Disparities Persist in Infant Mortality 

Creative Approaches Work to Close the Gap 

By Kauthar B. Umar, MA


Closing the Gap, Working Toward Our Goal • August 2003


During the last several decades, reducing infant mortality has 

been an ongoing challenge. The Centers for Disease Con 

trol and Prevention (CDC) states that despite substantial 

reductions throughout the United States, Black/White disparities in 

infant mortality rates persist. From 1980 to 2000, infant mortality 

rates declined 45.2 percent among all races, although the decline was 

greater for Whites (10.9 to 5.7 percent) than for Blacks (22.2 to 14.0 

percent). 

“Insufficient prenatal care resulting in low birth weight is a major 

factor associated with infant mortality,” said Dr. Fern Johnson-Clarke, 

chief of the Research and Analysis Division at the District of Columbia Department of Health (DCDoH). According to the DCDoH, in 

2000, the percentage of low birth weight infants (those weighing 

fewer than 5.5 pounds) in the District was 11.9—with low birth 

weight affecting Blacks almost twice as much as Whites. 

Yet, progress is being made through the DC Healthy Start Project. 

Initiated 10 years ago with funding from the Health Resources and 

Services Administration (HRSA), the project provides women with 

access to comprehensive prenatal care services they may not otherwise 

receive. “Women receive case management throughout the cycle— 

from pregnancy to delivery,” said Johnson-Clarke. 

Since its inception, the DC Healthy Start Project has helped 

reduce infant mortality by 45 percent in the District. The Project, 

currently in its third phase of HRSA funding, has broadened its focus 

in various ways, and now includes outreach to fathers and prenatal 

depression screening. “As a result, since [the program began] none of 

the women who have participated in the Healthy Start Project have 

had an infant die from a preventable death,” said Johnson-Clarke. 

REACHing Out 

Racial and Ethnic Approaches to Community Health (REACH) 

2010 Project is a national demonstration project managed by the 

CDC that supports Healthy People 2010—the nation’s health promotion and disease prevention initiative. The primary objective of 

REACH 2010 is to help communities mobilize resources to support 

programs that eliminate the health disparities experienced by racial 

and ethnic minorities. 

Through Michigan’s Genesee County Department of Health, 

the REACH Project in Flint takes a slightly different approach to 

reducing infant mortality. It works to improve the overall health 

status of women. In Flint, where the infant mortality rate of Blacks is 

about two and a half times that of Whites, the Department’s division 

director of Maternal and Child Health Services, Lillian Wyatt, has 

been working with the community. 

“One of the things we needed to do was to get the community 

involved in reducing infant mortality,” said Wyatt. “First, we needed 

to identify what the community already knew about infant mortality, 

what they thought was actually the cause of their babies dying, and 

areas where they thought they could help to solve the problem.” 

In an attempt to fully engage the community and foster community mobilization, the REACH Project has developed three strategies: 

Community Dialog, Educational Training and Outreach, and Advocacy. 

Community Dialog 

The dialog strategy brings representatives from across the community to discuss infant mortality, and to develop a communitybased intervention aimed at reducing baby deaths. “To be truly effective in addressing infant mortality in the Black community, the project 

brings together groups that would otherwise not meet to address race 

and racism as they relate to infant mortality,” said Yvonne Lewis, 

executive director of Faith Access to Community Economic Development (FACED), a non-profit corporation that provides resources to 

low-income residents of Flint and Genesee County. “The dialog is a 

series of four sessions designed to bring 15 to 25 mothers, educators, 

and health professionals together,” said Lewis. “We engage the community. We ask the community questions like , ‘What is infant mortality? What are the causes?’” 

Infant mortality is defined in the first session and its causes are 

identified in the second. Possible solutions are addressed in the third 

session, narrowed down to one idea, and then put into action by the 

fourth session. By meeting with health care providers and discussing 

the factors to high infant mortality rates in the Black community, 

some groups have been able to bridge the gap and work together to 

reduce infant deaths. 

All interventions reinforce themes of cultural appropriateness 

and anti-racism. According to Lewis, the groups focus on how Blacks 

access health care services in the county, and embrace the notion that 

racial difference in infant death rates is a symptom of cultural, institutional, interpersonal, and internalized racism. Lewis maintains that 

this approach includes educating health care professionals about race, 

racism, and race-based privilege. 

“One of our major hospitals didn’t have a real strong role in the 

African American community and a dialogue group that completed 

their fourth session decided to do interventions with physicians at 

that hospital,” said Lewis. “Physicians need to be a part of correcting 

the problem, so we introduced them to our Maternal and Infant 

Health Advocacy Support Services program.” 

With an audience of obstetricians and gynecologists, the dialogue group discussed disparities in infant mortality and 

community in the solution. After discovering that physicians believed the real issue to be non-compliant patients, 

continued on page 2 >>>> 

engaged the 

Disparities Persist in Infant Mortality 

is based on the Summit workshop “Promising Practices in 

Eliminating Health Disparities: Infant Mortality.” 

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 
Disparities Persist in Infant Mortality 

Creative Approaches Work to Close the Gap 

By Kauthar B. Umar, MA


Closing the Gap, Working Toward Our Goal • August 2003


the dialog group decided to recruit physicians to participate in the 

FACED referral process. 

“Group members provided an orientation to physicians on utilizing our referral process to get expectant mothers the additional 

support they may need during their pregnancy,” said Lewis. “The 

dialog group created this action plan one year ago, and today we have 

OB/GYN’s and primary care physicians in three hospitals involved in 

this particular referral system.” 

Educational Training 

The Project’s Educational Training strategy assists the University 

of Michigan with 

cultural competency training of future health professionals, faculty, 

and staff. The African American Cultural Educational Awareness Center was developed to serve the community with health education in a 

similar manner. 

Through an educational component called Black Unity and 

Spiritual Togetherness, men and women expecting children are paired 

with friends or family members labeled “birth sisters and brothers.” 

The partnership addresses cultural elements from a family perspective 

and provides education on healthy parental behaviors, which lead to 

healthy pregnancies, followed by healthy births and ultimately, healthy 

children. “All of us together have to work collectively on the issue,” 

said Lewis. 

Outreach and Advocacy 

The Outreach and Advocacy strategy utilizes referrals from the 

Women, Infant and Children Program to identify women who are in 

the early stages of pregnancy or recently gave birth. Those mothers are 

then paired with maternal and infant health advocates, who offer 

support during the pregnancy and up to the child’s first year. Billboards, television, and radio commercials have also been developed to 

reinforce the message. 

“We want that message to ring out loud and clear—babies don’t 

have to die,” concluded Lewis. 

For more information on the DC Healthy Start Project, contact Dr. 

Fern Johnson-Clarke, District of Columbia Department of Health at 

202-442-9032.

For more information on the Flint REACH Project, call 810-257­

3194. 

For more information on Faith Access to Community Economic 

Development, e-mail Yvonne Lewis at yvonlewis@hotmail.com or call 

810-232-7733.

Office of Minority Health Resource Center 2 U.S. Department of Health and Human Services