Fort Worth

Community outreach as critical as healthcare to reduce infant mortality

Hundreds carried red and white umbrellas up Main Street in downtown Fort Worth in a march against infant mortality on Aug. 12, 2009.
Hundreds carried red and white umbrellas up Main Street in downtown Fort Worth in a march against infant mortality on Aug. 12, 2009. Star-Telegram archives

On the first Saturday of every month in Oakland, Calif., people gather at the Castlemont Community Market to browse while children attend a swimming clinic and play in a school gymnasium.

A passer-by would never guess the event is helping a baby live longer than a year.

In hotspots of high infant mortality around the country, events like this target the complex social and environmental factors that stack the odds against some babies. The goal is to help women get healthy before they get pregnant.

“In order to have healthy babies you have to have healthy moms, and in order to have healthy moms you have to have healthy communities,” said Erica Jordan, a family dynamics researcher at the University of West Florida and a leader of her community’s effort to reduce infant deaths.

Tarrant County has long struggled with infant deaths — the county had highest rate among the state’s largest counties in 2013. African-Americans are the hardest-hit, with an infant death rate two to three times higher than white babies.

Infant deaths also are more common among the poor, those without health insurance and mothers younger than 20 and older than 40, according to research. Prematurity was a factor in 40 percent of infant deaths in Tarrant County in 2013, according to the county health department.

For years, community health leaders in Tarrant tried to tackle the problem by improving prenatal care, but they have concluded that alone won’t solve the problem.

Now, with the help of a five-year, $3.5 million federal Healthy Start grant awarded to the University of North Texas Health Science Center, they’re trying to tackle the social, lifestyle and chronic health issues tied to infant death.

Programs in California and Florida show how a community-oriented, wraparound approach could reduce infant deaths in Tarrant County.

The Magnolia Project in and around Jacksonville, Fla., and the Alameda County Public Health Department’s programs specifically target African-Americans.

They have community markets, health fairs, classes on healthy living, baby showers. They walk door-to-door to publicize events and services. And they coordinate so programs don’t duplicate efforts.

Staff with the Magnolia Project are out in the community almost every day, said Faye Johnson, interim executive director of the Northeast Florida Healthy Start Coalition. They have health fairs around the city two to three times a year and regularly visit public housing projects.

The health department for Alameda County, Calif., uses quarterly baby showers to recruit women with risk factors connected to infant mortality, said Anna Gruver, coordinator for maternal, paternal, child and adolescent health.

Expectant mothers socialize, play educational games and learn about perinatal health and stressors that affect pregnancy. They eat a healthy meal together and participate in raffles for items such as car seats.

Last year, about 130 women attended. The county aims to enroll about 100 in its home visitation programs.

The community market is part of a program called Best Babies Zone, which focuses on a ZIP code in Oakland that has a high rate of infant death. .

Such outreach is vital because healthy lifestyles are as important as healthcare in preventing infant death, said Brent Ewig, director of public policy and government affairs for the Association of Maternal & Child Health Programs.

In Tarrant County, the March of Dimes’ Honey Child program offered faith-based prenatal education and mentoring to pregnant, African-American women. Each year, the program had a baby shower to promote prenatal education, serving 40 to 60 women statewide.

Honey Child was discontinued last year because it didn’t reach enough women to show it was effective in reducing infant deaths, said Carmen Branch, communications director for March of Dimes in Dallas-Fort Worth.

Frequent public events

In Jacksonville, women have responded particularly well to weekly classes on subjects ranging from nutrition to personal finance, Johnson said. Participants earn points for meeting goals such as attending the classes or prenatal appointments. They can exchange points for household products.

About 700 women participate each year, said Erin Addington, a spokeswoman for the Northeast Florida Healthy Start Coalition.

Alameda’s ClubMom program is similar. Several times a month, 10 to 20 mothers gather in an informal setting to learn how to take better care of themselves. Topics include stress, nutrition, exercise, domestic violence and family planning.

Both agencies offer other services to curtail infant mortality, such as mental-health and clinical services and home visitation programs.

Infant death rates have dropped in both communities.

In Alameda County, the infant mortality rate dropped from 4.9 deaths per 1,000 births in 2000-02 to 4.2 in 2011-13. The black infant mortality rate went from 10.6 in 2000-02 to 7.6 in 2009-11, though it rose to 10.4 two years later.

In the county that includes Jacksonville, the infant mortality rate has dropped from 10.9 deaths per 1,000 births in 2004 to 8.8 in 2014. The rate among black infants has dropped from 15.7 in 2004 to 13.8 in 2014.

In 2013, Tarrant County’s infant mortality rate for non-Hispanic African-Americans was 12.76 deaths for 1,000 births. Overall, the rate was 7.11 deaths for 1,000 births.

Similar efforts in Tarrant County

That community connection is key to one effort to battle infant mortality in Tarrant County. The Healthy Moms-Healthy Babies-Healthy Community Initiative, or H3, is a coalition of pastors, educators, child-care workers, healthcare workers, community service organizations and parents.

All the members of the coalition live, work or serve in southeastern Fort Worth, one of the clusters of high infant mortality. Marcy Paul, an instructor in the UNTHSC Department of Behavioral and Community Health and the H3 project manager, said the group tries to come up with solutions from within the community.

That makes sense to Jordan, the University of West Florida researcher. “Every community is different in what it needs to reduce its rate,” she said. “There’s no specific formula.”

Paul emphasized a grassroots approach. Too often, people don’t know what programs are available or even that they need them, she said. “Sometimes it’s taking a book to a daycare to read it so I can meet the moms,” she said.

H3 members go to workplaces to show them how to set up areas for mothers to pump breast milk. Those employers can be certified as Texas Mother-Friendly Worksites.

“It’s going to take a while to know if the numbers are going down,” Paul said, but “the more people we touch and who touch us, the more people who receive resources because of that coalition coming together.”

Programs rely on cooperation

Some approaches elsewhere can’t be duplicated in Tarrant County. For instance, the California and Florida programs are each run through a single organization.

This allows staff to share what’s working and ensure that they don’t duplicate efforts, said Jessica Luginbuhl, special projects manager for the Building Blocks for Health Equity Unit in the Alameda County Public Health Department.

Tarrant’s campaign to reduce infant mortality has never been run by a single agency.

“I can see how that’s attractive in other places, but that’s not how things are here,” said Amy Raines-Milenkov, chairwoman of the Tarrant County Infant Health Network and assistant professor of obstetrics and gynecology at UNT Health Science Center. “So we’re dependent on collaboration among ourselves and between organizations.”

That has resulted in a fragmented approach, said Ann Salyer-Caldwell, associate director of community health promotion for Tarrant County Public Health.

The Tarrant County Infant Health Network has created a guide to help people find the right services. Many programs target different people — first-time mothers, for instance, or those with drug addiction. The guide lays out the requirements of each one and whom to contact.

Some state health agencies, including ones in California, Florida and Oklahoma, have hotlines for maternal and child health. Salyer-Caldwell said that could help.

In Texas, people can call 211 to find healthcare and social services. The people who answer the phone are trained to interview callers to learn more about their problems, even if someone is just seeking help with an electricity bill.

Another difference between Texas and Florida: Florida law requires every pregnant woman and newborn to be screened for infant-mortality risk factors.

Texas doesn’t require such screening.

The groups trying to reduce infant death in Tarrant County are working together better than they used to, Raines-Milenkov said. They understand that they’re accountable to the overall goal of reducing infant mortality.

“I think there is something else at work here,” she said. “And that is the recognition that one approach, one organization or individual, cannot undo what it took years and years to create.”

Alec Horner contributed to this story. The stories in this series were reported and written by 2015 graduating seniors in TCU’s Department of Journalism.

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