July 20, 2018
A Push to Reduce Infant Mortality

A Push to Reduce Infant Mortality

by Peter Jaret  

Cheri A. Pies, MSW, DrPH, is a clinical professor at the University of California, Berkeley, School of Public Health, and the principal investigator for the Best Babies Zones Initiative. This national consortium of partners works to lower infant mortality rates and improve the health of mothers and children. Pies discusses what the program aims to achieve—and how all of us can help.

What are Best Babies Zones?

Best Babies Zones are small geographic areas in large cities that bring together community residents and interested partners to identify strategies and interventions for reducing infant mortality in their communities. Infant mortality rates for black women in the US, for example, are 2.4 times higher than for white women. In Best Babies Zones, we’re working to reduce infant mortality by looking at the health of women and children across the full course of their lives. The idea behind Best Babies Zones is based on the work of Geoffrey Canada, who created the Harlem Children’s Zone—an area in Harlem where community leaders could focus their efforts on improving the health and well-being of children. Good prenatal care, as important as it is, is not enough. We need to look at the health of women and children across their life course to be sure children are born healthy and grow up in communities that enable them to thrive.

With such an ambitious goal, where do you start?

We’ve established three Best Babies Zones—the Castlemont neighborhood in Oakland, Calif., the Hollygrove neighborhood in New Orleans, La., and the Price Hill neighborhood in Cincinnati, Ohio. All three places have high infant mortality rates. And they are places where there is already an awareness of the problem and a willingness to work to improve the health and lives of infants and children. All three of these zones are small, which allows us to focus our efforts. Price Hill is our largest, and it’s just four square miles. Hollygrove and Castlemont are even smaller. Once local partners establish the zone, we work with them to mobilize the resources in that community to improve the health and opportunities of families living there. What we’re working toward is achieving health equity, so that every child growing up there has a fair opportunity to reach his or her full potential.

Why is the life course perspective so important in your work?

Traditionally in the field of maternal and child health, the focus has been on making sure women have healthy babies by getting them into prenatal care. But we now know that what happens to that mother, when she’s growing up, can have an influence on her baby. Did she get enough to eat? Did she experience trauma or severe stress? Did she feel threatened or in danger? We know that stress experienced by the mother can influence the health of the child. For example, the children of women who experience famine have a higher risk of developing diabetes and being obese. In the Netherlands following World War II, researchers were able to track generations of people born after the infamous Dutch Hunger Winter, and found that even the grandchildren of people who suffered malnutrition that winter were more likely to have physical and mental health problems. The idea behind a life course perspective is to try to improve all the things that go into determining health, including economic, educational, health, and community resources, across people’s lifetimes.

The first three Best Babies Zones have been in place for several years. What have you learned?

We’ve learned how important it is to listen to community residents. They’re the ones who know what needs to be changed to improve the conditions in their communities so that they can raise their kids in healthy places to achieve their full potential. The answers haven’t always been what we expected. In Hollygrove, for instance, the residents told us that they wanted us to work with them to fight efforts to reroute a train through their neighborhood. At first the staff worried that this didn’t seem to have much to do with child and maternal health. But we all realized that it had everything to do with it—from working with other community organizations to building trust among the residents that we could work on the issues that they were concerned about. The residents didn’t want a train coming through their neighborhood 27 times a day. They worried that the train would be dangerous and would cause pollution. By working with them to address the larger policy, we built that trust and contributed to a greater sense of community.

What were some other surprises?

In Oakland, the residents wanted a more vibrant local economy in their neighborhood. Again, that didn’t seem directly related to infant mortality at first. But the community members wanted to improve the socioeconomic center of their community. They wanted business opportunities and a safe place to gather, which translated into a monthly community market. Over the two and a half years since it opened, this community market has grown to have up to 25 vendors and sometimes hundreds of people coming to the market. In addition, the concentrated effort in the zone has brought a boot camp for new dads, a baby shower for new moms, and other services and activities to the community. The residents knew better than we did what would work for them, and they’ve really embraced it.

Do you try to find residents who are willing to take the lead?

In all of these communities, there are already leaders with good ideas. Our role is to support them, to provide a way to grow those ideas and make them sustainable. In Castlemont, for instance, mothers were concerned that their kids didn’t have a safe place to play. On their own, they had already tried to create safe play areas. With help from Best Babies Zones, they’ve expanded that into a really successful, well-attended play group with hundreds of kids.

In Price Hill, a group of pregnant and parenting mothers who had experienced poor birth outcomes were concerned about not having enough social support, about wanting to get to know people in the neighborhood. With support from Best Babies Zones, they divided the neighborhood into blocks, and the women in the group became block captains. They went door to door, over the course of about a year, meeting people. They brought cribs, smoke detectors, and books for the kids to read. They identified families that needed more social connection. Those moms really became the leaders.

How do you measure progress and success?

The ultimate goal is to lower infant mortality. But it can take years—perhaps as long as 20 years—to see the rate go down significantly. For now, we are looking at near-term goals, such as increasing community engagement, building a sense of trust within the community, increasing access to parenting education, and encouraging more residents to become engaged. As the zones become more developed, we will begin to look more closely at specific health-related measures, such as breastfeeding rates and access to prenatal care.

What can those of us lucky enough to live in more advantaged neighborhoods do to help?

First, try to understand the challenges people in disadvantaged neighborhoods face. When we went to Oakland to talk with women about poor birth outcomes, the main issue that kept coming up repeatedly was their fear of gun violence in their community. It was risky just to go for a walk. In Hollygrove, in New Orleans, when we first started to work there, there wasn’t a single food market or medical clinic of any kind. The community had no school—not an elementary school or junior high or high school.

Then think about ways you as an individual could help. Improving health requires the participation of many types of people. It’s about more than access to quality healthcare. We need to engage residents from communities near and far to help bring together diverse partners—organizations like banks and financial institutions, for example, who will offer loans so that people can own where they live. And we need to build educational resources. So if you see a role for yourself as a mentor, a literacy coach, someone who can volunteer at a community market or bring a farmer’s market to the the community, go for it.

This opinion does not necessarily reflect the views of the UC Berkeley School of Public Health or of the Editorial Board at BerkeleyWellness.com.

Also see How Stress Hurts Children’s Health.

Image credit:Alameda County Public Health Department