This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.
Dr. Kimberlydawn Wisdom, founder of the Women-Inspired Neighborhood (WIN) Network: Detroit
, recalls working with a Detroit mom who was pleasantly surprised that her fourth child was so big compared to her previous three.
"She said, 'All of my other three children were born very small,'" Wisdom says. "They were premature. She had normalized prematurity."
Thirty-one years of Michigan Department of Health and Human Services
(MDHHS) data show Black infant mortality rates that are consistently two and sometimes even three times higher than in white communities. Black infants accounted for 44% of the 636 infant deaths in Michigan in 2021
, despite only making up about 18% of total births.
WIN, a program launched at Henry Ford Health
to improve Black infant health outcomes in Detroit, is one of several initiatives working to reverse this trend in the Detroit area. From group prenatal care and efforts to rethink the birth process, to targeted home visits and breastfeeding programs, these initiatives are focused more on dignity than medical interventions — with surprising results.
Factors at play in Black infant mortality
"We as a society have got it all wrong about health inequities," says Dr. Arline Geronimus, a professor of health behavior and health education at the University of Michigan. "We either chalk them up to individual behaviors, or we question people's moral character. … We each have this human biological canvas, and if it's treated in certain ways, it will have the same results. The difference is, in our society, we treat people differently."
Systemic patterns of oppression stemming from racism
can exacerbate existing health conditions, or cause them to develop in healthy individuals — and their unborn children. This racial bias even extends into health care systems
, which can deter women from seeking prenatal care.
"Historic disenfranchisement in many communities across the state has led to a lack of affordable housing, unsafe neighborhoods, inadequate transportation, limited economic opportunities, and unhealthy food options," says Chelsea Wuth, MDHHS associate public information officer, via email.
These factors contribute to "weathering," a theory advanced by Geronimus and other researchers examining the connections between racism and health. When the body's fight-or-flight response is activated on a regular basis — in this case, as a result of systemic racism — it takes a physical toll.
"Your heart is racing chronically. You're always vigilant, so your brain is not at rest," Geronimus explains. "That chronic heart racing will eventually harden your arteries. It will eventually give you hypertension. You will have mobilized stores of fat and sugar in your bloodstream, which over time can lead to diabetes and obesity."
Not only does weathering impact pregnancy, but that chronic stress response also diverts nutrients from growing fetuses. As a result, weathering can lead to low birth weight (LBW), growth retardation in utero, and preterm birth, which Geronimus describes as "the big-ticket predictors for infant mortality."
The WIN Network
"The fix is not some rocket-science, way out-there solution," Wisdom explains. "We help these women feel valued, like they belong, that they can have hope and they can be successful in their pregnancy."
WIN does this by utilizing a system of 10 two-hour group prenatal visits based on the CenteringPregnancy
model. A certified nurse midwife provides participants with one-on-one care before facilitating a group discussion. WIN tweaked the model slightly by inviting a community health worker (CHW) to co-facilitate. Nutrition, stress management, labor and delivery, breastfeeding, and infant care are just a few of the topics covered.
Studies have shown that CenteringPregnancy correlates with longer gestation and higher birth weight
and lower risk of preterm birth
, particularly for Medicaid-eligible women
. The Michigan Council for Maternal and Child Health
(MCMCH) Healthy Moms Healthy Babies initiative recommends a $10 million investment in Michigan's fiscal year 2024 budget to support new and existing CenteringPregnancy infrastructure.
"We have found phenomenal outcomes," says Wisdom. "We've had over 600 women through the program and zero preventable infant deaths."
Dr. Kimberlydawn Wisdom, founder of the Women-Inspired Neighborhood Network: Detroit.
Wisdom attributes this success not just to medical intervention, but to genuinely caring about the women who participate in the program.
"Many of the women that we work with don't have a mother, a sister, an auntie, that looks after them," Wisdom says.
WIN connects those women with a CHW who offers knowledge and support, directing participants to resources like stable housing, breastfeeding programs, and higher education. In many cases, Wisdom says, the CHWs become lifelong friends of the women they work with.
"That person can become anything from their surrogate auntie, their surrogate grandma, [to] their surrogate best friend," Wisdom says. "They have someone that believes in them. That goes a long
Doulas, breastfeeding, and home visits
WIN is a demonstration of the power of compassionate care, and doulas can have a similar impact. A doula's role is to provide caring, nurturing support to a mother during pregnancy, labor, and the postpartum period. This could involve gentle touch, reassurance and encouragement, suggesting labor techniques, explaining medical procedures, and advocating for the mother while she negotiates the vulnerable work of childbirth. A 2013 study found that doula assistance correlated with better birth outcomes
, including fewer LBW babies and fewer complications during labor.
As of this year, Michigan Medicaid began reimbursing for doula services. A federal requirement states that in order to utilize a doula, Medicaid recipients must provide a doctor's note. To remove barriers to access, the state's chief medical executive, Dr. Natasha Bagdasarian, issued a standing recommendation that satisfies the requirement. Finally, the state's fiscal year 2023 budget allocates funding to build a statewide doula infrastructure.
However, healthy pregnancies and births are just the beginning. Breastfeeding and home visit programs also empower mothers to raise healthy babies.
Black mothers may face barriers to breastfeeding
, and as a result, their children may lose out on the health benefits of their mother's milk. Programs like Black Mothers' Breastfeeding Association
and Detroit's St. John Hospital Mother Nurture Project
provide knowledge, address disparities, and advocate for Black mothers' rights. Meanwhile, home visit programs
supplement traditional maternal knowledge networks, meeting parents where they are to connect them with resources while ensuring safe home environments and parenting practices.
"Home visitors are trusted partners that work with families throughout pregnancy and infancy to promote healthy pregnancies, positive birth outcomes, and healthy infant growth and development," Wuth says. "Home visitors provide resources, referral, and care coordination to assist families with access to healthy food options, adequate transportation, safe and affordable housing, and other social drivers of health."
There's no doubt that modern medical care saves lives. But for vulnerable women, the medicalization of pregnancy
may unwittingly alienate them — from health care systems, but also from the natural process of pregnancy.
"The health services are tertiary prevention. It's that last, technological hail Mary pass," Geronimus says. "But wouldn't it be better to do primary prevention, to have the mothers not have had those weathering experiences that lead their babies to then require the lifesaving services of very expensive, high-tech treatments?"
There's still work to be done to address racial inequities in the health care system
. To that end, the MCMCH Birth Equity Education Project
has released a series of policy guidance documents calling for, among others, the diversification of the health care workforce and embedded lactation support in health care settings. Meanwhile, the Michigan League for Public Policy's call for more robust paid parental leave policies in its Right Start 2020
document remains unanswered.
A poster outside Dr. Kimberlydawn Wisdom's office.
Nevertheless, Wisdom anticipates good things for Detroit's infant mortality rates moving forward. WIN is in the process of expanding, both within Henry Ford Health and outward, to Corewell Health West in the Grand Rapids area and even to Cleveland.
"We've demonstrated that you can impact the infant mortality rate pretty significantly," she says. "So if we're able to spread in scale, which we're in the process of doing, … we hope to see a very significant and sustained decline in our infant mortality rates."
Brooke Marshall is a freelance writer and the author of Lucky: An African Student, an American Dream, and a Long Bike Ride. You can contact her at firstname.lastname@example.org.
Photos by Nick Hagen.