In Memphis, black mothers are three times more likely than white or hispanic mothers to lose their child before it reaches its first birthday, according to the Shelby County Health Department.
Shelby County’s infant mortality rate is nothing new, it’s been well documented by the media and the subject of more than a decade of consistent work from a small army of doctors and health advocates pushing for policy change.
The latest numbers for Shelby County report an overall rate of 9.2 deaths per every 1,000 live births in 2013. While this is a significant improvement from a decade ago, when the rate was 14.9 deaths per 1,000 live births, black women are at a much higher risk for losing their children with 12.4 infant deaths per 1,000 live births.
“We still have work to do,” said Michelle Taylor, a pediatrician who serves as the Shelby County Health Department’s associate director and deputy administrator for the Maternal and Child Health division.
But now, her campaign to reduce those numbers is being hampered by a new state law that calls for arresting women who test positive for controlled substances.
“Women in Tennessee and in Memphis are leaving the state to have their babies so they won’t get prosecuted. It really was a very poor move from the state legislator’s part,” said Linda Moses, an OB-GYN with more than 20 years of experience working with impoverished Shelby County women in need of prenatal care.
Several women’s health organizations have recently collaborated to form the “Healthcare Not Handcuffs” initiative, aimed to raise awareness and ultimately reform around the new Tennessee law. Additionally, a closed summit on infant mortality will be held on May 7 to discuss new strategies for dealing with the infant mortality crisis.
The first law of its kind in the nation, the so-called Tennessee pregnancy criminalization law is now injecting a fear of arrest into the challenges of getting birth mothers to get early medical care.
“So what is happening now, is that women with those issues were often slow to start prenatal care in the beginning. But now because of that fear, they are coming in less often and not disclosing anything we don’t (already) know,” said Moses.
Before taking a position as an assistant professor of OB-GYN at the University of Tennessee Health Science Center, Moses practiced in the most affected Shelby County ZIP codes, the same areas where she was raised. She explains that the vast majority of her job was education and she now worries that fewer at-risk pregnant women with addictions will receive the help they desperately need.
“It’s just going make our problems worse, and who’s going to pay for that is going to be the children, the babies. That mom is not going to come in and be seen for fear that her baby is going to be taken away.”
Until the new law, the efforts of Moses, Taylor and others were being met with some success.
“Believe or not, people have been talking about this in a sustained way for the past 10 years,”said Taylor. “What other issue in Shelby County can you think of where people have been really talking about, thinking about it, and working to keep it in the forefront for 10 years?”
Taylor and Moses are two of a four-person panel that met for a screening of “Beyond Babyland,” a 2010 documentary that explores the racial disparity in Shelby County’s infant mortality rate. The primary cause of infant mortality in Shelby County is low birth weight stemming from very little or no prenatal care. For many black women in the area’s most impoverished ZIP codes, prenatal care and general pregnancy education are not readily available.
For Taylor and the other panelists – Mid-South Peace and Justice Associate Director Ace Madjlesi, and University of Memphis anthropology professor Kathryn Hicks – reducing the IMR means looking at all poverty-related obstacles and finding solutions that are based in prevention, not medical intervention after birth.
“This is social science, not rocket science. We know what works and what doesn’t work.” Ace Madjlesi
More than two dozen organizations in Shelby County are tackling the IMR, all with a specialized focus. The Memphis Bus Riders Union is pushing for more bus services to in the worst ZIP codes for infant mortality, so that pregnant mothers dependent on public transportation have a better chance to make it to a public health clinic. A Step Ahead foundation is working to make long-acting reversible contraceptives accessible and affordable.
Hicks, who is a faculty affiliate for the University of Memphis Center for Research On Women, sees the law as the latest measure of restricting access for Tennessee’s poorest and already marginalized women.
“This is due to discrimination on socially defined race, and based on class – which gives people different experiences and access to opportunities,” said Hicks.
For the panelists, every piece of the IMR puzzle is related to a lack of access, which is what they hope to address at the summit.
“During that summit we are going to be presenting our revised community strategic plan for the infant mortality rate,” said Taylor.
The invite-only summit will place a strong emphasis on treating the root problems of Shelby County’s IMR, rather than the result. Taylor feels that a multi-pronged approach that focuses on community and education will have a better chance of receiving funding if they can demonstrate how much money the state has the potential to save through preventative measures.
“Don’t worry about what people’s motivation are,” said Taylor. “Tell them how much it costs to take care of a baby that was saved, but sat in the NICU for nine months. Then tell them how much that costs versus helping a family on the front end. Then… They’ll suddenly love the conversation you’re having.”
