Ericka Malone leans over the edge of a wooden park bench. She loops a finger around the bottom of her shoe and steps into a pair of black, lace-up heels.
Behind her, a few neighborhood kids huddle near the playground. They scatter, laughing in the afternoon sun.
The neighborhood is part of the 44320 ZIP code, where infant mortality rates are among the highest in the state.
Kids born here are less likely to make it to the playground, because they’re less likely to survive infancy in the first place.
Malone has lived here most of her life, and is now one of dozens of state-certified community health workers trying to change the way we think and talk about infant mortality. Every day, she helps new parents navigate everything from breastfeeding and applying for Medicaid benefits, to accessing mental health care and finding safe, affordable housing.
By 2050, she hopes the supportive communities she helps build each day are plentiful, and that parents, caregivers and babies no longer need the services community health workers provide.
But the work required to reduce infant deaths across the city may span generations. And to make real change, Malone says community health workers will have to adapt — and train a new generation of health workers to carry the torch.
Racism affects health outcomes for both moms and babies
In 2016, the infant mortality rate among Black infants in Summit County was 4.5 times the infant mortality rate among white infants.
The following year, Akron mayor Dan Horrigan appointed Tamiyka Rose as the city’s health equity ambassador and secured state funding for Full Term First Birthday — a collaboration between 19 Summit County agencies designed to reduce infant mortality and preterm births across the county.
Since then, the county’s overall infant mortality rate has fallen by about 9%. But for community health workers, that decrease isn’t a simple victory.
In 2019, Black babies born in Summit County were still 2.8 times as likely as white babies to die before their first birthdays — and more likely to be born early and underweight.
Community health workers like Malone address that disparity on the ground, working with clients to help them access prenatal care, transportation, fresh foods, educational opportunities and even help paying rent and utilities — all resources that lessen stress and help ensure the delivery of healthy, full-term babies.
But Malone says Black parents need more than just resources to help their babies stay healthy during their first year of life. They also need spaces to heal from the generational trauma of racism and connect with their babies and one another.
Across the country, Black babies experience far higher rates of infant mortality than white babies. Akron is no exception.
Rose says that isn’t because Black Akronites are “less healthy,” but rather, because they experience the effects of centuries of systemic violence and inequity.
“The good news is that our infant mortality rate dropped,” she says. “The bad news is we have a huge disparity still, and that disparity is because of the structural racism in our society.”
Nationally, Black parents are 50% more likely than white parents to give birth prematurely, regardless of other factors like income and education levels.
According to Summit County Public Health, nearly 18% of Black moms living in Akron gave birth prematurely last year, compared to just 8.2% of white moms.
The trauma that Black people experience as a result of racism builds up over time, contributing to preterm labor, says Dr. Ciara Dennis-Morgan, clinical director at Minority Behavioral Health Group in West Akron.
In neighborhoods across the city, parents may struggle to pay rent, find safe housing and access mental healthcare — all barriers that heighten stress levels.
When pregnant people experience chronic stress, the adrenal glands release high levels of Cortisol, the body’s primary stress hormone — which studies have linked to premature births.
Currently, the city’s goal calls to reduce premature births to the national average of 9.8% by 2025, and completely eliminate deaths caused by unsafe sleep.
Low birth weights and premature births put babies at risk — but so do other factors
Babies born prematurely may face a higher risk of death and long-term health complications, including issues with the brain, lungs, eyes and heart.
But environment — whether home or neighborhood — can also pose risks.
Sleeping in bed with an infant or putting babies to sleep with siblings is never safe, says Rose. Instead, babies should always be put to sleep alone, on their backs and in a crib or foldable playpen.
To help reduce sleep-related deaths, initiatives under Full Term First Birthday provide playpens to new parents and caregivers for free.
Maintaining a healthy diet is also essential to a healthy pregnancy, but decades of racist housing and zoning policies have affected the availability of fresh produce in many neighborhoods.
When people who are pregnant can’t easily access nutritious foods for themselves, their babies may not get the nutrients they need to stay healthy.
Shaleeta Smith, manager of Maternal Child Health at Summit County Public Health, says she’s had trouble finding fresh foods in her own neighborhood.
“Within a five mile radius, all there is is corner stores, and there’s no healthy fruits and vegetables available at my disposal,” Smith says. “So when we talk about disparities, I really feel like we have to think [about] more than just what the data tells us.”
How mental health care and strong support networks help keep babies healthy
To counter accumulation of trauma and grief, Black parents also need access to free or low-cost mental health care.
“Years ago, we used to think about postpartum and connecting women to services after they have the baby,” Dennis-Morgan says. But over the last decade, a more holistic and preventive care model has emerged.
The CenteringPregnancy Program brings pregnant people together in a circle with their health care provider and 8-12 other expectant parents due at the same time. The circle provides a safe, supportive space to talk through victories and challenges.
After their children are born, parents move on to the CenteringParenting Program and maintain those connections as their children grow.
‘I am all the things that I didn’t get as a kid.’
For nearly four years, Malone has worked as a community health worker through the Summa Health Equity Center, managing a full caseload and facilitating Centering Circles.
Before she became a community health worker, Malone was a young mom herself.
At just 12 years old, she became the primary caregiver for her own newborn child, and a handful of her younger siblings.
“I pretty much did it all by myself,” Malone says. “I grew up in a very abusive, alcoholic, substance abuse, any-and-everything-you-could-imagine home, which is why I became the mother of two by age 15. My mom — between her addiction and prison bouts and just life — I basically raised all of my siblings.”
In 1999, Malone graduated from Firestone High School at the top of her class. She became a licensed cosmetologist and barber and an ordained minister.
Now, she provides holistic support for new moms facing many of the same challenges she did.
“I am a caregiver. I’m a lover. I’m an educator. I’m an encourager,” Malone says. “I am all the things that I didn’t get as a kid. Any and all ways that you can show a person love and honor and respect, that’s what I try to do. Because I know the importance and value of having the village.”
For Malone — the mother of two adult children and three teenagers — the care and community she helps provide as a community health worker is second nature.
“I try to meet [people] with love, whatever that looks like — which is probably why this job stresses me out so damn much,” Malone says. “I try to show up and be a trustworthy person in their lives and show them that I’m honest and open and truly here to help.”
“I’ve been in the game for way longer than I’ve had an official title,” she adds. “I’ve been doing this as long as I can remember.”
A legacy of community health and birth work
For centuries, Black women have provided infant and maternal care as doulas, midwives and birth workers. The knowledge held by Black birth workers is often shared and passed down through generations.
“You have to have the heart to do this work,” says Deatra Hunt, a community health worker with Minority Behavioral Health Group. “There’s no way you can do this work and not be emotionally vested.”
On a spring day near the shoreline of Akron’s Summit Lake, Hunt’s earrings glint in the sun. Today, she’s hopeful about her work. But it isn’t always easy.
“I did [have a client] and the baby passed away at six months old,” Hunt says. “This was a client that was close to me. I’d take her places, I’m watching the baby and holding the baby, and that sense of loss…”
For Hunt, 51, who has five children of her own, helping moms, parents and caregivers navigate their grief and joy is both painful and edifying.
“People have to realize their own pain and deal with it the best they can,” she says. “So when they bring it up, just being there and going through the memories and offering that support. That makes it hard, but it’s so worth it. That, too, is a labor of love.”
With support from community health workers like Hunt, new parents can tackle other issues, like pursuing new job and educational opportunities.
“A lot of times, it’s that one peg,” Hunt says. “It’s that one thing, that you just don’t think is wrong. If you help them with that, now they’ve got a little ‘oomph’ in them to move on to other things that are going on in their lives, to change things.”
What does the future look like?
At Stoner-Hawkins Park, the setting sun turns the playground gold.
Malone sits on a bench near the basketball court. Behind her, a pair of toddlers race toward a swingset.
Right now, Malone is training and mentoring the community health workers who will carry her work into the next decade. The COVID-19 pandemic hasn’t made it easier.
“With all the disparities that have come to the surface because of the pandemic — the number of additional lives lost, the digital divide, the additional health care issues — I pray that the fallout from this, three to seven years from now, won’t be as bad as I think it’s going to be. However,” she says, “I think it’s going to be heavy.”
Malone’s work isn’t just about her West Akron neighborhood — or the women she works with every day. It’s about a much larger hope for future generations.
Before she hands over the reins to a new generation of community health workers, Malone hopes to see a drop in infant deaths and premature births, along with an increase in the kinds of support networks families need to help babies thrive.
Malone’s bigger vision — one she acknowledges may not materialize in her lifetime — is this: “all the systemic barriers will be gone, generational racism and generational poverty will cease to exist. Black moms, Black babies and Black bodies don’t have to keep dying, Lord, at the hands of each other or by police or the U.S. government.”
“The day I no longer have to talk to my clients about domestic violence cases. The day I don’t have to talk to slumlords who are evicting them for whatever reason. [The day] that all babies are happy and healthy on their first birthdays. The day I don’t have to clock in to do this work anymore,” Malone says. “That’s when I will have arrived.”
H.L. Comeriato covers public health at The Devil Strip via Report for America. Reach them at HL@thedevilstrip.com.
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