Mississippi's lost babies

In part 4 of 'America Left Behind,' we examine why black infant death outpaces Botswana

In part 4 of 'America Left Behind,' we examine why black infant death outpaces Botswana
Jamekia Howard walks in the cemetery where her two babies are buried, Hollandale, Miss., Dec. 8, 2015


At the end of this year, the targets set by the United Nations in 2000 for developing countries will expire. In this project, we take those eight Millennium Development Goals and examine how some communities in the United States measure up. We have applied each goal to the U.S. by looking at an indicator used to measure a country’s development success and interpreting it for a specific community in America. The eight goals are: eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality, improve maternal health, combat HIV/AIDS and other diseases, ensure environmental sustainability, and develop a global partnership for development. In this piece, we look at why infant mortality is so high in Mississippi.

In the tiny town of Hollandale, in the Mississippi Delta, mother Jamekia Howard sat in her living room and solemnly flipped through photographs of two of her children.

Later Howard, a 31-year-old social worker, pointed to graves marked by small metal signs in the Sanders Garden Memorial, where her babies were buried. The cemetery, just a short drive from her house, serves most of the black families in her Washington County town.

“I go visit them all the time,” she said.

Both of Howard’s babies died before they turned 1. She lost her boy De Terrance to a birth defect that left him without an esophagus, when he was just 1 month old. Her daughter Fremya was a stillborn two years later, in 2004. Both were premature, she said.

Since Howard lost her babies, the infant mortality rate has improved in Mississippi. Over the past five years, the number of babies dying before their first birthday has declined by 15 percent.

But at 8.2 infant deaths per 1,000 live births, Mississippi has the highest infant mortality rate in the U.S., which has a national average of 5.9 deaths per 1,000 live births, and black infants are nearly twice as likely to die as white babies.

In fact, if Mississippi were a country, it would fare worse this year in infant death than Lebanon — considered a developing country by the United Nations — or Bosnia, dubbed an “economy in transition,” according to estimates by the Central Intelligence Agency.

There isn’t one clear explanation, but health experts have noticed some trends. According to a 2015 report on infant mortality by the Mississippi Department of Health, mothers’ health before and during pregnancy is one of the biggest contributing factors to infant deaths.

Jamekia Howard lost two children before giving birth to a son, Freddie Lee Robinson, Jr. now eight years old. (Click to enlarge images)

Like many whose babies have died in Mississippi, Howard had a medical condition before she got pregnant. She has long had a hyperactive thyroid, she said, but wasn’t aware of the potential effects on in utero development until recently. She said she had prenatal care but her doctors didn’t explain the risks of her condition on pregnancy.

“If I knew, I would have held out,” she said. “I didn’t know the risks back then.”

Race is a factor too. Statistically speaking, Howard was more likely to lose her babies than the average woman her age because she is black.

While the black infant mortality rate dropped by nearly 19 percent from 2009 to 2014 in Mississippi, the rate remains disproportionately high, at 11.2 deaths per 1,000 live births. That is significantly worse than in Botswana, which saw 8.9 infant deaths per live births in 2015 — despite the fact that Botswana has an average annual income of $7,240 and 0.4 physicians per 1,000 people, compared with the United States’ 2.4.

State health officer Mary Currier has said that the racial disparity is largely due to poverty and social determinants of health.

In Mississippi black people are more likely than white people to be poor, with 40 percent and 11 percent falling under the poverty line in 2013, respectively, according to the Henry J. Kaiser Family Foundation. The CDC also shows that nationwide, black women are 50 percent more likely to give birth to a premature baby.

Infant mortality among black people in Mississippi is twice the national average


Sources: Centers for Disease Control and Prevention, Mississippi Vital Statistics

Poor access to adequate health care, including low-income Mississippians’ lower likelihood to have access to transportation, plays a major role too, according to the state and Kim Robinson, the program manager of national policy initiatives for the Children’s Defense Fund.

As part of her advocacy work, she helps mothers find services like Medicaid and the Community Action Network, a partnership of organizations dedicated to improving opportunities for the underprivileged.

Robinson said the issue of adequate health care in Mississippi is twofold. Often, she said, mothers don’t know when to see a doctor to begin with.

When mothers do seek out care, especially in early stages of pregnancy, there’s not adequate transportation for them to get to providers. “Some mothers travel 30 miles or more, because it’s an issue of them not having someone local,” she said. “In rural parts of Mississippi, specifically in the Delta regions, there is a huge-access-to-care issue.”

Grave markers in cemeteries in the Mississippi towns of Terry, Summit and McComb. (Click to enlarge images)

It’s not just Mississippi that ranks poorly in terms of infant mortality. Worldwide, the United States fares worse than most other developed countries.

In the CIA’s World Factbook list of nations’ estimated infant mortality rates for 2015, the U.S., with 5.87 deaths per 1,000 live births, has the 167th-highest rate out of 224 countries — between Serbia and Croatia. In comparison, Monaco has the lowest rate, 1.82 deaths per 1,000 live births.

The rate of infant death in the U.S. has long baffled experts, and improving it is one of the objectives of Healthy People 2020, a government road map for bettering national health. Experts aim to get the national infant mortality rate down to 6 per 1,000 live births.

One way is to reduce premature birth, the country’s No. 1 killer of babies, according to the CDC. A 2015 report put together by the March of Dimes shows that about 380,000 babies are born prematurely in the country each year. Four states received an F grade for prematurity — including Mississippi, which saw nearly 13 percent of babies born early. According to Dr. Renate Savich, the division chief of the highest-level neonatal care center in the state, at the University of Mississippi Medical Center, much of what causes prematurity in the state is preventable. “We have lots of extreme prematurity — babies born at 22, 23, 24 weeks,” she said. “A lot of that has to do with very little prenatal care. There’s high obesity, high hypertension, smoking. You just have poor health in mothers before pregnancy.”

Jelessa Washington, 27, at home with her children, Do’Koriean, six, and Kourtney, five months. (Click to enlarge images)

In some areas of Mississippi, mothers and social workers are coming together to reverse those trends.

Such is the case in Rolling Fork, a remote town in the delta, where Nickie Parker, a social worker with the nonprofit Cary Christian Center, recently met with 27-year-old Jelessa Washington and her two children in their three-bedroom trailer. Kourtney, 5 months, was recovering from a cold. Do-Koriean, 6, was also sick, with an ear infection. “It is the season,” said Parker told Washington.

Their home, where the three of them live with Washington’s father, was cramped but warm and cozy. The baby played on a fuzzy blanket in front of a sectional sofa. A miniature Christmas tree with bright ornaments was on a kitchen table, with presents underneath.

Parker encouraged Washington to keep giving the prescribed medications — Benadryl and Robitussin — and praised her for taking the kids to the doctor at the first sign of infection.

As part of her work, she makes regular home visits to mothers like Washington, asking if the women and their kids regularly get to a doctor, are eating well and have safe sleeping arrangements.

The organization’s workers travel up to 30 miles to see more than 70 mothers who live in small communities in and around Sharkey County, off highways surrounded by cotton fields and soybean farms.

Many mothers have to travel farther than that to visit a doctor, since there’s no obstetrician in town. The area is so rural, there is only one major grocery store, which serves Sharkey and Issaquena counties.

Nickie Parker, the parent liaison with the Carty Christian Center, visits families in Hollandale, top, prepares for a meeting in Cary. Fellow caseworker Debra Booker knocks on a door in Rolling Fork on Dec. 8, 2015. (Click to enlarge images)

Despite rural seclusion and a high rate of poverty, Sharkey has had a low infant death rate. The 2015 state report shows the rate there is under 5.2 deaths per 1,000 live births — one of the lowest in Mississippi.

Parker attributes the statistics to the work of the Cary Christian Center and to the relationships and trust built among new mothers in the area.

“Home visiting is the key,” she said as she drove away from the visit with Washington. “I don’t want them to feel like I’m drilling them. Because they’re going to shut the door on you if you do. They might not shut the door physically, but they will emotionally.”

Debra Booker holds her 16 month old grandson Jahari Stubs Parker. She had two miscarriages before she gave birth to her daughter LaTamela Taylor. Taylor, 26, herself also had two miscarriages before giving birth to Jahari. (Click to enlarge images)

Social worker Tashunda S. Vaughn, who works about 145 miles north of Cary in Tunica, agrees. She said a big part of the job is giving information in bite-size portions and withholding judgment.

She is part of the Tougaloo College Delta Health Partners Healthy Start initiative, which is federally funded. She and six other case managers — all registered nurses or licensed social workers — meet with about 300 pregnant clients in seven counties to reduce infant mortality among the high-risk and underserved.

Like Parker, Vaughn is very hands-on with her clients. She goes to their homes, teaches them about breast-feeding, colic and developmental benchmarks. Recently, her organization held a community baby shower for parents in need of supplies.

She trailed the ambulance when 23-year-old Lendrika Muse was brought to the hospital and later attended the birth of her daughter, Kailah.

“I probably wouldn’t get to the doctor or nothing if it weren’t for them,” Muse said. “Us being so young and everything, they help us out.” She now has four healthy children.

In Hollandale, Howard had a success story too. Her last baby, Freddie Lee, was born eight years ago and is now a strong, active boy.

According to Savich, mothers like Howard now have a better chance of having healthy babies, thanks to those collaborative efforts being made between private organizations and state entities.

“I’m really confident in the next five years, Mississippi is going to make dramatic improvement,” she said.

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