Why is the Black infant mortality rate in Wisconsin still three times higher than the white rate?
Wisconsin has made no significant progress in improving mortality rates among Black and Native American infants, according to new data released by the state Department of Health Services that examines the root causes of the disparities.
Nothing will improve, Wisconsin's leading public maternal health official said, until fundamental changes happen in how race and health intersect.
From 2019 to 2021, Black infants in Wisconsin were three times more likely to die before their first birthday, and American Indian or Alaska Native infants were 1.5 times more likely to die before their first birthday, compared to white infants, according to a March 2023 DHS report.
Deeper analyses of deaths of Black and Native American babies released Thursday pinpoint two key drivers of those disparities: low birthweights and sudden unexpected infant death, which is when a baby dies before their first birthday and the cause is not clear before investigation.
Authors of the reports conclude these are the two areas upon which the state has to focus its efforts if it wants to truly improve Wisconsin's racial gaps in infant mortality rates, which consistently rank among the widest in the nation.
"I will say these inequities have been very persistent over time," said Jasmine Zapata, DHS chief medical officer for maternal health, and a pediatrician. "We're not seeing any significant moves in the right direction."
Racism, societal inequities drive health disparities
The state's overall infant mortality rate from 2019-2021 was 5.7 deaths for every 1,000 live births.
But for several racial groups, the death rate was significantly higher: 5.9 for non-Hispanic multi-racial babies, 6.7 for American Indian or Alaska Native babies, 7.7 for non-Hispanic Hmong and Laotian babies, 8.6 for non-Hispanic babies of other racial identities.
By far, Black babies in the state faced the worst outcomes, with a mortality rate of 13.2 deaths for every 1,000 live births.
Any infant death is one death too many, Zapata said, and the impact of the losses affect entire families. But the cause of infant deaths cannot be placed on any individual, she said.
Solutions must come at a societal level, and can include helping mothers and babies access quality health care, addressing food insecurity and training medical professionals about racism and implicit bias, she said.
Research shows systemic racism alone can influence birth outcomes for mothers and babies. Even when income is accounted for, infants remain at risk. An expansive study out of California, for example, found that babies born to the richest Black mothers are twice as likely to die before turning 1-year-old than those born to the richest white mothers.
"A lot of times, when we talk about these issues, it can be very sensitive, because people place the blame on the individual mother or birthing person," Zapata said. "But it is very important to recognize that we have oppressive systems that we must change."
Such solutions may seem broad, but Zapata explained how they can be baked into attempts to address the specific issues of low birthweights and sudden unexpected infant deaths.
For example, low birth weight is most commonly tied to premature birth and intrauterine growth restriction, which is when the fetus doesn't grow well during pregnancy. These conditions can be caused by substance use during pregnancy, or not getting the proper nutrients. Even excess stress can cause high blood pressure or preeclampsia further increasing the risk of low birth weight. Thus, efforts to make sure people have access to health care, healthy food, and can manage stress, including from racism and societal inequity, can improve the health of mother and child.
Many sudden unexpected infant deaths can be linked to co-sleeping, which can put babies at higher risk. But the decision to co-sleep can be rooted in cultural practices and traditions, even instinct. So when it comes to teaching parents about safe sleeping practices, updated guidelines that educate people about those risks in a culturally-aware way can be key.
"I've been working on this topic for many, many, many years, and it's one of the first times I've seen real, raw conversations that include groups that might not want to do what has been traditionally recommended," Zapata said of new guidelines on safe sleeping from the American Academy of Pediatrics. Those guidelines still oppose co-sleeping in all circumstances, but acknowledge doctors may have to talk through cultural preferences.
The state health department is following those newer guidelines, she said.
Political battle over postpartum Medicaid coverage could be shifting
Neither sudden unexpected infant death nor low birth weight are new to health care providers, Zapata acknowledged, but the report's findings will help the health department focus its overall strategy to address infant deaths.
But Wisconsin has long struggled to move the needle on racially disparate birth outcomes. A 2020 study published in the Journal of Perinatology, of which Zapata was an author, found that Wisconsin had the worst Black infant mortality rate in the U.S. among 36 states and the District of Columbia. In Oct. 2022, DHS said the three-fold discrepancy in infant mortality rates for Black babies compared to white babies has been largely unchanged for decades.
Zapata said preliminary data from the pandemic years indicates the problem has only gotten worse.
Among the steps already taken by the state are the allocation of federal funding into programs that try to change the state's trajectory through things like doula training and breastfeeding support. DHS also established a Maternal and Infant Mortality Prevention Unit to work with community groups that are working on solutions.
More: Milwaukee's free doula program hopes to empower women, lessen race-based health challenges
Asked by the Journal Sentinel for an example of something that other states have done to significantly combat infant deaths, Zapata pointed to a policy change that has historically faced opposition by Republicans who control the legislature but is now gaining more traction: extending postpartum eligibility for Medicaid coverage.
So far in the budget process, Gov. Tony Evers' proposal to make this expansion has been retained by Republican legislative leaders. The final budget bill is still under consideration and could be tweaked. But a group of Republicans have signaled their support for the idea in a separate, standalone bill that proposes the same idea and had a public hearing earlier this year.
The extension would lengthen Medicaid postpartum care coverage up to 12 months. That would have a tremendous impact, given that Medicaid covers four in 10 births nationally, according to the Kaiser Family Foundation. Wisconsin is one of 13 states that has not adopted the expansion, a tracker run by the foundation shows.
More: Black moms, their babies face higher health risk in Wisconsin, but Legislature won’t address it
"Ensuring access for all mothers and birthing people in Wisconsin, not just (in) the short period of time during pregnancy, but being able to have them have access to high quality care for that first year after the baby's born, is extremely important," Zapata said.
Journal Sentinel reporter Sarah Volpenhein contributed to this story.
Contact Devi Shastri at 414-224-2193 or DAShastri@jrn.com. Follow her on Twitter at @DeviShastri.
This article originally appeared on Milwaukee Journal Sentinel: Wisconsin continues to have wide racial gap in infant mortality rates
