it takes a village: communities working to achieve birth...
TRANSCRIPT
It Takes a Village: Communities Working to Achieve Birth Equity
Introduction
Global Infant Safe Sleep Center Education Program
OUR MISSION
• Empowering the world’s communities by achieving equity in infant survival. Although it is evident that there is work being done by a plethora of agencies and organizations worldwide to address the disparities in birth outcomes and infant survival, the concern is in many cases the vulnerable and marginalized don’t always have a seat at the proverbial table.
• The Global Infant Safe Sleep Center supports vulnerable and marginalized global communities in an effort to reduce Sudden Unexpected Infant Death.
Featured documentary by Rhonda L. Haynes
• In the early 1920s the terms “granny,” and “granny-midwife” were synonymous with black midwives in the rural South.
• Few physicians—white or black—were willing to attend births for the two or three dollars per delivery that midwives would accept. (Indeed, midwives would sometimes be given a chicken as payment or not be paid at all.)
• African American mothers also preferred home births to hospital deliveries because they could avoid the prejudice and discrimination they often experienced in White society.
Definition Sudden Unexpected Infant Death (SUID)
• SUID: death of an infant less than 1 year of age that occurs suddenly and unexpectedly.
• After a full investigation, these deaths may be diagnosed as: (suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac arrhythmias, trauma (accidental or non-accidental), or SIDS).
• Sudden Infant Death Syndrome (SIDS): sudden, unexplained death of a baby younger than 1 year of age that doesn’t have a known cause after:
• A complete investigation (complete autopsy, examination of the death scene, and review of the clinical history).
In some cases, where the evidence is not clear or not enough information is available, the death is considered of undetermined cause.
Definition
The Facts
• The U.S. SIDS rate dropped more than 60% between 1994 and 2014. However, the rate of infant deaths from other sleep-related causes has increased.
• In the U.S. the number of SIDS deaths in 1994 was 4,073 and in 2014 that number dropped to 1,545.
• The number of other sleep-related infant deaths in 1994 was 903 and in 2014 that number more than doubled to 1,945.
• This means that we still have work to do to raise awareness about safe infant sleep practices, especially in higher risk communities.
Knowledge
Risk Factors
• Babies who are put to sleep on their tummies, have a risk of dying from SIDS that is 5x higher than those who sleep on their backs.
• Babies who are usually put to sleep on their backs, but for some reason are placed on their tummies, even just once, are 7-8 times more likely to die of SIDS.
• The SIDS risks for African American babies is twice as high as that of white babies.
• American Indian/Alaska Native babies is 3-4 times greater than white babies. • Other factors, which can be compounded, are related to the baby's
environment, especially when exposed to second hand smoke, which increases the SIDS risk 2.5 times.
Risk Factors
What You Can Do: Recommendations for Infant Sleep Safety Until their first birthday, babies should sleep on their backs for all sleep times—for naps and at night.
Esophagus (Tube to stomach)
Trachea (Windpipe) Esophagus (Tube to stomach)
Trachea (Windpipe)
Baby in the stomach sleeping position
Baby in the back sleeping position
Author By: Rachel Y. Moon, MD, FAAPLast Updated 1/12/2017Source American Academy of Pediatrics (Copyright © 2016)The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Healthychildren.org
Use a firm sleep surface.
• A crib, bassinet, portable crib, or play yard that meets the safety standards of the Consumer Product Safety Commission (CPSC) is recommended along with a tight-fitting, firm mattress and fitted sheet designed for that particular product.
Author By: Rachel Y. Moon, MD, FAAPLast Updated 1/12/2017Source American Academy of Pediatrics (Copyright © 2016)The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Healthychildren.org
What Moms Can Do: Recommendations for Prenatal & Postnatal
Breastfed babies have a lower risk of SIDS.
• Breastfeed or feed your baby expressed breast milk.
• The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months.
• Even after you add solid foods to your baby's diet, continue breastfeeding for at least 12 months, or longer if you and your baby desire.
Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the baby's sleep area • These include pillows, quilts,
comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides.
• If a parent is worried about baby getting cold, one can use infant sleep clothing, such as a wearable blanket.
• In general, baby should be dressed with only one layer more than a parent is wearing.
Author By: Rachel Y. Moon, MD, FAAPLast Updated 1/12/2017Source American Academy of Pediatrics (Copyright © 2016)The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Healthychildren.org
Room share—keep baby's sleep area in the same room where you sleep for the first 6 months or, ideally, for the first year • Place your baby's crib, bassinet,
portable crib, or play yard in your bedroom, close to your bed.
• The AAP recommends room sharing because it can decrease the risk of SIDS by as much as 50% and is much safer than bed sharing.
• In addition, room sharing will make it easier for you to feed, comfort, and watch your baby. Author By: Rachel Y. Moon, MD, FAAPLast
Updated 1/12/2017Source American Academy of Pediatrics (Copyright © 2016)The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Healthychildren.org
Bed-sharing is not recommended for any babies However, certain situations make bed-sharing even more dangerous. Therefore, you should not bed share with your baby if:
• Baby is younger than 4 months old. • Baby born prematurely or with low birth weight. • Parents or any other person in the bed is a smoker (even if you do not smoke in bed). • The mother of the baby smoked during pregnancy. • Medicines or drugs taken that might make it harder for you to wake up. • Alcohol consumption • You are not the baby's parent. • The surface is soft, such as a waterbed, old mattress, sofa, couch, or armchair. • There is soft bedding like pillows or blankets on the bed.
Author By: Rachel Y. Moon, MD, FAAPLast Updated 1/12/2017Source American Academy of Pediatrics (Copyright © 2016)The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Healthychildren.org
Recommendations for Infant Sleep Safety It is fine to swaddle your baby. • However, make sure that the baby is
always on his or her back when swaddled.
• The swaddle should not be too tight or make it hard for the baby to breathe or move his or her hips.
• When your baby looks like he or she is trying to roll over, you should stop swaddling.
Never place your baby to sleep on a couch, sofa, or armchair. • This is an extremely dangerous place
for your baby to sleep.
Try giving a pacifier at nap time and bedtime. • This helps reduce the risk of SIDS,
even if it falls out after the baby is asleep. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier.
• This usually takes 2-3 weeks. If you are not breastfeeding your baby, you can start the pacifier whenever you like. It's
• OK if your baby doesn't want a pacifier. You can try offering again later, but some babies simply don't like them. If the pacifier falls out after your baby falls asleep, you don't have to put it back in Author By: Rachel Y. Moon, MD, FAAPLast Updated 1/12/2017Source American Academy of
Pediatrics (Copyright © 2016)The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Healthychildren.org
Don’t Take The Chance
Reenactments
What Moms Can Do: Recommendations for Prenatal & Postnatal Do not smoke during pregnancy or after your baby is born. • Keep your baby away from smokers
and places where people smoke. • If you are a smoker or you smoked
during pregnancy, it is very important that you do not bed share with your baby.
• Also, keep your car and home smoke-free. Don't smoke anywhere near your baby, even if you are outside.
Do not use alcohol or illicit drugs during pregnancy or after the baby is born. • It is very important not to bed
share with your baby if you have been drinking alcohol or taken any medicines or illicit drugs that can make it harder for you to wake up.
Schedule and go to all well-child visits. • Your baby will receive important
immunizations at these doctor visits. Recent evidence suggests that immunizations may have a protective effect against SIDS.
Author By: Rachel Y. Moon, MD, FAAPLast Updated 1/12/2017Source American Academy of Pediatrics (Copyright © 2016)The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Healthychildren.org
Life Course Approach
“In thinking of America, I sometimes find myself admiring her bright blue sky — her grand old woods — her fertile fields — her beautiful rivers — her mighty
lakes, and star-crowned mountains. But my rapture is soon checked, my joy is soon turned to mourning. When I
remember that all is cursed with the infernal actions of
slaveholding, robbery and wrong, — when I remember that with
the waters of her noblest rivers, the tears of my brethren are
borne to the ocean, disregarded and forgotten, and that her most
fertile fields drink daily of the warm blood of my outraged
sisters, I am filled with unutterable loathing.”
Fredrick Douglass
The Race Factor
What’s Killing African American Infants Racism is fueling a nation By By Zoë Carpenter
• Bevan Baker, the health commissioner, described Milwaukee’s infant-mortality work as an opportunity to reckon with what is perhaps America’s most profoundly destructive legacy. “When you look at the racial disparity, it forces us as citizens and residents of this great nation to deal with the incomprehensible notion that race matters,”
The Affects of Discrimination
Dr. Camara Phyllis Jones, president of the American Public Health Association, proposed a now widely cited framework for understanding how discrimination affects health outcomes, breaking it down into three categories: • Internalized Racism • Personally mediated • Institutional discrimination
Race Does Matter
• Internalized racism - Operates to damage the self-esteem of some among stigmatized groups. Internalized racism refers to the acceptance, by marginalized racial populations, of the negative societal beliefs and stereotypes about themselves—beliefs which reinforce the superiority of Whites and devalue people of color, and which can lead to the perception of oneself as worthless and powerless.
• Personally mediated - Personally mediated experiences include things like being treated differently at a doctor’s office than white patients; black women who report these kinds of experiences have been found more likely to have low-birth-weight babies
• Institutional discrimination—which refers to the ways in which unequal treatment has been baked into our social, economic, and political systems—impacts individual health too. It’s apparent in the disparities in the criminal-justice system, in education, in predatory lending practices that target African Americans, and in the siting of polluting industrial facilities near communities of color.
Chronic Stress
• Chronic stress raises amounts of cortisone, a hormone that at elevated levels triggers labor. It can also cause an inflammatory response that restricts blood flow to the placenta, stunting infant growth.
• But it’s not just stress during pregnancy that matters: Health experts now think that stress throughout the span of a woman’s life can prompt biological changes that affect the health of her future children. Stress can disrupt immune, vascular, metabolic, and endocrine systems, and cause cells to age more quickly.
Stress Kills • All of these effects together create what scientists call “allostatic
load,” or “the cumulative wear and tear on the body’s systems owing to repeated adaptation to stressors,” according to a 2006 study published by Arline Geronimus and others in the American Journal of Public Health.
• Geronimus, a University of Michigan professor, developed what she calls the “weathering” hypothesis, which posits that black Americans’ health deteriorates more rapidly than other groups’ because they bear a heavier allostatic load.
• “These effects may be felt particularly by Black women because of ‘double jeopardy’ (gender and racial discrimination),” Geronimus and her co-authors noted. (Infant mortality is just one of many forms of disease that fall disproportionately on black Americans. The list includes cervical cancer, asthma, diabetes, and cardiovascular disease.)
The Father Factor
The Truth: Pregnancy and
African American
Fathers
Black Fathers Have Frequent Involvement In Their Children’s Lives • It’s important to highlight that African American fathers are very
involved in their children’s lives. In 2013, a U.S. National Health Statistics Report (NHSR, 2013) found that Black fathers spend much more time interacting with, nurturing, helping, and accompanying their children in activities than the general public is typically lead to believe.
Togetherness Is Key • Dr. Amina P. Alio at the University of Rochester Medical Center and
colleagues (2013) found that the mostly African American participants in their study said that ideal fathers were “present, accessible, available, understanding, willing to learn about the pregnancy process and eager to provide emotional, physical and financial support” to the pregnant woman
Silent Agreement Can Erect Barriers To Father’s Involvement During Pregnancy • Dr. Lisa Paisley-Cleveland (2013) from Hunter’s College in New York
found that Black fathers’ participation during pregnancy varied but more than half of the women in her study felt emotionally supported by their partners, even as some struggled through marital problems.
The Paternal Side of
Pregnancy
• The first study confirms that African American fathers are excellent fathers.
• The second study indicates that African American men and women agree on the characteristics an ideal father should have both during and after pregnancy.
• The second and third study suggest that barriers can be erected that keep fathers from being involved during pregnancy.
• Taken together, the three studies tell us that African American men are willing partners during and after pregnancy but may need clearer messages about how to be involved when their partners are pregnant.
• Men need to break the silent agreement and ask their partners what they expect when they’re expecting.
• Health care professionals, worship communities, schools, friends and families, can also help by sending clear messages to future fathers that they are welcome and needed partners during pregnancy. Future-fathers are important
The Truth: Pregnancy and African American Fathers by Marta Sánchez successfulblackparenting.com
It will take a Village
• Infant mortality is a wicked problem. It requires us to think about health less as a matter of biology and more as the result of political choices and socioeconomic realities.
• It has no single solution. But “the point is not to frame complexity as daunting,” said Nancy Krieger, the Harvard epidemiologist, “but actually as opening many avenues for effective action, and asking how different groups that are already engaged can understand how their issues relate to infant mortality.”
“The American people have this to learn: that where justice is denied, where poverty is enforced, where ignorance prevails, and where any one class is made to feel that society is an organized conspiracy to oppress, rob, and degrade them, neither person nor property is safe.”
• Fredrick Douglass
What can be done?
• “Many initiatives do not embody the community voice, support, and participation that is necessary for sustainable long-term results.” It is necessary for future approaches to involve minority communities to reduce this rate.
Building an academic-community partnered network for clinical services research: the Community Health Improvement Collaborative (CHIC), Institute of Medicine, 2006
ADDRESSING THE DISPARITY KIRWAN INSTITUTE ISSUE BRIEF • February 2014
Community Dialogue • Engage • Educate • Empower
CHANGING A TRADITION CHANGING A POSITION KEEPING OUR BABIES SAFE • According to census figures, 2.7
million grandparents are raising grandchildren. In response to this shift in caregiving, the Global Infant Safe Sleep Center is launched this a campaign, which focuses on the increasing number of non-parental caregivers who care for infants.
• This campaign will promote six key messages derived from the American Academy of Pediatrics Infant Sleep Safety and SIDS Risk Reduction Guidelines, understanding there are additional recommendations that highlight “Best Practices” for parents and caregivers:
Key Messages for Grandparents/Caregivers
Put the baby on back to sleep in a crib or
bassinet Do not use crib bumpers or blankets Offer a pacifier Make sure babies are immunized Don’t smoke in your house or around
baby Do not overheat
It Takes a Village: Communities Working to Achieve Birth Equity
Jackson, Mississippi
Jackson, Mississippi
Detroit, Michigan
Detroit, Michigan
Detroit, Michigan
Little Rock, Arkansas
Tulsa, Oklahoma
Columbus, Ohio
Columbus, Ohio
Jacksonville, Florida
Faith-based organization fights infant mortality
The Michigan Chronicle
In 2015, 765 infants in the state of Michigan never reached their first birthday • In honor of Mother’s Day and to combat
infant mortality and Sudden Infant Death Syndrome (SIDS) deaths in Michigan, the C.A.R.E. (Concerned About Reaching Everyone) hosted “No Baby Left Behind” SIDS Risk Reduction Workshop and crib giveaway on Saturday, May 6, 2017 from 10 a.m. to noon at the City of Detroit Health Department, 55 West Seven Mile Rd., in Detroit.
GISS-Global Infant Safe Sleep Center
1461 Mt. Vernon Ave. Columbus, Ohio 43203
1 888 367-1110 Ext 1
(614)304-6206
Dr. Stacy Scott