Addressing women's chronic stress to improve 'Black Infant Health'

W.K. Kellogg FoundationWhat does talking about money have to do with reducing infant mortality rates? More than you might think.

Financial empowerment is the focus of a WKKF-funded program designed to supplement and enhance the core model of the California Black Infant Health Program (BIH). But to better understand how financial empowerment relates to the societal factors that impact the health of  African American mothers and children, you have to understand BIH and its new approach to improving birth outcomes.

Addressing the social determinants of health

In 1989, the California Department of Public Health launched BIH to address the alarming two-to-one disparity in infant mortality rates between African Americans and their white counterparts. BIH has developed in parallel with Healthy Start, the widely adopted federal program begun in 1991 to address infant mortality and related problems, including low birthweight and preterm births. Today, BIH spans 15 local health jurisdictions across California where more than 75 percent of African American births in the state occur.

BIH began with a focus on prenatal care. Yet an assessment of the program conducted in 2006 by the Center on Social Disparities in Health (CSDH) at the University of California, San Francisco found that although great work was happening across the state, the program’s one-on-one case-management model and its emphasis on prenatal care did not go far enough.

BIH leadership retained CSDH to work with them to develop a new model that supports prenatal care while more fully addressing the social factors impacting African American mothers, especially chronic stress due to economic hardship; isolation and lack of social support; and the need for self-actualization and empowerment.

Group sessions build resilience and social support

BIH still works with clients one-on-one to connect them with social and health services, but its new model centers on weekly group sessions – 10 prenatal and 10 postpartum. Although supported by current science, this group-based focus is an innovative approach for programs like BIH, according to Sue Egerter, co-director of CSDH.

And so far, it looks like it’s working. Beyond providing information and education, the group model offers women a positive experience they engage in co-creating. “One of the challenges facing African Americans,” says Jenée Johnson, program director for San Francisco BIH, “has been the dismantling of our community.” As a result, young women find themselves culturally bereft and socially isolated. The group sessions address African American heritage, relationship building, stress reduction, goal setting, nutrition and exercise – life skills that empower women to make healthy choices for themselves, their child and their family.

“We’re helping women build character,” says Johnson. “They’re developing a vision for themselves, setting goals and breaking them down into smaller, achievable activities. We’re doing things that in another place and time happened at the kitchen table.”

Financial empowerment enhances the core model

Kitchen table conversations bring us back to the financial empowerment program that has been piloted at three BIH sites. The program consists of four group sessions that deepen conversations about financial values; the connections between wealth, money and health; financial goal-setting; and saving and managing money.

During the pilot in San Francisco she facilitated, Johnson saw the benefit of having participants with very different backgrounds, from a college graduate to someone coming out of recovery. Johnson even hired one of her BIH clients with culinary experience to cater the evening sessions. The participants bonded over good food and gained a role model. Most of the women who participated in the pilot sessions loved the program. Many told Johnson they didn’t want it to end. Participants in Contra Costa County were so diligent with their assignments that all noticed when one woman failed to turn in her homework. Her excuse: She was at the hospital having her baby!

A benchmark for maternal and child health programs nationwide

As it goes forward, BIH is looking at maternal and child health across a woman’s life course. Its group-centered model, its attention to the complex social determinants of health and its financial empowerment program position BIH as a benchmark for maternal and child health programs nationwide.

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“Empleen el dinero del modo en que crean conveniente, siempre y cuando promueva la salud, la felicidad y el bienestar de los niños.” - Will Keith Kellogg

“Sèvi ak lajan an jan w vle depi se sante timoun, byennèt timoun ak kè kontan pou timoun w ap ankouraje.” - W.K. Kelòg