Los Angeles County had an ambitious plan, but it’s still struggling to shrink the Black infant death rate

Back in 2018, the Los Angeles County Department of Public Health announced an ambitious plan to cut the gap between Black and white infant mortality in L.A. County by 30% by 2023.

At the heart of this plan lies a five-year collaborative effort among local and state health departments, nonprofits, health care providers and community organizations. The African American Infant and Maternal Mortality (AAIMM) Initiative builds upon the county’s existing infant and maternal health programs with added services like expanded access to doula care, free home visits to Black families and breastfeeding education and support for Black mothers, among a slew of other services. 

The AAIMM initiative has been an auspicious undertaking, with many hundreds of mothers, health officials, nurses, doulas, academic experts, and community advocates providing time, expertise, input and enthusiasm into the project. Even so, the needle has yet to move significantly on LA County’s disturbingly high Black infant mortality rate. 

Health experts point to the crippling influence of institutionalized racism as a looming roadblock to these efforts. A key term is “weathering,” coined to describe the body’s response to stressful situations, and the wash of stress-triggered hormones like cortisol which monopolize the energy the human system should be putting into fostering healthy pregnancies. Such weathering can predispose Black women to chronic conditions like hypertension, gestational diabetes and preeclampsia. 

And yet, the county’s efforts are notable for several key areas of improvement. They include filling gaps in vital services, improving regional health care access, and broadening efforts to meaningfully shift hardened racial biases among health care professionals. Here are just five of my key takeaways from the series: 

1. State-mandated implicit bias training for all perinatal health care professionals — the first such program in the country — went into effect at the start of 2020, and yet compliance rates are still unknown.

2. Programs to help hospitals identify and then fix institutional racial blind spots to improve their quality of care to Black families have found that some hospitals were guilty of mistreatment of Black health care workers.

3. It is unclear if and how Black infant mortality rates in L.A. County have been impacted by rising homelessness. Despite estimates that approximately 1,000 women a year in LA are homeless at the time they give birth, the county public health department doesn’t keep an accurate record of the overlap between infant deaths and homelessness.

4. Despite the attention and resources poured into the Antelope Valley — where Black infant mortality rates are the worst in the whole county — the cities of Lancaster and Palmdale remain primary care shortage areas with low provider-to-patient ratios and high numbers of residents living below the poverty level. One expert called the valley a “maternity care desert.” 

5. Despite emerging science illustrating the strong overlap between environmental exposures and poor infant and maternal health outcomes, the links between the LA County’s separate departments for environmental health and infant and maternal health remain tenuous at best.

The sprawling story has been one of my toughest to report by virtue of the size and scope of the problem, with its tentacles reaching into almost all aspects of everyday life — everything from a doctor’s attitude during a routine visit to the way in which a bad smog day can dangerously increase a mother’s stress levels. Still, I’ve found a couple useful reporting approaches: 

Bring prior expertise to an unfamiliar topic. As someone with a reporting background in environmental science, my natural curiosity in this area led me to realize that the connecting threads between the environment and the health of mothers and babies is seriously understudied, with major implications for public health. 

Mine existing sources. In order to forge new avenues and connections, I found that some of my key sources in areas ostensibly unrelated to infant and maternal health had good contacts of their own, as well as other useful ideas of pursuit. 

If given the chance to work on the series again, I would, however, approach it a little differently.

Make small bite-sized chunks. The sheer enormity and complexity of the issue proved hard to wrap my hands around, and so, next time, I would focus in on narrower topics within the greater whole. 

Acknowledge the great work being done. In a push to identify fault, it can be all too easy to lose sight of the good. Many dedicated individuals work tirelessly to change the story for Black families in LA County, and given a redo, I would make better attempts to highlight their important work.

“It’s a gloomy situation,” said one of the experts I spoke with, citing the county’s current birthing outcomes. “But there’s a break in the clouds and an opportunity here that we’re definitely acting on.”