Last week, Michigan’s Senate Health Policy Committee discussed maternal and infant health regarding disparities between races and ethnicities, achievements made this past year, and policy recommendations to improve outcomes.
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Dawn M. Shanafelt, the director of the Division of Maternal & Infant Health and Title V Maternal Child Health at the Michigan Department of Health and Human Services (MDHHS), testified to the committee regarding the state’s statistics for infant and maternal health and advancing health equity.
Shanafelt said that Michigan is making progress regarding the infant mortality rate per 1,000 live births, which was first recorded at 20.3 in the 1970s, compared to the record low rate of 6.2 in 2021. She dove deeper into the 2021 data showing that the rates varied drastically between race and ethnicity. The infant mortality rate per 1,000 live births was 11.6% for Black individuals, 6.5% for Hispanics, 5.7% for Asian/Pacific Islanders, and 4.4% for white individuals.
“The rates vary drastically, especially for Hispanic and Black babies,” Shanafelt said. “These differences in mortality rates are called disparities, and disparities are the result of inequities.”
Shanafelt said that in 2020, 161 babies died from sleep-related causes in Michigan, which she said are preventable for the most part.
She said that in 2019, there were 145 recorded cases of maternal mortality among Black women and 59 among white women in the state.
“As with the infant mortality rate, disparities are clearly evident,” Shanafelt said. “Maternal and infant outcome rates should not be varied by race, ethnicity, or geographic location. Disparities are the symptom and statistical evidence shows the systemic inequities.”
Shanafelt said the Michigan Maternal Mortality Review Committee (MMRC) reviews every infant death in the state, and it considers whether an intervention could have averted deaths. MMRC defines “preventable death” as instances in which the chance of death could be reasonably prevented by providers, patients, facilities, systems, communities, or policies. MMRC concluded that 64% of pregnancy-associated deaths in Michigan between 2015 and 2019 were preventable.
Shanafelt said these preventable deaths are not just a Michigan problem but a nationwide problem that is going to take a multipronged approach to overcome. One part of the solution is MDHHS’s new Doula Initiative, launched earlier this year. Shanafelt said more than 90 doulas have registered for this program since it began in January.
Dr. Jennifer Torres, manager of the Office of Women’s Health and Birth Equity at the Michigan Public Health Institute, testified to the committee regarding the results of the Achieving Birth Equity through Systems Transformation project, which is a project addressing racial inequities in maternal and infant mortality for Black and Native communities.
The project was funded by the Michigan Health Endowment Fund and is now developing and implementing specific strategies that challenge the status quo for targeted communities. The project is being carried out by two community partners: the Inter-tribal Council of Michigan and various county health task forces like Raising Up Healthy Babies.
When it comes to collecting race data among Michiganders for reporting on maternal and infant mortality, Torres recommends adding an “American Indian Alaska Native” identification for individuals who identify under that umbrella. Under Michigan’s current approach to reporting the race of infants, the infant’s race is identified based solely on the mother’s race. Torres recommends including both the race of the father and mother to have a more holistic view.
Last to testify in front of the committee was Amy Zaagman, executive director of the Michigan Council for Maternal and Child Health. She wants to ensure that Michigan pursues legislation to address birth equity—the assurance of optimal birth conditions for all people by targeting racial and social inequities.
Zaagman said that the climate is “really ripe” for addressing birth equity as there is now more awareness and policy initiatives focusing on maternal health. These include the Healthy Moms Healthy Babies initiative at the state level and the “Momnibus” bill at the federal level.
“I get the question of, ‘What’s the one thing I can do to prevent child mortality?,’ and it just doesn’t work that way,” Zaagman said. “… it needs to be a combination of sustained efforts over time that changes and challenges systems to see a reduction and improvements in outcomes.”
Zaagman listed out recommendations including implementing more doula services to improve birth outcomes, codifying MDHHS’s new Doula Initiative, establishing statutory levels of maternal care (18 states have done this), and licensing free-standing birth centers to facilitate reimbursement and sustainability (Michigan is one of eight states that do not license free-standing birth centers). She also recommends statutorily requiring paid maternity leave, providing space for breastfeeding at work, and strengthening Michigan’s home visiting system for pregnant individuals.