Photo at top: Mariah Hunt with her husband and two children.
Katrina Davis delivered her baby boy, D’Angelo, at 25 weeks. She says the doctors called him a micro-preemie because he was born weighing just 2 pounds, 3 ounces.
At the time, Katrina had to go into emergency labor because she developed preeclampsia, a condition where pregnant women get high blood pressure and a high level of protein in their urine, causing their hands, feet and legs to swell. If untreated, it can lead to death for the mother and the baby.
When Katrina went to the hospital, she says she could barely walk, and her face was so swollen she couldn’t see. Her blood pressure was a dangerously high 186/142. Though she successfully delivered her son, he couldn’t leave the hospital for months and had to constantly be monitored by doctors.
“He couldn’t even fit in preemie-sized clothes,” she says. “He had a sized diaper that could fit on a Barbie. He was so small — but he learned how to become stronger.”
Now D’Angelo is 2 years old. Katrina says he’s healthy, and “jumping off steps and running away and is the definition of a ‘terrible two.’”
Before delivering D’Angelo, Katrina was under a lot of stress. Her husband was cheating on her. She was the sole caretaker for her other two kids, ages 10 and 6, and working two jobs. She says she was extremely overwhelmed and often felt guilty for not spending enough time with her children.
“I was going through so much and my body couldn’t take it,” she says. “The thing is, you don’t even feel the stress until it hits your body physically. I knew it was there. I knew he was cheating. I knew the kids had to get to school. I knew I had to do everything for the kids. And work two jobs.”
She remembers her 6-year-old son coming up to her one day and telling her she wasn’t spending enough time with him. This hurt her tremendously.
“In my head I knew me working these jobs would benefit them, and that’s what I kept telling myself,” she says. “But they don’t see you at work. They don’t see the money coming in. They don’t see the house is paid. They just see that mom’s not home.”
Dr. Jennifer Savitski, chair of the Department of Obstetrics and Gynecology at Cleveland Clinic/Akron General, says infant mortality rates are related to maternal stress levels — especially among Black moms — which are causing preterm deliveries and greater chances that Black babies won’t make it to their first birthday.
And according to 2017 statistics from the Ohio Department of Health, Black infants are three times likelier to die before their first birthday than white infants.
Infant mortality is defined as the death of a live-born baby before their first birthday. According to Summit County Public Health, Akron has one of the highest infant mortality rates in the state, with an average of 9.47 deaths per 1,000 live births.
Of the 214 deaths that occurred in Summit Country from 2013 to 2017, 61% occurred in Akron — but Akron is only home to about 37% of the people in Summit County.
Most of the infant deaths occurred in zip codes 44305, which includes parts of Middlebury and Goodyear Heights; 44306, which includes East Akron; 44310, which includes North Hill and Chapel Hill; and 44320, which includes West Akron.
Those neighborhoods are 57%, 75%, 45% and 82% African-American, respectively — whereas only about 30% of Akron residents are Black, according to Census data.
The leading cause of death for infants in Ohio is premature birth. As of 2017, 32% of infant deaths were related to prematurity. While the overall infant mortality rate in Ohio has decreased since 2000, Black infants were three times more likely to die within the first 27 days of their lives than white infants, according to the Ohio Department of Health.
Smaller babies are less likely to make it because their bodies are often not developed enough to handle being outside of the womb. According to Dr. Savitski, sometimes babies’ lungs aren’t ready to be breathing air and the blood vessels in their brains are delicate, putting them at a higher risk for internal bleeding. Aside from this, smaller infants are more likely to develop necrotizing enterocolitis, an intestinal disease. This can lead to the intestines being surgically removed.
Many doctors are linking preterm labor to the stress Black mothers face, as well as poor social determinants of health like access to healthy food, economic opportunity, safe and affordable housing and environmental factors like exposure to pollution.
Savitski says chronic stress is toxic.
“Although we can say in the area of maternal and infant care, we see metrics where Black women are doing worse and Black babies are doing worse, the reality is, Black people, in general, are doing worse,” she says. “These individuals have experienced so much stress in their lives. That stress is now everyday normal life. But our bodies don’t know that it’s everyday normal life. So then you start getting the changes in the hormone levels, and the changes in how our brain develops memories and processes emotions and deals with fear.
“And that leads into the concept of toxic stress,” she continues. “When you get a certain level of stress that’s chronic — and in some ways threatens your basic existence — that’s where it becomes toxic … Think of it as: I’m a caveman. I see a saber-toothed tiger. So then I either fight, run or freeze. And the cortisol rushes into my system to give me the energy to run away. The problem is when you are faced with that saber-toothed tiger every single day and that hormone level is high in your body every single day — but then you have to start functioning. You have to eat, and drink, and work, take care of family members, take care of kids. That cortisol level is not productive in your body.
“The saber-toothed tiger to Black women in this country is housing, it’s jobs, it’s economic advancement.”
According to a 2018 report from Elevate Akron, much of Akron’s Black population has been excluded from economic opportunity. Dr. Cheryl Johnson, an OB-GYN at Summa Health System, says combating infant mortality in Akron means focusing efforts on reducing maternal stress. And that means making life better, all around, for mothers.
“Economic stability is a huge one,” Johnson says. “We talk a lot about [the] school-to-prison pipeline and the mass incarceration of the African-American male and how that stress weighs on the female provider in the home. That increases maternal stress, whenever you have a fragmented family and the responsibilities aren’t even. And so we find moms working two or three jobs. Or they don’t have a strong support system. Or the dad is in and out of the picture because of incarceration.”
Fathers play an important role in reducing maternal stress and supporting infants, says Pastor Eugene Norris, the founder of Fame Fathers. Norris currently works in West Akron on educational initiatives to help dads navigate fatherhood.
Fame Fathers offers a multiplicity of programs targeted at new dads. For example, Fame Fathers was partnered with Cleveland Clinic and Summa Health System on “Daddy Bootcamp,” a day-long class that coaches dads on what to expect from new babies and how best to support moms.
They also hold “Inside-Out Dads” for fathers who are incarcerated. The program gives dads a chance to take “Daddy Bootcamp” in jail or prison, so they’re ready to be supportive when they leave.
Fame Fathers also encourages safe sleep practices by giving away free Pack ‘n Plays to parents. A Pack ‘n Play is a safe sleeping bassinet for babies.
“I realized that fathers didn’t understand what was going on,” Norris says. “Our guys don’t really understand what our ladies are dealing with out there when they’re expecting. And particularly as it relates to infant mortality.”
The goal, says Norris, is to push for more educational initiatives and knowledge in the community. But this has often been difficult because they’re “overlapped with so many other systematic challenges.”
He explains, “It’s like Summit Lake. If you went out there and found three dead fish, you’d say, ‘what happened with these fish? Something’s going on with these fish.’ If you saw 300 fish out there, you’re going to say, ‘What’s going on with this lake?’ And that’s the system. That lake is what’s doing it, and you’re seeing a product of that system.”
“What’s going on with this lake” and how do we fix it?
Mental health services
Mariah Hunt, 24, is learning how to navigate motherhood one day at a time. She likes to tell 7-month-old Makavelli and 3-year-old Makayla that the three of them are “growing up together.”
After putting them to sleep each night, she takes inventory of the day. Did she hug them enough? Did she tell them she loves them enough? Did she talk to them enough?
Each morning, Mariah wakes up around 8 am and prepares breakfast for her and Makayla. She cleans the house after breakfast. Around 10 am, she starts “school” for Makayla, where they go through flashcards and colors and shapes to ensure Makayla is kindergarten-ready. Right now, she says Makayla can identify a pentagon and octagon, which Makayla is excited about.
Noon is lunchtime, followed by nap time for the kids. Mariah typically tries to rest during this time before the kids wake up and are ready to play for a few hours before their dad comes home.
The family has dinner together and watches television before the kids read, then sleep at 9 pm. Mariah usually studies for her online classes at the University of Phoenix until as late as 2 am.
On top of working toward her degree in business management, Mariah manages doctor’s appointments for Makavelli. The baby has craniosynostosis, a condition in which the bones in a baby’s skull close too early, which requires him to wear a helmet for 23 hours per day.
Mariah suffers from depression, which she says is exacerbated by her busy schedule.
“It’s more of life hitting you hard, especially with two. And you’re just now trying to get into the swing of things and you’re breastfeeding. And so it’s me and [Makavelli], constantly,” she says. “Sometimes I get down because I don’t have enough time to make sure I’m taking care of me.”
Mariah wants to be the best mother she can possibly be, but it’s challenging because her mother was often abusive, giving her up to the foster care system when Mariah was just 11. Without a good mother figure to model her parenting after, Mariah often feels alone.
Breaking the cycle of violence, learning how to be a good mom and taking care of her own mental health is a “battle,” Mariah says.
Her husband, Mike, works long hours to support the family while Mariah studies for her online classes and takes care of Makayla and Makavelli.
“Trying to be a mom is hard,” she says. “Especially trying to keep up. I have days where I’m down, or I just feel overwhelmed with everything. I try to center myself. I try to decompress and breathe, but it’s like the day goes and there are not enough hours in the day to actually focus on my emotions.”
Growing up, Mariah watched her dad physically abuse her mom. Though her parents are still together today — Mariah keeps in touch with them for the sake of her younger siblings who are living with her parents — Mariah feels like she can’t forgive them for putting her in foster care.
“Why did I have to be dealt these cards? I just wanted a mom and dad. As a child, my mom and dad weren’t really teaching me anything. I was always yelled at or whooped or just told to shut up. I wasn’t talked to,” she says. “A lot of things I’m trying to learn on my own. But what I went through as a child, it’s helping me be a better parent.”
Learning how to cope with trauma continues to be a challenge for many Black women who grew up in foster care, broken households or extreme poverty, and those who have survived domestic violence and abuse.
Dr. Lodge says the mental health component of maternal health is often overlooked.
“These social determinants of health we’re talking about, as it relates to housing, transportation, et cetera — it has a psychological impact,” Lodge says. “And that is why we see stress, anxiety, depression and other mental disorders within the African-American experience. And because that’s not understood, or it goes untreated, it’s why we continue to see low birth weights [and] premature deliveries, which then leads to infant mortality. And so that whole mental health component is essential.”
She continues, “It’s the psychological impact of not having these things and then being blamed for not having them that creates the stress that then leads to prematurity, low birth weight, [and] infant mortality.”
MBHG Clinical Coordinator Dr. Ciara Dennis-Morgan says they take a holistic approach to counseling, which means they look at the systems and barriers that women are facing and try to connect them to agencies that may help.
“Anything that is impacting the mother, child and family system, we’re attempting to address it and provide support around [them]. We also teach skills and model certain behaviors,” Dr. Dennis-Morgan says.“If we’re talking about the bus system, like how do you ride the bus or utilize that, sometimes there are cases where we can provide bus passes or link them to other community resources where there is support.”
Mariah says she’s filled out an application packet for MBHG and hopes to receive counseling soon.
“I need somebody that would help me regulate my emotions,” she says. “My emotions are all over the place. And I don’t know how to address them properly.”
When mothers lose their babies, experts say they often blame themselves — and the people around them may indirectly or directly blame them too. That guilt can take a toll on mother’s mental health.
For December West, a community health worker, the guilt was the worst part.
West’s infant was stillborn. She delivered the baby early.
“It was hard because what did I do wrong? That’s the first thing,” December says. “What did I do wrong? Did I not take my prenatal [vitamins] enough? Was I working too much? Because sometimes I’ll overdo it. I have to work, work, work, work, work. I don’t sit down to get my adequate rest. And even though the doctors say ‘it’s not you,’ that sometimes this is how things work, but I still feel like I did something wrong.”
Safe and affordable housing
Madelyn Elizabeth Milligan lives in an Akron Metropolitan Housing Authority apartment complex off Arlington and Wilbeth roads with her four children and husband. She says AMHA saved her and her husband from eviction when they were living in their home in Copley.
When she first moved into the neighborhood a year ago, Madelyn says she was worried for their safety. Though she still doesn’t allow her kids to play outside on the playground, she says she feels more comfortable today.
“When we saw that we were struggling, we have to do it for our kids,” she says. “I know this area is not the prettiest and it’s not so great. And people talk a lot of bullshit about this area. But we’re surviving and we haven’t seen anything wrong.
“You have to be in the hood in order to know what it feels like. It’s not bad,” she continues. “It doesn’t matter where you live. You’re going to make it home — and this is our home, for now.”
Madelyn and her family are lucky. AMHA Executive Director Brian Gage says they have a two-year waiting list for affordable housing units, though preference is given to veterans, emancipated youth, disabled people and other vulnerable communities.
Dr. Savitiski’s team spends half a day at AMHA’s Joy Park homes and half a day at the Reach Opportunity Center in Summit Lake every month, providing medical counseling and education about healthy pregnancies and women’s health.
Gage says AMHA also holds “Mom-ME Time,” where mothers can receive group counseling through Child Guidance and Family Solutions, twice a month in four AMHA developments. The program also screens mothers for depression and refers them to mental health providers for further assistance.
But community organizers say regulations set by the housing authority can split families apart. Dr. Tania Lodge, clinical director at Minority Behavioral Health Group (MBHG), argues that the requirements set by the housing authority are “not perpetuating single-family households.”
“Sometimes what we see is, even when we get our families involved with subsidized housing or AMHA, they don’t last in those homes because of the limitations and restrictions,” Lodge explains. “You can’t have your baby’s father here because he’s not on the lease. Or because somebody has a legal background. It’s limiting.”
For example, a person may be evicted from AMHA housing because of drug-related activity or violent criminal activity. After eviction, that individual is barred from applying to housing for three years.
AMHA regulations say the agency will consider “the individual circumstances of the household” when determining whether the person may be permitted to apply before the three-year wait period is up, but only if the evicted person completes a rehabilitation program.
Support from the medical system
Summa Health System and Akron General both have centering programs for moms. A centering program works in two ways: It gives doctors a chance to sit with the moms for longer periods of time to educate them about prenatal care, and it provides new moms with a support system made up of other women.
Dr. Cheryl Johnson at Summa Health System says educating moms is a lot easier when you have 90 minutes to sit with them, rather than the five to 10 minutes doctors typically have with patients.
“They love coming to centering,” Dr. Johnson says. “And what I can attribute that to is, they’re really in isolation. A lot of times when women are pregnant, it’s not something that’s celebrated in our society. We have a lot of young mothers. We have a lot of moms who are on their fourth or fifth baby, so they’re not being celebrated. But they feel a connection when they come to centering and they’re around other women just like them.”
December West says the isolation and lack of support can be debilitating for women. In two years of community health work, she’s only worked with one or two women whose partners are present.
“They’re doing it by themselves,” she says. “Most moms I interact with are single. And they’re not only doing it on their own, but they have other children. So having to care for the other kids and take care of yourself is hard.”
Project Ujima, a grassroots organization that works to empower women, is currently partnered with Summa Health Systems and Minority Behavioral Health on a centering program that takes place every Wednesday and Thursday. The Sisterhood Support Circle includes 10 to 15 women per session.
They use a centering curriculum to teach women how to parent and provide them with the hands-on support they need. For example, they encourage women to talk with their babies, show them how to feed them, talk about what nutrition looks like as babies grow and explain how safe sleep works.
Taba Aleen, program coordinator for Project Ujima, teaches the class. She says many of the women mistrust the medical industry and are often uncomfortable taking birth control. She adds that dispelling faulty information passed on from previous generations is key to helping women.
“Most of the answers [about their reluctance to use birth control] have to do with, ‘it’s going to make me fat.’ Or, ‘it’s going to mess my body up, so that when I want to get pregnant, I can’t get pregnant,’” Taba says. “Even when we’re doing a session on vaccines, some of the women have said that they didn’t trust the flu shot because they thought that if they were Medicaid clients, or they had Medicaid insurance, somehow they were getting a different dosage type than richer people who have private insurance.”
LaKesh Hayes, executive director of Project Ujima, says teaching moms how to plan their pregnancies is one focus of the program.
“Most of us may have a background of seeing pregnancies just happen. And we don’t know the terminologies of planned pregnancy,” LaKesh says. “We don’t understand that. We don’t know that you’re supposed to plan and put yourself in a certain position to be able to welcome a child and be able to care for a child. That is foreign to a lot of us in the community.”
Most recently, Project Ujima opened The Zalika House to expand the centering program and continue supporting moms.
“The house is more of an expansion of what we can’t do in a two-hour circle. We can do things at the house where we can watch a movie that has to do with healthy relationships, and maybe we’re then going to use that movie to have a discussion around partners who cheat,” Taba says.
Birthing Beautiful Communities, a program that started in Cleveland and recently opened a branch in Akron, works with low-income moms to provide doulas. Doulas traditionally come into the birthing process closer to delivery, but at Birthing Beautiful Communities, doulas begin helping moms early in the process.
In Ohio, doulas typically cost anywhere from $800-$1,000. But Birthing Beautiful Communities is grant-supported and free to women of color who need doulas. The doulas the moms work with are often their neighbors. They offer transportation, education and emotional support. Most importantly, they go to hospital visits and appointments to help act as translators between moms and doctors.
The goal of the organization is to empower women working with the medical system so they can make informed decisions about their babies.
“As a medical professional, you talk in a certain way, and you don’t necessarily realize that somebody is completely oblivious to what you’re saying,” says India Robertson, director of state training and expansion. “We were finding a lot of women who had babies previously who felt like ‘my labor was hijacked.’ Or ‘I didn’t get the experience that I wanted.’ Or ‘I felt discriminated against.’”
Certain areas of Cleveland have had some of the worst infant mortality rates in the country, which is what encouraged Christin Farmer to create the organization.
“Christin’s vision was, ‘how about we provide doulas for the people who actually need the services the most? The people who are at the highest risk for maternal mortality, for infant mortality?’” Robertson says.
Women often feel isolated and silenced in medical institutions where doctors typically don’t look like them or take the time to explain medical procedures in detail Robertson explains. Dr. Jennifer Savitski says she can probably count the number of Black OB-GYNs in Akron on one hand. In her department at Cleveland Clinic/Akron General, there are none.
Dr. Savitski, who is the first female chair for the Department of OB-GYN at Cleveland Clinic/Akron General, says the medical industry needs to focus on empowering patients and encouraging doctors to make shared decisions with their patients.
“Dealing with oppression in particular”
In late November,Summit County Public Health received $2.48 million from Ohio Department of Medicaid and the Ohio Medicaid Managed Care Plans to address African-American infant mortality rates in Greater Akron.
The funding will support 11 agencies in Akron, including Birthing Beautiful Communities, Child Guidance and Family Solutions and Cleveland Clinic/Akron General.
Many resources exist in Akron for mothers, and connections to agencies and resources are growing. Still, Akron’s infant mortality rate continues to be among the highest in the state, and Ohio’s is among the highest in the country.
And while it’ll take years before we see a drastic change in numbers, this year, Akron continued its Full Term First Birthday initiative, which aims to reduce infant mortality among Akron’s Black babies. One of the program’s goals is to “address structural racism and the interplay between race, equity, infant mortality and pre-term births.”
Within the report is an acknowledgment of the “insidious role of racism, implicit bias and structural racism in shaping culturally unresponsive organizational cultures and practices.”
The plan brings together more than 20 organizations committed to addressing infant mortality rates in Akron, including Summit County Public Health, AMHA and Axess Pointe. To begin meeting its goals, the City of Akron hired Tamiyka Rose as the Health Equity Ambassador.
“The structural racism in our community is economic,” says Rose, who in November was appointed Assistant to the Mayor for Public Policy. “It’s going to take time. It’s been 400 years since slavery. That was 1619. It’s 2019. It’s going to take step by step. But I can tell you that Mayor Horrigan is on board. He sees it, and he is ready to make change. And he understands it’s going to come from….the rich white men in powerful places having the courage to change the policies and procedures that have been in place for decades to allow for women to make a change.”
By 2025, Akron hopes to reduce premature births and infant mortality among all infants by 50%.
So while infant mortality rates in Akron have decreased over the years, it’s going to take more effort in continually addressing the structural racism and lack of economic opportunity for Black women in Akron.
Dr. Lodge says so much attention is being put into referring women to organization after organization, but the heart of the problem, which is oppression, is not being talked about enough. She says many of her clients blame themselves and feel shame about their situations rather than recognizing the system’s built against them. This leads to disempowerment, she adds.
“I think oppression is the catalyst to why we see the disparity with African-American babies… Racism plays a role in it. Classism plays a role in it. Ageism plays a role in it,” say Dr. Lodge. “And the difficulty with moving the needle is because we’re not really dealing with oppression in particular. We’re trying to put bandages on it.”
Noor Hindi is The Devil Strip’s Senior Reporter. Reach her at firstname.lastname@example.org.