Baltimore has been tackling a major crisis in their city for years— infant mortality, and the disparity in survival rates between white and black babies. The Commons’ Emma Coleman spoke with Rebecca Dineen, the Baltimore City Health Department’s Assistant Commissioner for the Bureau of Maternal and Child Health, about how they have been able to improve the health of mothers and babies.
In 2008, a black baby born in the city of Baltimore was five times more likely to die than a white infant. The rate of infant mortality in the city was so bad that Baltimore ranked fourth highest in the nation. The city had been looking at the issue for years, and armed with new data, they were ready to do something. The first step? Declaring a public health crisis.
Across the U.S., infant mortality rates are surprisingly high when compared to other developed nations— and maternal deaths are similarly elevated. The racial disparities in these figures are impossible to ignore, with black mothers dying at a rate three times that of white mothers during pregnancy and childbirth. Baltimore isn’t alone in trying to right its course after coming to terms with the severity of the situation in their city. New York recently announced a pilot to reduce racial disparities in childbirth deaths, D.C. launched a Maternal Mortality Review Commission, and Cradle Cincinnati released a $25 million plan to reduce infant mortality. But nowhere have these efforts been more widespread and pioneering than Baltimore.
“In some way, shape, or form, infant mortality touches everyone in the city,” says Rebecca Dineen, Baltimore City Health Department’s Assistant Commissioner for the Bureau of Maternal and Child Health. With that mentality, the city began creating a plan to bring down infant mortality that would deeply involve all members of the community. The Health Department started by partnering with two local nonprofits, the Family League of Baltimore and Health Care Access Maryland, to develop a citywide initiative, B’more for Healthy Babies, that addressed the primary causes of infant mortality. The strategy identified eleven high impact areas, with particular emphasis on infant safe sleep, family planning, maternal smoking, and maternal obesity.
With over 150 partner organizations, including hospitals, nonprofits, philanthropies, churches, and neighborhood associations, the goal of the initiative is to unify all of the efforts across the city to improve maternal and infant health into one aligned strategy. In order to achieve this, the team borrowed strategies for public-private partnerships from international public health campaigns, where resources are often scarce. “We’re more likely to have a population-level impact when we work collectively than if we were competing for resources, working with smaller client bases, and protecting our funding streams,” explains Dineen.
The strategy works along the life course, and includes the care coordination of pregnant women and infants, home visiting by nurses and social workers into families with young children, provision of free cribs for families who need them, support to families with substance use and mental health concerns, teen pregnancy prevention, WIC services, and much more.
One of the key elements of the BHB initiative was the creation of a central triage system that identified all Medicaid-eligible pregnant and postpartum women and infants. Through the use of Medicaid data, the city can find those most in need and target resources that would be most useful to each individual. The system also has a public-facing component to help families find information. “It helps people navigate an incredibly complex system of services from the health and social sectors. From nurse home visits to housing vouchers, we’re able to streamline all the concerns that expecting parents are facing in one place,” Dineen explains. Perhaps most importantly, the centralized triage system also allows for follow up, which ensures that the BHB initiative can continue to touch parents’ lives after their baby is born.
Though the initiative has a major focus on evidence-based solutions, data doesn’t drive everything they do. The city has community collaboratives in neighborhoods that they identified as high-risk, including Upton/Druid Heights and Patterson Park North and East, and through community outreach have been able to interact with 30,000 residents. They also conduct maternal interviews to get an in-depth understanding of mothers’ experiences with providers, and to see the personal impact that racism in the medical system has on pregnant women. “The stories of mothers who have lost their children have shaped this initiative much more so than anything else,” says Dineen. These stories can become cornerstones of the work done by the city to reduce infant mortality. One such story, that of Dearea Matthews, whose son died in his sleep, inspired the ABCDs of infant safe sleep campaign, and Matthews now serves as a public health ambassador.
As the B’More for Healthy Babies initiative gained steam, they were able to expand their public-private partnerships and introduce new programs. In 2010, the Bureau of Maternal and Infant Care at the Health Department partnered with the Family League of Baltimore, Planned Parenthood of Maryland, and Weight Watchers to design the wellness program B’More, which offers opportunities for obese and overweight women who are low-income and postpartum to get nutritional counseling and lose weight.
Central to the ability of the city to convene private and public partners in pursuit of common goals is the trust they place in their partners. “If trust is at the foundation of the work, and everyone recognizes the indicators we’re working towards, and we have the data to support those, AND we have community buy-in, that’s a powerful recipe for change. When people see that, it’s easier to get more partners to buy in,” Dineen explains. “It’s important that people don’t see this as ‘the Health Department’s agenda’– it’s everyone’s agenda.”
The results of this effort have been incredibly impactful. In seven years, Baltimore reduced infant mortality by 36%, and cut the disparity between black and white babies by more than half in the same time frame. With centralized systems, a strong coalition of public and private partners, a focus on evidence-based programs, and a strong integration of the community into the initiative, Baltimore has become a leading example of how cities can confront crises before they become too big to tackle.