EDITOR'S NOTE: This article is part of an ongoing series on infant mortality in Richland County and has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems.
BOSTON, Mass. – One day while driving to the movies, Kimberly Phinnessee was pulled over for speeding by an Ontario police officer.
It was a routine traffic stop as she was en route to Cinemark 14 Mansfield Town Center. The officer issued her a ticket and both went about their day.
But given a recent rash of police brutality incidents against black men and women reported in the mainstream media, Phinnessee experienced the traffic stop with a running undercurrent of fear.
“My 15-year-old son was in the passenger seat, and I told him keep your hands still, don’t make any moves … things you don’t ordinarily think about,” Phinnessee said. “I have a valid driver’s license, I have insurance, but it’s the fact that if I make a certain move, is the police officer going to think I’m a threat to him? If my son picks up his phone, is the police going to feel he’s a threat?”
Phinnessee recalled the panic she felt and the rise of her blood pressure.
“Thinking about it now, had I been pregnant I can imagine my stress would’ve gone through the roof,” she said. “I have to teach my children to take extra precaution, and that’s stressful.”
As a community health worker for Third Street Family Health Services in Mansfield, Phinnessee often works with clients who feel they have also experienced racial profiling.
“Or they feel like every time they go somewhere, they feel like they’re being watched,” she said. “It’s a common thread in the community, unfortunately.”
The clients Phinnessee works with are dealing with stressors in their lives just by virtue of needing the help of community health workers and the Community HUB Pathways model. Community health workers address needs including housing, food, clothing and employment that are sources of stress and may lead to a poor pregnancy outcome.
All pregnant women experience stress. However, a burgeoning amount of research shows both the subtle and blunt effect of racism on pregnant women of color lead to a constant undercurrent of stress -- and therefore less successful pregnancy outcomes for black babies.
In 2016, the infant mortality rate of black babies in Richland County was 2.6 deaths per 1,000 births, while the infant mortality rate of white babies was 7.79. The U.S. Census estimated that in 2015, 87.4 percent of the population in Richland County was white, while 9.6 percent of the population was black.
Zoom out further, and the disparity between the white infant mortality rate and black infant mortality is stark. According to the Ohio Department of Health, the infant mortality rate for all babies in state of Ohio in 2015 was 7.2.
Accounting only for white babies, Ohio’s infant mortality rate was 5.5. For only black babies, it was 15.1 – nearly three times as high. It’s a trend that continues nationally.
“There is no fair and legitimate reason other than the social disparities that we know and recognize that our black infants in this country are dying at twice the rate of our white infants," said Richland Public Health Commissioner Martin Tremmel in a meeting of the county’s infant mortality task force in February. "That should be troubling to us.”
More and more research is pointing to the chronic stress of living day-by-day with discrimination as a possible reason for so many deaths of babies of color.
“Recent data suggests that chronic stress associated with being a minority, particularly being African American, for some biological reason, increases the risk of delivering a premature, low birth weight infant,” said Dr. James Collins, a neonatologist at Children’s Memorial Hospital in Chicago, in the PBS series “Unnatural Causes.”
Stress hormones are part of pregnancy under normal conditions. When those hormones reach a certain level, they may help trigger labor. But what might happen if you went into pregnancy already overloaded with stress hormones?
In September 2015, research by Dr. Collins cited in the Ohio Commission on Minority Health (OCMH) white paper stated that a black woman with a professional degree is more likely to experience a poor birth outcome than a white woman without a high school diploma.
That fact was repeated by Deborah Allen, executive director of the Boston Public Health Commission in Massachusetts – a state with the lowest infant mortality rate in the country. In 2016, the Centers for Disease Control and Prevention (CDC) reported Massachusetts had an infant mortality rate of 4.3 deaths per 1,000 live births. In comparison, that same year Ohio had a 7.1 infant mortality rate.
“Race outweighs cigarettes as a cause of preterm birth,” Allen said. “That’s really astounding.”
While the Massachusetts infant mortality rate has historically been low, disparities between white and black infant deaths still persisted. In 2015, the infant mortality rate for black babies in Massachusetts was 7.1; for white babies, it was 3.8.
This is a marked improvement than in years past. In 2014, the Boston Public Health Commission released a report, “Closing the Gap,” showing that from 2000 to 2012, the black infant mortality rate in Boston had gone from 13.6 in 2000 to 6.5 in 2012.
“The white infant mortality rate has barely changed, but that’s because it was so low to start with,” Allen said. “But the black rate has plummeted, and we were left wondering if this is meaningful or was this a fluke.”
Long story short: the numbers were meaningful. The resource-rich state of Massachusetts has long had in place programs involving home visiting, women’s groups and access to healthcare and health insurance.
However, in order to truly have an impact on infant mortality rates, it requires a more “upstream” approach to actual policies. According to Dr. Maya Rockeymoore, founder of Allies in Reaching Community Health Equity (ARCHE), upstream is where racism becomes most problematic.
“If racism permeates policy, and if policy follows by actually denying resources to communities of color because policymakers don’t believe resources should be directed to those people, then what you have is a structural racism that is designed to undermine the health of populations that are discriminated against,” Rockeymoore said.
In the city of Boston, where politicians are mostly progressive, the city’s “safety net” programs are robust. Elsewhere in the country, the subtle effect of racism often works against those who need the safety net programs most.
“The safety net programs people identify with black people invariably serve more white people,” Allen said. “When you assault food stamps or even the much-hated Aid to Families with Dependent Children, you’re mostly assaulting white people, but white people who have bought into a lie that those programs are for black people. Do you really think that only lazy black people need these things?”
Progressive policymaking is particularly noticeable when comparing Massachusetts, the state with the lowest infant mortality rates, and Mississippi, the state with the highest infant mortality rates. Mississippi had an 8.9 infant mortality rate overall in 2015; the white infant mortality rate was 6.9, while the black infant mortality rate was a staggering 12.1.
According to Rockeymoore, studies show poor outcomes are much more frequent for people of color in states where segregation existed. For Dr. Charlene Collier, an OBGYN consultant for the Mississippi State Department of Health, that fact rings true in the Magnolia state.
“It wasn’t that long ago that medical care was segregated,” Collier said. “We’ve evolved as a society and that’s great, but it hasn’t been that long since those things were deeply a part of our country, where substandard care was OK across a lot of populations.
"These things still have an effect on health in ways we don’t totally understand.”
Allen described racism as a constant hum in the background, an undercurrent to most other stressors a pregnant woman may face in her life. But by making an effort to understand the black experience in America, she believes healthcare is moving in the right direction.
“Until you’ve really made an effort to talk to a black person about their experience – the sense of being constantly marginalized, constantly thought of as either deserving your fate as a poor person or not deserving your status as an affluent person – that every time you see a cop behind you it’s a potential life-threatening experience, that’s really a tough way to live,” she said.