says. While CityMatCH supports upstream solutions and encourages Equity Institute teams to pursue them, the institute’s main thrust and evaluation are focused on downstream, evidence-based practices for decreasing inequities in birth outcomes quickly. “We need to make progress on the gap right now,” Abresch says, “and we can.”
In Baltimore, for example, the Equity Institute team and an array of local partners are collaborating to strengthen outreach, services and support for women who have experienced a previous fetal or infant loss and are at the highest risk for a future infant death or a poor birth outcome. The Dayton, Ohio, team is expanding prenatal care to include progesterone therapy that has been proven to prevent preterm births for high-risk women.
The promise of these and other targeted, evidence-based approaches – and the certainty of measurable results – has generated tremendous interest nationwide as the Equity Institute selects its second group of teams.
To illustrate the momentum behind the Equity Institute, the promise it holds and the high hopes it has raised in the maternal and child health field, Abresch shares a story about a conversation he had with the dean of a prominent school of public health. “What is your moon?” the dean asked Abresch, wanting to know his big goal. “We want to be part of a broad effort that completely eliminates the gap in infant mortality rates in a major city in the next ten years,” Abresch answered. The dean burst into laughter. “Your moon is too high,” he said. And then he added, “But I want to be part of it.”
