Infant mortality in Dane County, which has been about three times higher in Black babies than white babies for many years, more than doubled among Hispanics in recent years, with the latest figures showing Hispanics having the highest level of any group.
It’s not clear what has caused the alarming increase in deaths of Hispanic or Latino babies before their first birthday, but health officials and advocates say structural racism, toxic stress and a lack of Spanish-language resources may be contributing factors.
“Being a parent here as a Latino ... is really difficult, regardless of how many years you have been in the United States or if you were born here,” said Mariela Quesada Centeno, manager of Roots4Change, a Madison-based cooperative of six Latina or indigenous doulas, or birth coaches.
“We’re very, very concerned with this increase,” said Katarina Grande, maternal and child health supervisor with Public Health Madison and Dane County, which is working with Roots4Change and other groups to address the problem.
“Public Health is just one player in this huge, complex issue,” Grande said. “It’s going to take a full community approach to make a difference here.”
Statewide, the infant mortality rate for Hispanic babies also climbed in recent years and is now higher than for non-Hispanic babies, according to the Wisconsin Department of Health Services.
A decade ago in Dane County, deaths among Hispanic babies were less common than for whites, Asians and Blacks. Since 2015-2017, when there were five infant deaths per 1,000 births among Hispanics babies, the rate has gone up to 11.3 deaths per 1,000 births in 2018-2020. In the latest period, the rate was 10.8 for Blacks, four for whites and 1.4 for Asians.
Preterm birth and low birth weight, key contributors to infant mortality, appear to have gone up among Hispanics during the past decade, but Grande said the changes are not statistically significant. Rates of cesarean-section deliveries and sudden infant death, which can be caused by co-sleeping, are similar among whites and Hispanics, she said. Breastfeeding, which is linked to good birth outcomes, is high among Hispanic mothers immediately after birth, she said.
Hispanic babies of mothers who were born outside of the United States, who account for about 60% of the Hispanic births in the county, appear to have lower rates of infant mortality, preterm birth and low birth weight than the 40% of Hispanic babies of mothers born in the U.S., Grande said.
Stress and isolation
Quesada Centeno said increased stress on Hispanic mothers from the intensified debate over immigration surrounding the 2016 election may have helped fuel the rise in infant mortality in Dane County.
“Our families were under attack and are still under attack, even locally,” she said. “That is social stress. It does transform in the body. When you’re pregnant, that increases the risk.”
When her second daughter was born 12 weeks premature and spent nearly three months in the neonatal intensive care unit at SSM Health St. Mary’s Hospital, staff attended to the technical needs, but Quesada Centeno felt isolated, with little emotional support, she said. The girl, now 7, is doing well.
“I felt so lonely,” said Quesada Centeno, who lives in Brooklyn. “Everything was too medical.”
Maricela Martínez, a mother of four who is also a doula with Roots4Change, said that during one of her pregnancies, doctors downplayed her complaints of breast pain. She later realized she had mastitis, inflammation that can be treated with antibiotics.
With her youngest child, a girl born in December, doctors wanted to induce labor. But Martínez, of Madison, preferred to wait for her to come naturally, which happened at nearly 42 weeks gestation.
“Sometimes the medical system is rushing,” she said. “When we give permission to our body to open ... the body responds.”
The doulas at Roots4Change, which started in 2018, assist Hispanic mothers before, during and after birth by providing emotional and practical support, such as with breastfeeding. They hold parent discussion groups in Spanish, in an effort to improve maternal and child health throughout the community, Martinez said.
Paired with the state health department, the co-op is among six community organizations and state health departments participating in a project through the Association of Maternal and Child Health Programs to identify reasons for inequities in perinatal health.
‘Roller-coaster of emotions’
The Roots4Change doulas also support one another during their own pregnancies. On a recent day, doula Jennifer Valencia talked with Martinez and others about challenges with her third pregnancy, for which she was at 20 weeks.
Her first daughter, now 4, was premature. Her second, now 3, had to be resuscitated at birth and stay in the NICU. “Everybody forgot about me and was taking care of my baby,” said Valencia, of Sun Prairie.
Now, with a third child coming, she wishes her parents and extended family were nearby so they could help. They live in North Carolina. She and her husband came to the Madison area six years ago for his job.
“It’s a roller-coaster of emotions,” Valencia said.
Distance from family and cultural traditions is a common stressor for Latina mothers in the Madison area, said Dr. Patricia Téllez-Girón, a UW Health family medicine provider who treats many Latinas at Wingra Family Medical Center in Madison.
“We have lost a lot of our social support,” she said. “Before we used to have abuelita (grandmother) who used to say, ‘Breastfeeding is best for you.’”
While most Hispanic women start breastfeeding their babies, many later switch to formula much of the time, especially when they return to workplaces that don’t support breastfeeding, said Téllez-Girón, co-chair of the Latino Health Council in Dane County.
Some mothers fear seeking health care or social services if they are uninsured or undocumented, she said. In the past couple of years, more women have been immigrating from Honduras or elsewhere in Central America while pregnant, with little or no prenatal care on the way, she said.
“We’re going to see more and more women doing that,” Téllez-Girón said.
Shiva Bidar-Sielaff, co-chair of the Latino Health Council and vice president for diversity, equity and inclusion at UW Health, said expanding paid family leave and Medicaid coverage for women after birth would help Latina and other mothers. Paid family leave is part of a bill under debate in Congress, and the Republican-controlled state Legislature this year increased postpartum Medicaid coverage from 60 days to 90 days after Democratic Gov. Tony Evers proposed extending it to one year.
Black and Hispanic efforts
Efforts to address poor birth outcomes among Black babies in Dane County could also help Hispanic babies, organizers say.
The county’s Black infant mortality rate, which had long been higher than for whites, dropped nearly 70 percent from 1990-2001 to 2002-2007, a dip that gained national attention as a success story. But the rate went back up starting in 2008 and generally has remained high, leading to renewed efforts to reduce it.
A 2019 report by the Madison-based Foundation for Black Women’s Wellness and the Dane County Health Council said stressed families, economic struggles and institutional racism are key reasons Black babies in the county are twice as likely as white babies to be born with low birth weight, which contributes to infant mortality.
In December, the groups plan to include a care coordination screening tool in Verona-based Epic Systems Corp. electronic medical records used at SSM Health, UW Health, UnityPoint Health-Meriter and Group Health Cooperative of South Central Wisconsin. The tool will identify non-medical needs of pregnant Black women — such as housing, child care and transportation — and track referrals to nonprofit groups, said Lisa Peyton-Caire, president of the Foundation for Black Women’s Wellness.
Eventually, the tool will be used for Latinas and other pregnant women, she said.
“Black women and Latinx women are facing many of the same inequities in health care access, health care quality and quality-of-life issues around income, housing and all those stabilizing pieces that women and families really need to have healthier outcomes,” Peyton-Caire said.
Public Health Madison and Dane County is also continuing efforts that could benefit both groups, said Daniel Stattelman-Scanlan, the department’s perinatal supervisor.
One is a Fetal Infant Mortality Review, or FIMR, which analyzes infant deaths to identify patterns. A FIMR report with data from a decade ago identified high diabetes rates in Hispanic mothers, but it’s not clear whether that is playing a role in the recent surge in infant deaths, Stattelman-Scanlan said.
Public Health nurses also make home visits to pregnant women and new mothers at risk for poor birth outcomes. The effort has been hampered by the COVID-19 pandemic, but visits are picking up again and referrals for Spanish-speaking women are increasing, said Merta Maaneb de Macedo, one of the nurses.