[solemn music]
- Nathan: The harsh reality is from the first day they're born,
Black babies are much less likely to thrive
and more likely to die than white infants in Wisconsin.
The same holds true for their mothers.
In fact, this has been true since the first infant
and maternal mortality data was gathered in 1912.
- I think one of the big things that people don't realize
is that this is a problem that we have identified
more than a century ago.
- Nathan: Tiffany Green is a professor
for population health sciences at UW-Madison.
She says that while overall, maternal mortality
has greatly decreased in the last century,
the gap between Black and white mothers and infants
has persisted, especially in Wisconsin.
- Tiffany: We still unfortunately
have among the highest Black infant mortality rates
in the country,
meaning Black babies that don't reach their first birthday.
Black birthing people have about
five times the pregnancy-related mortality rate
relative to their white counterparts in Wisconsin.
- In general, we are leaders in the nation
as it relates to many of the inequities that we see.
- Nathan: Dr. Jasmine Zapata is the chief medical officer
for community health
at the Wisconsin Department of Health Services.
- There's no one answer.
We could talk about this for hours and hours.
It's multifactorial.
- Nathan: Advocates say one potential reason
we see disparities is because health care providers
can carry implicit biases into the clinic.
- So a lot of times when we talk about implicit bias
and talk about racism in our health care system,
a lot of people think about, like,
direct, interpersonal racism
where somebody would come up to me and say,
"I don't want you to treat me 'cause you're Black."
That's not a lot of what we see.
A lot of it is unintentional.
- Nathan: Because of those unintentional biases,
Zapata says Black people are less likely
to go to a doctor when something is wrong,
which can lead to worse health outcomes.
- There are many people,
especially in the maternal and child health fields,
that have access, that have insurance,
and they're still not attending their health care appointments.
Just because you have insurance
and you can physically make an appointment,
is it somewhere that you feel safe and comfortable?
- Nathan: But while access to quality health care
can be a large driver in outcomes,
national data shows that even the infants
of the richest Black mothers suffer worse health outcomes
than the babies of the poorest white mothers.
- I think we focus a lot on hospitals and doctors
because that is something
we can easily wrap our heads around.
But the reality is there are a lot of reasons,
and I think they have a lot more to do
with the social environment.
- Nathan: And the societal environment
for Black Wisconsinites is one defined by racism.
When it comes to where Black Wisconsinites live,
only a quarter own their own home.
They face one of the highest income gaps in the country
and are five times more likely to live in a food desert
than white people.
- A lot of people have linked things like segregation,
things like the resource-deprived environments,
to the risk of prematurity, and those things matter.
- Nathan: Dr. Zapata says she experienced
this difference in outcomes firsthand
when she had her second child.
- I got pregnant with my second child, a little baby girl.
I was so excited, and she was due on January 2,
but on September 20,
I had a sharp pain in my lower abdomen.
- Nathan: When it happened,
she was in class for medical school
and knew something was wrong.
Doctors told her that it was just false labor,
but when she saw blood a few minutes later,
she went to the hospital.
- Ultimately, within two hours, I was in an emergency C-section,
and I delivered a one and a half-pound baby
who didn't cry when she came out.
When babies come out, they're supposed to be kicking,
screaming, crying.
It was completely silent.
- Nathan: Her daughter was then taken
to the neonatal intensive care unit to start her breathing.
- It was so hard for me at that moment
because I knew all the statistics
about Black birth outcomes.
- Nathan: After three weeks in the NICU, Zapata's baby
was able to thrive and is now a very healthy teenager,
but Zapata knew the outcome could have been much different.
- I knew that it was a honor that she was there with me
because there are so many other birthing people
and families, particularly Black women,
Black birthing people who do not have that same outcome.
- There are reasons above and beyond
sort of these individual-level characteristics
that don't explain why we are seeing these disparities.
- Nathan: But there is work being done to bring parity
to birth outcomes for Black mothers and infants.
In 2022, Governor Evers announced
$16 million in additional funding
for DHS to work on closing those gaps.
- We're currently working on this
with intensity and passion.
- Nathan: Dr. Zapata says there are three big things
that money is going toward: increasing access
to health care for Black mothers and infants,
educating current health care practitioners about the issues,
and increasing the number of Black doctors and nurses.
- We will have a bigger impact if we can go upstream
and focus on how can we eliminate some
of the very factors and social determinants of health
that cause some of these health outcomes
in the first place.
- Nathan: Along with the $16 million,
health care providers in Dane County have another effort
to improve the social determinants of health
called ConnectRx.
ConnectRx is a program that provides support
to pregnant Black people at risk.
- Making sure that families at risk
of losing their places are getting housing,
making sure that they are getting food.
I've heard, been privileged to hear stories
about people getting employment that they need.
- Nathan: The program also connects mothers
with doulas if they choose,
and with an individual community health worker,
both during pregnancy and after.
- I'm just stunned at the work that they've been able to do
that addresses these social determinants.
- Nathan: But even with these programs,
Green says more needs to be done.
- When we talk about things like Medicaid expansion,
which we have refused to do in our state,
despite the fact that places like Georgia and Mississippi
have expanded postpartum Medicaid for up to a year.
- Nathan: The Wisconsin legislature
removed Medicaid expansion
from the governor's budget again in 2023,
making Wisconsin one of only a few states
which has not expanded postpartum coverage.
- If we live in a Wisconsin where everybody
is able to reach their highest potential,
everybody needs access to a provider.
- Nathan: While expanded coverage remains elusive,
health officials look to fill the gaps
and improve the outcomes wherever they can.
For Here & Now, I'm Nathan Denzin.