According to WalletHub.com “2016 Best and Worst Places to Have a Baby”. Wallethub.com is a virtual financial planning company that helps individuals track their spending and saving, help repair credit and help individuals protect their credit history including protecting identity. Wallethub.com tracks people and money and in their opinion, if you cannot afford to have a baby, you shouldn’t. When the parameters of delivery budget (cost to have a baby, cost of living and cost/availability of health insurance), overall health care ranking (maternal and infant mortality, rates of prematurity, availability of professionals such as midwives and pediatricians, etc.. ) and baby friendliness (i.e. parental leave, available childcare, support for new moms, etc..) were analyzed for the 50 states and the District of Columbia, Vermont ranked number 1 as best place to have a baby by wallethub.com.
It is important to plan for children as unintended pregnancies can cause huge financial strains on families and can have serious health implications for mothers and infants if pregnancies occur too close together. But there are other, equally important issues to consider before becoming pregnant; availability of and access to quality prenatal care, adequate food resources, housing, how will the mama/family fare without mama’s income, childcare and availability and accessibility of resources such as transportation that may pose potential roadblocks to a healthy pregnancy and birth.
The article in question alluded to the fact that if a couple cannot afford a child, they should not have a child. Well, I live in Texas where availability of and access to family planning information and resources is extremely and increasingly limited. So what is a couple to do? Perhaps they cannot afford a child but in Texas, there is not readily available contraception and virtually no access to abortion. Should people simply stop having sex? That won’t happen!
I agree, finances should factor into the decision of whether or not to have a child. The reality is that conception is happening regardless of financial status (or even couple status!!). In my opinion, the best states or more pointedly, the best places to have a baby (because there are little oases within what I will call “maternity deserts”, areas that are fairly void of any sort of maternity support or reproductive health care) are places with the following:
- obstetricians and midwives, and facilities that allow both to perform deliveries
- birthing facilities that use the least amount of intervention that is safely possible
- birthing facilities that allow fathers and doulas to be present to support mama during labor and delivery
- birthing facilities that allow mama to freely move during labor
- birthing facilities that believe in immediate skin to skin bonding between mother and baby (even before wiping off the vernix, provided there are no health complications in either mother or baby!)
- birthing facilities that promote breastfeeding and provide immediate and readily available lactation support to new mothers
These characteristics should define whether or not a provider, a hospital or birthing center, a city or town or a state is “best for mama and baby.” The worst state in which to have a baby according to Wallethub.com is Mississippi and yet I would bet that within that state there are a few hospitals or birthing centers that are supportive of childbearing women and offer quality care and support. In addition to financial considerations, prior to pregnancy (or at least prior to birth) mamas and their partners should research health care providers and the health care facilities available to them in their states, cities and communities. For sure some cities will have more resources than others, and some states will have more resources than others. But that doesn’t mean that having an uncomplicated, normal healthy birth is absolutely impossible. It just means that mamas will have to be savvy, do research about what is available and collect as many resources for themselves as possible.
Mamas, be careful what you read. The headline “Vermont is the best place to have a baby” is misleading alone, may have had many mamas ready to relocate and truly doesn’t give mamas and their families tools and tips to evaluate birthing resources and facilities in their area that may in fact be “Mama and Baby Friendly”. I believe that every woman can have a healthy, uncomplicated pregnancy and birth a healthy full term normal weight infant. This is much easier to do in some areas where resources are more readily available than in others, but it is possible none the less. Use the aforementioned list as a guide to evaluating resources and with a bit of research, you too can make your pregnancy, labor and delivery mama and baby friendly-no matter where you live in the United States!
Mamas on Bedrest & Beyond is committed to helping mamas have safe, healthy pregnancies, labors & deliveries and healthy full term babies. If you need help finding resources in your area, e-mail firstname.lastname@example.org.
September is Infant Mortality Awareness month and on Saturday, September 24, 2016, Mamas on Bedrest & Beyond and her supporters will walk from Seton Medical Center in Austin to The Dell Seton Medical School at the University of Texas to raise awareness of Black Infant Mortality. Why are we walking?
From 2000 to 2013, The National Vital Statistics Report shows the infant mortality rate (IMR) declined nationally, yet there remains a persistent 2—3 fold disparity in IMR of black infants compared to their white and hispanic counterparts. Texas follows this trend with an IMR of 5.8 overall in 2013. But looking at specific data from the Texas Department of Health and Human Services for 2013, while the overall IMR was 5.8 deaths per 1000 births, the IMR of black infants statewide was 11.9 deaths per 1000 births. The picture gets even gloomier if we look at Travis County. In 2012 (the last year for which data has been compiled) the IMR for black infants was 13.6 deaths per 1000 births, 2.85 times the death rate of white infants. In 2013, the disparity ratio for IMR of black infants to all infants in Texas was 3.02, or black infants are 3.02 times more likely to die before their first birthday than infants of other races here in Travis County.
Austin/Travis County is the state capital and one of the wealthiest counties in the state. Yet since 2000 Austin/Travis County has failed in its attempts to improve birth outcomes and survival rates for black infants to match those of infants of other races. The IMR for 2013 actually represents an increase in IMR from previous data.
The Call to Action
We believe that an IMR of 6.0 deaths per 1000 or less is attainable for black infants in Travis County, just as it has been attained for infants of other races. Here are 6 steps we could initiate to make this possible:
- Strongly encourage the Texas Legislature to take the Medicaid Expansion funds allotted for the state by the Affordable Care Act. This alone would insure another 1.3 million Texans, many of them women and infants, and give more access to comprehensive prenatal care, post natal and pediatric care.
- Work to increase the number of black health care providers (physicians, nurses, midwives, lactation consultants, childbirth educators and community health workers) in Austin/Travis County.
- Include members of the black community in the conversation about Place Based health initiatives and new treatments (like 17P for the prevention of preterm labor) so that they can make informed decisions about their health care, help educate members of the community and increase utilization.
- An aggressive community outreach campaign which includes community gatherings for conversations, presentations at churches and other community venues and even door to door health information and health education efforts by members of the community.
- Educate and elevate. Black citizens in Travis County are not looking for a handout, but a hand up. When information is presented in a clear and understandable way, people are more receptive, more apt to listen and more likely to act.
- Support initiatives that will help restore the infrastructure in the black community such as improved schools, jobs, affordable housing, safe and affordable childcare, additional security, public transportation and grocery stores.
What are you doing to raise awareness about Black Infant Mortality? Share your thoughts and events in our comments section below.
For more information about our walk or to get involved, e-mail us at email@example.com
The National Vital Statistics Report, Volume 64, Number 9. August 6, 2015
The Office of Minority Health and Health Equity, Infant Mortality for the State of Texas and Travis County
Did you know that September is Infant Mortality Awareness Month?
Globally, The United States spends more on healthcare than any other country. Yet, it has worse birth outcomes than many other countries globally. Despite recent declines in infant mortality, the United States ranked 26th among the 29 Organization for Economic Co-operation and Development (OECD) countries in 2010, behind most European countries as well as Japan, Korea, Israel, Australia, and New Zealand (1). The U.S. infant mortality rate of 6.1 infant deaths per 1,000 live births was more than twice that for Japan and Finland (both 2.3), the countries with the lowest rates. Twenty-one of the 26 OECD countries studied had infant mortality rates below 5.0.
Overall in the United States, white infants die at a rate of 5-6/1000 births and Hispanic infants have a similar infant mortality rate. African American Infants die at a rate of approximately 11.4/1000 births. I’m here in Texas and our infant mortality rate for white and hispanic infants is 5.5/1000 births while it is 11.4/1000 for African American Infants. In Travis County (the Greater Austin Area where I live), African American Infants have an infant mortality rate of 11.5/1000 births, whereas white infants have an infant mortality rate of 3.7/1000 births and Hispanic infants 6/1000 births.(2) What is the cause of this disparity?
Researchers and public health officials have numerous speculations as to why the IMR for African American infants is so poor,
- Delayed initiation of prenatal care among African American women
- Lack of access to quality prenatal care
- Lack of insurance
- Preterm labor/Prematurity
- Low birth weight
- Birth Defect
- Maternal health complications
However Dr. Michael Lu, an obstetrician and gynecologist at the David Geffen School of Medicine at UCLA and a professor in the Department of Community Health Sciences and the Center for Healthier Children, Families and Communities at UCLA School of Public Health has proposed other reasons for the birth outcome disparities. In his groundbreaking research paper “Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach“ (3) Dr Lu and his colleagues point to systemic racism in American culture as the underlying cause of the birth outcome disparities. Lu and his colleagues point out that racism passed down through generations, as well as repeated racial slights in the daily lives of African American women has created an allostatic load of stress on African American women that is affecting their overall health, but in particular, their reproductive health and causing the negative birth outcomes we see in African American women and infants. To address these social determinants of health, Lu and his colleagues propose a 12 point Life-Course approach to closing the racial gap in birth outcomes.
- Provide Inter-conception care for women with prior adverse pregnancy outcomes
- Increase access to preconception care for African American women
- Improve the quality of prenatal care for African American women
- Expand healthcare access over the life course for African American women
- Strengthen father involvement in African American families
- Enhance systems coordination and integration for family support services
- Create reproductive social capital in African American communities
- Invest in community building and urban renewal
- Close the education gap
- Reduce poverty among African American families
- Support working mothers and families
- Undo Racism
Lu and his colleagues have presented an approach that not only address issues surrounding pregnancy and childbearing, but also addresses the social issues affecting African American families and communities. Lu makes some very bold statements, ones that some people may be loathe to accept and even less likely to act upon. But as Lu says in his publication,
“We will not close the Black-White gap in birth outcomes without political will to do so. Political will is the ability to command resources to make things happen (i.e. implement the 12 points).”
As the saying goes, “Where there is a will, there is a way!” The question now becomes do we the American people have the will, the actual desire to close this gap?
MacDorman MF, Mathews TJ, Mohangoo AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe, 2010. National vital statistics reports; vol 63 no 5. Hyattsville, MD: National Center for Health Statistics. 2014.
Austin Travis County Health and Human Services Department. Infant Mortality Rate Causes of Death for Travis County, 2000-2011. Data Source, Center for Health Statistics, Texas Department of State Health Services. Texas Behavioral Risk Factor Surveillance System (BRFSS) 2011-2012
Lu, M.C., MD, MPH, Kotelchuck, M., PhD, MPH, Hogan, V., DrPH, Jones, L., MA, Wright, K., PhD, MPH, Halfon, N., MD, MPH. “Closing The Black-White Gap in Birth Outcomes: A Life-Course Approach” Ethnicity and Disease, Volume 20, Winter 2010.