Racism, poverty among factors that contribute to Michigan's dreadful infant mortality rate

As Detroit and the rest of Michigan  continue to struggle with troubling infant mortality rates, a new report urges leaders to tackle systemic issues like racism and poverty while extending postpartum Medicaid coverage.

The report — released  late last week by the Michigan League for Public Policy — also recommends expanding home visiting programs and restoring tax credits for low to moderate income earners to improve the health of mothers and their babies.

"I don't think we can look at rates of mortality or morbidity and say that we're doing any of this in an excellent way," Amber Bellazaire, the report's author, said in an interview. "This is, in part, a call to action."

Michigan ranks 36th in the country in infant mortality, according to the report, "Strong Moms for Thriving Babies: Right Start 2020." Detroit had the state's highest infant mortality rate in 2018, at more than 16 deaths per 1,000 births, according to the state's most recent statistics. The city’s preterm birth rate also is at a 13-year high.

The problems persist locally despite Detroit Mayor Mike Duggan's focus on reducing infant mortality and preterm birth since taking office in 2014. The city's signature program to combat the issues, Make Your Date, was the subject of a critical Detroit Office of Inspector General report last year that found Duggan's selection of the program involved preferential treatment.

On Friday, Detroit's top health official said she supports the report's recommendations.

The city's two major prenatal care outreach efforts are a transportation service for pregnant women to make their doctor visits and the SisterFriends program, which pairs pregnant women with volunteer mentors.

"The recommendations for extended Medicaid coverage, more home visits, and better reimbursement for physicians would all make major contributions in this area," Chief Public Health Officer Denise Fair said in a statement to the Free Press.

Read more: As Mayor Mike Duggan touts Make Your Date's success, Detroit's preterm birth rate spikes

Read more: Duggan administration admonished for preferential treatment of Make Your Date program

The study urges leaders to fund the recommendations and take a broad view of the environment in which Michigan mothers are living.

Gov. Gretchen Whitmer's 2021 budget recommendations include a Healthy Moms, Healthy Babies initiative, but more action and investment is needed, according to the report.

"We want the overall message to be that there are opportunities for improvement," Bellazaire said. "We don't want women or policymakers to feel that there's nothing that can be done about these dire statistics."

Racism, educational attainment and access to nutritious food all factor into infant mortality, according to the report, which cites research that found black women are no more likely to experience certain childbirth complications, yet they are two to three times more likely to die when those complications arise when compared to white women.

Bellazaire admitted that addressing entrenched racial bias is not an easy task. But she said it is important for medical professionals and others to question themselves.

"I am certainly not suggesting that any health care provider is consciously ignoring risk factors or warning signs for any patient that they are working with," she said. "It is best to treat a whole person and interrogate the environment a person is existing in, and not just treating symptoms when they come up."

The report makes six specific recommendations:

• Fortify the Affordable Care Act and Michigan's rates of health insurance coverage.
• Extend Medicaid coverage from 60 days to 12 months postpartum.
• Enhance health plan reimbursements rates for services that benefit maternal and infant health, such as doula services and lactation support.
• Expand home visiting programs offering health screenings and connections to parenting services.
• Advocate for paid parental leave policies to promote families' economic security and bonding time between parents and their child.
• Restore Michigan's Earned Income Tax Credit, which benefits low to moderate income workers. The study cites research that shows states with generous EITCs see reductions in preterm birth.

Fair agreed with the report's emphasis on EITC. "The City of Detroit has led the way in that effort, increasing refunds to Detroiters by more than $74 million a year," she said.

Health care professionals said they support the report's recommendations — especially the extension of Medicaid coverage. The Michigan Department of Health and Human Services, the state legislature or both would be involved in implementing such a change, Bellazaire said.

Dr. Stanley M. Berry,  a Wayne State University Department of Obstetrics & Gynecology professor, said extending Medicaid coverage is money well spent.

"It's pay me now or pay me later," he said. "We either take care and prevent those diseases or we pay for the aftermath of it."

Dr. Courtney Townsel, a University of Michigan maternal fetal medicine specialist, said women with chronic medical conditions such as hypertension and diabetes require care after the existing 60-day period.

"When coverage stops at 60 days, their condition can worsen if they don't have the continuous care and observation or access to medication," she said.

Townsel also advocated for home visiting services. Lack of transportation can make it hard for some women to make their appointments after giving birth.

"If we can meet them where they are and ensure they have the information that they need then hopefully we can make a change," she said. "This is a step in the right direction and I think this can only shine a light on the issues and improve these outcomes and disparities."

Joe Guillen, a member of the Free Press Investigations Team, has been covering city governance and development issues for the newspaper since 2013. He previously worked at The (Cleveland) Plain Dealer covering county and state government. Contact him at 313-222-6678 or jguillen@freepress.com.