Dr. Sandra Lane and Kathleen Coughlin offered insights into a little-known local issue: the unequal health and survival of babies caused by poverty and structural discrimination. <\/p>\n\n\n\n
Sandra Lane is Chair of the Department of Health and Wellness, Professor of Social Work and Anthropology, and CNY Master’s of Public Health at Syracuse University, as well as Research Professor in the Department of Obstetrics and Gynecology at SUNY Upstate Medical University. She was the founding director of Syracuse Healthy Start, an infant mortality prevention project with the Onondaga County Health Department. <\/p>\n\n\n\n
She is the author of Why Are Our Babies Dying? Pregnancy, Birth, and Death in America,<\/em> which chronicles, in clear and simple prose, a decade of work on the unequal health and survival of babies caused by poverty and structural discrimination. When asked what inspired her to this field of work, Sandra explained that her first child was stillborn due to an infection introduced into her amniotic sac through amniocentesis. When she came to this area because of her husband’s job, the Syracuse Health Department needed someone to help write grants for infant mortality, and she chose to help others as well as honor her infant son. She couldn’t choose what happened to her, but she could choose how to respond. <\/p>\n\n\n\n Kathleen Coughlin has been Project Director of Syracuse Healthy\nStart since 2006. Her professional interests include studying\nbreastfeeding rates and duration, racial inequalities in maternal and child\nhealth, and access to early prenatal care. Kathleen explained that she got into\nher career because when she was in her twenties, her best friend had a\npremature delivery and the baby died. Kathleen was also pregnant at the time,\nand her friend’s baby’s death still motivates her to help women become educated\nand avoid the same gut-wrenching outcome. <\/p>\n\n\n\n Sandra opened by explaining part of her job history. From 1988\nto 1992 she was the Reproductive Program Officer in the Ford Foundation’s\nCairo, Egypt, field office with responsibility for Egypt, Sudan, Jordan, Yemen,\nLebanon, and the West Bank and Gaza. Then, in Arabic, Sandra greeted the\nMuslims in our audience, to the delight of all.\n<\/p>\n\n\n\n Sandra shared the fact that has inspired her research over the\npast dozen years: in the 1980s, Syracuse had the highest African-American\ninfant mortality in the country\u201430.8 deaths per thousand births, comparable to\nthat in many developing countries. This statistic refers to deaths from all\ncauses between birth and the first birthday. Sandra went on to explain that\nthis statistic indicates that our society lacks development; it is an indicator\nnot of lack of wealth, but of an inequitable distribution of wealth. This is an\nexample of structural violence: preventable harm or damage to persons that does\nnot result from someone committing an act of violence, but rather that emerges\nfrom an unequal distribution of power and resources and is thus built into the\nstructure of the society. <\/p>\n\n\n\n Sandra was interested in whether the infant mortality statistics\nwere predictive of higher mortality in Syracuse African-American adults. To\nfind out, she looked at death certificates filed in Syracuse vital records in\n2000. She collected information on both men and women identified as either\nAfrican American or Caucasian. (There were not enough identified as Asian, or\nNative American, or Latino to be statistically significant). She found\nthat fully half of African-American males who died in that year were under the\nage of 65, while only 25% of European-American males were under 65. In every age\ngroup up to 85 years, there was a higher percentage of deaths for African\nAmericans than for whites. Sandra calculated that if African Americans had the\nsame death rates as European Americans for the year 2000, there would have been\n75 fewer deaths among African-American males and 51 fewer deaths among\nAfrican-American females. <\/p>\n\n\n\n Analysis of death certificates revealed that a high number of\nthese excess deaths could be attributed to chronic diseases such as diabetes,\nstroke, heart disease, and kidney failure. And among African Americans, these\ndiseases are frequently not diagnosed until the individual already has organ\nfailure or severe circulatory problems that lead to amputation. Many African\nAmericans and Latinos delay visiting doctors because they do not have health\ninsurance. Excellus has estimated that 17% of employed adults in Onondaga\nCounty were uninsured between 1996 and 2003. And the Fair Wage Coalition has\nestimated that 50% of Syracuse employers don’t give health benefits. <\/p>\n\n\n\n Sandra looked at the percentage of pregnant employed women in\nthe Syracuse area who did not have insurance during their pregnancies. Among\nwomen age 20 and older who were employed, about 27% of white women and 50% of\nAfrican-American women and Latinas needed to receive Medicaid because they were\nuninsured. <\/p>\n\n\n\n Sandra and Kathleen work closely together, so Sandra passed the\ndiscussion to Kathleen. Kathleen explained that the medical establishment holds\nunsubstantiated opinions of uninsured patients. Many providers consider that\nthose who come to medical care late are drug users. However, pregnant women who\nneed public assistance sometimes delay getting services because of the stigma\nassociated with doing so. They also find it difficult to get the paperwork\ntogether and are intimidated by the process and accusatory questions that they\nface. Syracuse Healthy Start has worked to sensitize health care enrollers, so\nthat they will welcome pregnant women and help them feel more comfortable with\nthe experience of seeking help. Another problem discovered by a researcher who\nsurveyed medical providers in public clinics in Syracuse was that there were no\nfemale obstetricians, a definite obstacle for observant Muslim women and many\nrecent immigrants. (There is now one female obstetrician, with plans for more.) <\/p>\n\n\n\n Kathleen explained that although infant mortality rates have\ndecreased, a disparity still exists: 17 babies per thousand born to\nAfrican-American mothers, compared to about 6 per thousand born to\nEuropean-American mothers, die each year. Several community-based organizations\nhave stopped services for pregnant women because of funding cuts. Healthy\nStart’s funding has been flat for eight years, but they are making an effort to\nmaintain current staffing levels. <\/p>\n\n\n\n Sandy wanted to give us some good news and to tell us what\nprograms of Syracuse Healthy Start do work. First, according to statistics from\n2000 to 2002, providing case management for teens resulted in lower mortality\nrates for their babies than the rates for mothers in their twenties. This\nwas despite teens having a higher rate of sexually transmitted diseases (STDs),\nin part due to their having older partners. Second, focusing on health\nliteracy, with materials written at appropriate reading levels, has been\neffective. The city graduation rate of ninth grade students is 28.2%, according\nto the Urban Institute, which calculated the proportion of 9th graders who\nreceive a diploma when they reach the end of 12th grade. This is the lowest in\nthe state, so health education outside of the schools is essential.\n Third, Healthy Start gets pregnant women who are incarcerated at the\nJustice Center or Jamesville into care. There are between 100 and 140 of these\nwomen each year, and those who complete the care program and who remain local,\nwhere they can be followed, have outcomes similar to those of women who have\nnot been jailed. Fourth, for pregnant women, bacterial vaginosis is a serious\ninfection, and when it is treated, the racial disparity of early premature\nbirth in the first 32 weeks of pregnancy disappears. <\/p>\n\n\n\n What has not worked for pregnant women is welfare reform.\n The requirement to work until the 36th week of pregnancy is punitive and\nmay result in more time in the neonatal intensive care unit (NICU). Of the\ninfants of Temporary Assistance for Needy Families (TANF) clients, 15.7%\nrequired care in the NICU, compared with 6.5% of infants of women covered by\nMedicaid who did not receive public assistance. Kathleen explained that her son\nwas born at 34 weeks, so he was in the NICU. She was the only mom who was not\nvery young, and she had to think how expensive (NICU costs $1500 to $3000 per\nday) these births to uninsured teen mothers are to society. <\/p>\n\n\n\n Yet another risk factor was a woman\u2019s elevated blood level of\nlead when she was a very young child. When girls with high lead levels as\nchildren reached ages 15 to 19 years, they were over 50% more likely to be on\ntheir second<\/strong> or higher pregnancy. And the percentage of children with\nelevated blood level of lead is highest in those areas with the poorest birth\noutcomes. <\/p>\n\n\n\n Currently in Syracuse there have been many deaths by smothering\ncaused by co-sleeping. This is a problem because of our modern soft mattresses\nand fluffy comforters; it is not relevant when families slept on a thin mat\nwith a single blanket. Researchers were surprised when they realized that some\nlocal medical providers thought smothering was not a middle-class problem and\nhospital release procedures did not warn of the problem. After an information\ncampaign aimed at doctors and nurses, Kathleen was pleased that following the\nbirth of her most recent child, she received the same warnings not to put the\nbaby in bed between the parents that the teen parents received. <\/p>\n\n\n\n In the past, babies of lower socio-economic mothers at public\nclinics had their urine tested for drugs. However, recently Dr. Aubry began\nnotifying all mothers attending prenatal services that he wanted to do urine\ntests at the first pre-natal visit, with the understanding that no authorities\nwould be notified of the results and that drug users would be offered care.\nSandra and Dr. Aubry found that there were no differences in drug use among\nracial groups. One significant difference was that white women were smoking\ncigarettes more than black women. <\/p>\n\n\n\n Kathleen mentioned a study done in focus groups to find out what\nwomen’s perceptions were about smoking. Lower socio-economic groups, when asked\nwhat percentage of women smoke while pregnant, responded 70 to 80 percent. When\nupper socio-economic groups were asked the same question, they responded\n“none.” Kathleen said that perception can create its own reality, and\nif everyone seems to be doing something, it becomes acceptable. <\/p>\n\n\n\n Sandra’s statistical analysis has shown that intrauterine growth\nrestriction (IUGR), which results in low-birth-weight babies, is directly\nrelated to absence of a local supermarket (defined as a grocery market selling\na variety of types of food, including fresh produce and low-fat dairy). It\nmakes sense that lack of sources of healthy food for the mother would affect\nher pregnancy. Sandra projected a slide which showed the Syracuse areas with\nthe highest risk for poor birth outcomes, and another slide which showed areas\nwithin one-half mile of a supermarket. Proximity to a supermarket directly correlated\nwith better birth outcomes, regardless of income levels. Ironically, those\nhigh-mortality areas had three supermarkets prior to 1975. <\/p>\n\n\n\n Corner stores are available in high risk areas, but they provide\nlittle or no fresh produce or low-fat dairy, and what they have is likely to be\nout of date or twice as expensive as supermarkets. They make their profits from\nlottery tickets, cigarettes (including “loosies” or single cigarettes\nsold for fifty cents each), and alcohol. In fact, 68% of all lottery tickets\nsold in New York State are sold at corner stores, and $40 million worth are\nsold annually in Syracuse. Persons with incomes below $23,000 average $595 in\nlottery purchases, while those with incomes above $33,000 average $49 in\nlottery purchases. Again, the Syracuse zip codes with the lowest per-capita\nincome have the highest lottery sales, as people are buying hope. Lottery ads\nshow a high percentage of people of color, and they tout lottery tickets as\n“a good investment choice.” Since lottery money is supposed to\nsupport schools, and the money is distributed according to attendance numbers\n(how many students attend, not how many are eligible to attend), and Syracuse\nschools have an abysmal drop-out rate, a disproportionate amount of lottery\nmoney collected in Syracuse goes to high-attendance schools such as East\nSyracuse\u2013Minoa and Fayetteville-Manlius. <\/p>\n\n\n\n Sandra said that IUGR statistics can be considered a stand-in\nfor diabetes in older individuals. If adults do not have access to healthy\nfood, higher obesity and then diabetes can be the result. She called this\nanother example of structural violence: No one has consciously created this\nproblem. It is invisible, unlike spectacular accidents such as when a child\nfalls down a mine shaft and the entire town rallies to the rescue. She related\nthe irony of the location of a kidney dialysis center downtown. Kidney failure\nis often the result of diabetes or high blood pressure, both related to poor\ndiet. The dialysis center is sited on land that in the past had a supermarket,\nand its loss has contributed to inner-city poor diets. <\/p>\n\n\n\n Sandra told us that USDA licensing of markets, including corner\nstores, requires that 52% of sales should be food, but this is not enforced.\nAlso, state law restricts how much can be charged for milk, and corner stores\nexceed this. However, researchers do not want to turn in violators of either of\nthese laws, as that could inhibit cooperation that is needed for future\nresearch. <\/p>\n\n\n\n When asked about the possibility of providing public transportation\nto more distant grocery stores, Sandra said that it has been tried and that\nCentro is responsive, a good corporate citizen. However, it is difficult to ask\npeople to shop all at the same time, with children, and it is difficult for\nthem to carry groceries on a bus. The Southwest Community Center holds a weekly\nfarmers market in the summer. WIC (Women, Infants, and Children)\nprovides Federal grants to states for supplemental foods, health care\nreferrals, and nutrition education for low-income pregnant, breastfeeding, and\nnon-breastfeeding postpartum women, and to infants and children up to age five\nwho are found to be at nutritional risk. Locally, WIC is doing several\nfarmers markets downtown, with special checks that can be used only to buy\nfresh fruits and vegetables. <\/p>\n\n\n\n Another factor affecting African-American infant mortality in\nthe Syracuse area is the disproportionate incarceration of African-American\nmales, many times that of the white rate of incarceration. In Onondaga County,\nAfrican Americans comprise 9.4 percent of residents and 52 percent of the\ninmates in the local correctional facility. White residents are more likely to\nreceive probation or a fine. In situations where the father did not sign the\nDeclaration of Paternity within 48 hours after the birth, babies were almost\nfour times more likely to die between one month old and their first birthday.\nBabies need two parents. <\/p>\n\n\n\n WTB member Liz Spence related her experience with Ireland. Irish\nlaw requires that new mothers be given a six-month leave with pay and, if\nrequested, an additional six months without pay. In addition, the government\nprovides every new mother with a \u201cmother mentor\u201d to give advice and help for up\nto a year. <\/p>\n\n\n\n WTB member Bonnie Shoultz asked if Sandra had looked to see if\ntoxic mold is a problem here. Sandra said the researchers looked at that during\nan asthma study. Instead of mold being a problem, they found that 87% of the\nbabies’ urine samples showed high smoke levels, even though only 50% of the\nmothers smoked. <\/p>\n\n\n\n WTB co-founder Betsy Wiggins asked what can we do to support\nSandra’s and Kathleen’s work. Sandra suggested we work to get USDA rules on\nfood sales at corner stores enforced. Also, Rockefeller Laws need to be revised\nto lower the rate of African-American incarceration because the\ndisproportionate incarceration of African-American males results in babies with\nuninvolved fathers. Also, 92% of arrests for loitering were young\nAfrican-American males, arrests for just “hanging out.” Sandra\nsaid that Congressman Dan Maffei is very open to new avenues to address\nSyracuse problems. <\/p>\n\n\n\n Sandra said that she and her colleagues are conducting an\nepicenter zip code analysis. There are about 30 zip codes in New York State to\nwhich high numbers of incarcerated individuals return after release, and those\nzip codes have higher HIV rates among African-American women. Two of these zip\ncodes are in Syracuse. <\/p>\n\n\n\n Kathleen added that the smothering while sleeping issue is the\nnumber-one cause of preventable death in Syracuse. Parents may put an infant in\nbed with them because of the high cost of heating, or simply the cost of a crib\nand warm infant clothes. So Healthy Start tries to provide cribs and wearable\nblanket sleepers (not comforters) to moms who can’t find a crib from any family\nor friends, and she always looks for donations. This was met by a flurry of\nwomen offering cribs from their own homes. <\/p>\n\n\n\n In closing, Daryl Files told our speakers that we can choose to\nbe part of the solution to the problem of inadequate diet. She offered each\nwoman a packet of vegetable seeds to plant and suggested they consider donating\nthe produce to a local food pantry; a two-page list of local food pantries was\nhanded out along with the seed packets. Daryl then read a poem by Destiny\nPaige Bailey, “My Mother’s Garden,” that declares that we are our\nmothers’ gardens, grown and nurtured with love and care. <\/p>\n","protected":false},"excerpt":{"rendered":" Dr. Sandra Lane and Kathleen Coughlin offered insights into a little-known local issue: the unequal health and survival of babies caused by poverty and structural discrimination. <\/p>\n","protected":false},"author":3,"featured_media":7688,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[23],"class_list":["post-7501","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-programs","tag-advocacy",""],"_links":{"self":[{"href":"https:\/\/wtb.org\/index.php?rest_route=\/wp\/v2\/posts\/7501","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wtb.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wtb.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wtb.org\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/wtb.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7501"}],"version-history":[{"count":7,"href":"https:\/\/wtb.org\/index.php?rest_route=\/wp\/v2\/posts\/7501\/revisions"}],"predecessor-version":[{"id":8719,"href":"https:\/\/wtb.org\/index.php?rest_route=\/wp\/v2\/posts\/7501\/revisions\/8719"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wtb.org\/index.php?rest_route=\/wp\/v2\/media\/7688"}],"wp:attachment":[{"href":"https:\/\/wtb.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7501"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wtb.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7501"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wtb.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7501"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}