In Long Beach and across the nation, Black infants are less likely to make it to their first birthday than white infants. As this generations-long disparity continues, private practitioners and public programs are trying to change the way Black mothers are treated during pregnancy, in the delivery room and beyond.
“This is a topic that we should focus on and that we should educate the community and the larger populations about but we also need to talk about the solutions,” said Stevie Merino, co-founder & executive director of the Long Beach-based Birthworkers of Color Collective.
According to data from the Long Beach Department of Health and Human Services, Black infants accounted for over 24% of all cases of infant mortality from 2011 to 2021, despite the Black population in Long Beach accounting for 14.5% of the City’s population.
In comparison, 33.1% of the City’s population is white, but white infants accounted for less than 10% of infant mortality cases during the same time period.
“Definitely there are disparities and concerns,” said Evelyn González-Figueroa, community health manager of the City’s Black Infant Health Program. “The issue of African American families and mothers being disproportionately impacted are concerns of the nation, not unique to the city of Long Beach.”
In 2018 the nationwide mortality rate of Black infants was more than double that of white infants, according to data from the U.S. Department of Health and Human Services.
In response to these disparities, the City created its Black Infant Health Program in 1989 which provides valuable supportive services for new and expectant mothers, including group support sessions, transportation assistance, healthy meals, case management, educational workshops for parents and more.
Stereotyping can have deadly consequences
But the disparities continue, with Black infants still dying at a higher rate than any other race.
As a local midwife, Angelica Miller assists expectant mothers throughout their pregnancy, educating them and advocating for them and their babies from prenatal to postnatal care.
Miller said that in her experience, doctors believing Black women are “dramatic” or “uneducated” leads them to not listen to the concerns of mothers, which can have life-altering consequences.
In one instance, a Black pregnant client of hers was showing all the signs of preeclampsia —headache, swelling and high blood pressure—and went to the hospital. Preeclampsia is a pregnancy complication characterized by high blood pressure in people who had previously had normal blood pressure before pregnancy, protein levels in urine that may indicate kidney damage (proteinuria) and other signs of damage to the kidney or other organs. The possible risks vary from preterm birth, fetal growth restriction, brain injury, stroke and, in some cases, death.
The doctor refused to believe she had preeclampsia despite her pleading, according to Miller. She eventually was diagnosed with preeclampsia but it was too late—she lost her baby.
“Even if someone doesn't realize that they have an ingrained or inherent bias I think that highly contributes to it,” Miller said. “With the inherent bias, people, Black parents, aren't getting listened to and they're not being heard and then it leads to bad outcomes.”
Shari Kelly, interim executive director for perinatal and neonatal services at Miller Children and Women's Hospital, agrees that a change needs to be made.
The hospital participates in the Cherished Futures for Black Moms & Babies program, which aims to reduce Black infant and maternal mortality in Los Angeles County. Cherished Futures points to "structural racism as the root cause of unequal birth-related complications," according to its website.
"The biggest part is really listening and believing and acting on [Black women] as the subject matter experts of their own bodies," Kelly said.
Both Miller and Merino mentioned that higher educational or socioeconomic achievement doesn’t shield Black parents in hospitals and delivery rooms. A 2021 study published in the National Library of Medicine found that college-educated Black women face similar health disadvantages as white women with a high school degree or less.
"That's something that's really important that people need to know because [...] I do always think it's put back to, 'If this Black person just had a higher education or if they just did a little bit more, if they did better, their outcomes would be better.' And that's really not the case," Miller said.
The role of birthworkers in positive birth outcomes
In response to the dangers they face in hospitals, some Black families are turning to Black doulas to support, inform, and advocate for them through the process of having a child.
A 2013 study published in the Journal of Perinatal Education found that mothers who were assisted by doulas were four times less likely to give birth to an underweight baby and two times less likely to suffer birth complications.
A 2016 study by the University of Minnesota School of Public Health found that mothers with doulas were 22% less likely to have a preterm baby.
The Long Beach-based Birthworkers of Color Collective, cofounded by Merino, connects clients to doulas whose practices and backgrounds resonate with them culturally. To make doula care available to individuals of different economic standing, the collective charges clients on a sliding scale based on income.
Merino also acknowledged the work of the LA County Department of Public Health's African American Infant and Maternal Mortality (AAIMM) Initiative, which states "doulas are part of the solution" on its website. AAIMM recruits Black doulas to provide free services to expectant mothers across LA County. The doulas who work with the AAIMM program provide three prenatal visits, labor support, three postpartum visits and lactation support, all free of charge.
"This is a systematic thing that really needs to change, but there is at least some increase in positive birth experiences by having an advocate or having support, " Merino said.
