Racial and ethnic disparities in maternal and infant health outcomes remain large in Wisconsin

Racial and ethnic disparities in maternal and infant health outcomes show no signs of improvement in Wisconsin, according to a national report card from the nonprofit March of Dimes.

Wisconsin won the C overall. The state’s preterm birth rate has risen over the past decade to 10 percent. Despite that increase, Wisconsin is doing slightly better than the national average of 10.5 percent.

Yet this advantage disappears when looking at areas of the state with higher numbers of marginalized residents. In these communities, health outcomes for expectant mothers and babies lag far behind state and national averages. Babies born prematurely appear before 37 weeks of pregnancy.

“We don’t want to react to a health crisis. We want to be proactive and say, ‘Okay, we’re seeing this kind of upswing that’s slowly creeping in, how can we stop this from becoming an F across the country?'” said Emily Kittel, manager of maternal and infant health initiatives at the March of Dimes , Wisconsin.

The largest city in the state is already there. Milwaukee received an F on its report for an above-average preterm birth rate of 12.2 percent. The district earned a D- at 11.3 percent.

“We as a country have to say, ‘This is not good for our mothers, for our babies, and we can do better. And we need to do better,” said Dr. Nathan Lepp, associate clinical professor of neonatology at the University of Wisconsin-Madison.

While Dane, Outagamie and Milwaukee counties improved their preterm birth rates from last year, Brown, Racine and Waukesha counties fared worse.

Emmanuel Nguyen, a UW-Milwaukee associate professor of community health promotion and behavioral health, said these disparities are concentrated in poorer, under-resourced communities with large minority populations. He described the report as a “wake-up call” but said “for those of us in the perinatal health field, this is not new.”

Menominee, for example, has an 80.8 percent American Indian and Alaska Native population. Milwaukee’s black population is about 27.6 percent. Both counties are among the most vulnerable in the state for mothers to experience poor pregnancy outcomes, according to the March of Dimes’ “maternal vulnerability index.”

“I think what we need to do in the state of Wisconsin is continue to look at why we have such a large racial disparity. Is it the social determinants of health and the higher rates of black and brown communities experiencing food insecurity, housing poverty rates?” Kittel said.

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Black women gave birth prematurely at a 68 percent higher rate than all other women, up from 65 percent in the last report card. The groups with the largest disparities included 15.6 percent of black mothers and 12.7 percent of American Indian mothers, compared to 9.2 percent of white mothers.

Kittell also pointed to rural areas where people have limited or no access to prenatal care — about 21 percent of Wisconsin counties are considered maternity care deserts.

UW-Madison’s Lepp called these differences “profound and troubling.” Premature births are the second leading cause of infant death and can take an emotional and financial toll on families, according to the CDC.

Babies are at increased risk of infections and bleeding in the brain, Lepp said, and those who survive may suffer long-term health complications.

In Wisconsin, Medicaid doesn’t cover doula care, but it’s something Lepp said would improve health outcomes, along with expanding coverage for postpartum care from 60 to 90 days.

“We can hope that we can start to break away from these problems of access to quality care, of mothers being listened to and cared about and getting the care they need to be healthy,” Lepp said .

Wisconsin’s infant mortality rate is 5.8 per 1,000 live births. Lepp said that’s a slight improvement over recent years, but still above the national average of 5.4.

And the rate is two to three times higher for blacks in the city of Milwaukee, according to Nguyen. The most recent research shows that between 2016 and 2018, the infant mortality rate for black Milwaukeeans was about 16 percent, compared to 5.7 percent for whites.

“We still have a long way to go,” Nguyen said.

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