When Sarah Murphy found out she was pregnant, she was initially shocked.
"I didn’t think I would have kids, and then I ended up having him when I was 39," she said.
Her advanced age led to a medically complicated pregnancy. Her income wasn’t as high as she thought it should be to cover the associated costs.
And as the child of a black woman living in Allegheny County, Murphy’s baby was three times more likely than a white woman’s child to die before reaching his first birthday.
Historically, Allegheny County has had a higher than average infant mortality rate compared to the rest of the country.
While the rate has been reduced, for black babies, the rate is nearly three times higher than that of white babies. But efforts are underway to bring down the black infant mortality rate.
Two years ago, the last year for which numbers are available, the infant mortality rate in Allegheny County was 14.5 deaths per 1,000 live births for black babies. For white babies, it was 5.7.
While that 14.5 number is about average for black babies in the U.S., the racial gap is one of the starkest health disparities between blacks and whites in the country, said Dr. J. Nadine Gracia, deputy assistant secretary for the Office of Minority Health at the U.S. Department of Health and Human Services.
CHART: For black babies born in Allegheny County, there is a higher rate of infant mortality than for white babies. These numbers are per 1,000 live births. Source: Allegheny County Health Department
"Infant mortality is a mark of the health of the nation and of quality of life...," Gracia said, "so certainly these rates continue to be alarming and need to be addressed."
As high as those figures are, they are lower than they had been in the 1980s and early 90s. Then, black babies in Allegheny County were five times more likely to die than white babies.
The rate dropped with the help of locally based, federally funded programs that dispensed old-fashioned motherly advice, among other things.
'Part of the Family'
While she was pregnant, Murphy was connected with Dorretta Lemon, of Nurse-Family Partnership. Lemon, a registered nurse, visits at-risk, pregnant first-time mothers every month at their homes. She maintains her relationship with the mother and her infant until the child is 2 years old.
Lemon said that while she is checking the health status of the mothers, she is also providing other support.
"We're also mentoring them and encouraging them, to have their heart's desires met," she said. "We give them health information that's correct. We explain things that they may not ask when they go to the clinics."
Murphy’s baby, Joseph, who is now 6 months old, is healthy. Murphy credits that in part to the house calls from Lemon.
"Having someone come in as frequent as Dorretta does visit ... we have built a bond," she said. "I can pretty much share anything about my health and the baby’s health with her because she has been there since before he was born. She’s like a part of the family."
Going to Them
Between Nurse-Family Partnership, which started working in the county in the early 2000s, and Healthy Start, which started in the early 1990s, federally funded nurses and health professionals in Allegheny County visit nearly 1,000 high-risk pregnant women each year.
These free regular visits provide mothers with information about their pregnancies, their bodies and their nutritional needs. The new mother is then guided through her child’s early life. This has helped bring down the infant mortality rates.
But there are still deaths.
"It will always be a problem, because it is not just an isolated problem," said Cheryl Squire Flint, Healthy Start’s regional director.
She worries that with federal funding cuts and Pennsylvania’s reluctance to embrace parts of the Affordable Care Act, medical services could falter. The infant mortality rate, which fluctuates, could creep up again.
There are varying causes of death for the infants that die, among them premature birth, low birthweight and Sudden Infant Death Syndrome.
Researchers have tried to find the causes for the racial disparity. Some of it can be attributed to poverty, poor health habits and lack of access to health care. But Flint said it can also be an issue of trust.
"People have a hard time believing that there are medical complexes that people fly across the world to come to," Flint said, "and people six blocks away won't utilize the service and don’t have confidence in what takes place in their own city."
Research and Race
Valire Copeland, a professor at the University of Pittsburgh's School of Social Work, has worked as a consultant for Healthy Start teaching workers cultural competencies so they can build trust with the women they visit.
She said a lot of the research that points to smoking, living in polluted areas, obesity or lack of Vitamin D exposure as possible causes of infant mortality often involves a certain level of finger-pointing.
"We blame poor women for the poor health that they have," Copeland said. "They don’t always have access to health care. They don’t have the resources to properly care for themselves and their children, and we don’t have service systems that are sensitive to the needs of these women. They are not culturally sensitive to some of the racial issues."
Other research has looked at the ongoing stressful effects of discrimination on black women, according to Ron Voorhees, who runs the Allegheny County Health Department.
"What we find is that the infants of black mothers who have graduate degrees, whether they be doctors, lawyers, professionals, they are people with potential for good incomes; they still have much higher rates of infant mortality even compared with a white woman who dropped out of high school," he said.
The high infant mortality rate is a problem that those who live through it are not vocal about – either publicly or privately, said former Healthy Start director Carmen Anderson.
"This is something that we assume that everyone can do successfully and so forth and so, when it does not happen that way," she said. "I think people are generally not prepared to respond to the loss."
Anderson said that while organizations such as Healthy Start offer counseling to parents after experiencing that kind of loss, not everyone who experiences it seeks out behavioral health services.
"It in some ways becomes the norm, sadly, and so it goes with 'This is just a part of our experience,'" she said.
Anderson said this racial disparity is especially striking in a city that proudly touts its reinvention as a post-industrial, most-livable city.
"We are a region that prides itself on quality of life and healthy thriving families," she said, "and we cannot do that when a significant part of the community is not sharing in the prosperity and the wellness and vitality of the overall community."
Sarah Murphy’s baby is doing well.
Because of Dorretta Lemon, Murphy has been breast-feeding, and she keeps charts and records of her son’s growth.
But she said she has a lifetime of worries ahead of her – for blacks in Pittsburgh, health disparities exist across the lifespan.