The history of public health programming for Black infants and families in California and the birth disparities that persist

One need only glance at the statistics around perinatal outcomes for Black mothers and babies to see how pervasive racism has created a public health crisis with profound impacts on Black Americans.

In California, Black women are roughly four times more likely to die from pregnancy-related causes than women in all other racial/ethnic groups. California’s Black infants are almost three times more likely to die than white infants, regardless of the mother’s education and income. Indeed, a Black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education.

Research indicates these perinatal outcomes are the result of toxic stress built up over a lifetime of experiencing racism, compounded by provider bias and racial disparities in health care quality and access.

In an effort to improve Black infant and maternal health, the California Department of Public Health (CDPH) has overseen the Black Infant Health Program (BIH) since 1989. The program has gone through many changes over the last three decades as California increases its understanding of the root causes of disparities, the impact of stress on health, and the importance of social support.

In its current form, the BIH program operates in 13 counties where over 90% of Black babies are born, and consists of 10 prenatal and 10 postnatal group sessions on pregnancy and parenting. Participants learn proven strategies to reduce stress and develop life skills, with services provided for free by Family Health Advocates, Group Facilitators, Public Health Nurses and Social Workers. In addition to group sessions, participants may also receive individual sessions on client-centered life planning including referrals for needed services, family planning, and goal setting.

The First 5 Center for Children’s Policy with the help of Lanikque Howard, who primarily conducted the research, interviewed First 5 commission staff in 11 of the 13 BIH counties to learn about local coordination efforts. Most of these First 5s are partnering with their local public health department to address maternal and infant mortality and health disparities. Partnerships include supporting outreach and recruitment efforts, blending funding for joint programs and initiatives, and engaging in the Perinatal Equity Initiative (PEI) rollout.

Interviewees noted that mothers who are enrolled in BIH enjoy the program and believe it is beneficial. However, they also noted that the program sometimes fails to reach a large percentage of its target population. One of the challenges for enrollment, they said, is that referring providers may believe the best program for families is an evidence-based home visiting model. If a parent meets the criteria for both an evidence-based home visiting program and the BIH program, the provider is often more likely to focus on getting the parent enrolled into home visiting. In counties where individuals enrolled in BIH are not allowed to enroll in home visiting programs too, this approach can limit the number of parents who enroll in BIH.

First 5s can play a role in helping their local BIH implementing partners to recruit families, and to support more coordinated service delivery between BIH and local home visiting programs when dual enrollment is allowed. At the same time, we must recognize that disparities in perinatal outcomes for Black moms and babies are closely tied to racism experienced across the life course, and improvements to the BIH program are just one element of a larger effort the state must make to increase equity, and improve the health of California families. This year’s national racial awakening provides a moment to look at health disparities that affect the Black community with a wider lens, and to take on the root causes that lead to tragic outcomes with renewed vigor.