Racial disparities in maternal health and gaps in infant care persist nearly four decades after California started the Black Infant Health program, although major strides have been made.
Marking the state program’s 35th anniversary this month, the San Francisco BIH Program staff brought together current clients, former ones and public health workers to highlight some of these issues while celebrating Black History Month.
“The decades of racism that has happened to pregnant moms, and these mothers are now more outspoken about what’s happening to them when they go into delivery,” said Aline Armstrong, the director for Maternal Child Adolescent Health with the San Francisco Department of Public Health. “They’re being treated based on the color of their skin.”
Expectant Black mothers face a variety of additional challenges, including racism and socioeconomic concerns, according to the Department of Public Health, all of which can lead to babies being born underweight or prematurely.
“This [program] is designed as a sisterhood of talking about these impactful things that are happening to them,” Armstrong said. “Then getting resources and tools on how they can be an advocate for themselves as well.”
One of 19 programs under the umbrella of the Maternal Child Adolescent Health branch of The City’s Department of Public Health, the BIH Program stands out to staff and participants as being one of the only spaces in San Francisco for Black mothers to come together and find support with one another.
“I heard about it eight years ago when I was pregnant with my first kid,” said Ruth Arevalo, who said she came back when she became pregnant again with her 8-month-old son, Melle.
Under a lot of professional stress as a mental-health coach, and facing personal anxiety after learning hers was a high-risk pregnancy due to being over the age of 35, Arevalo said, she struggled with depression this time around.
“I was just anxious,” she said. “It wasn’t planned — welcome, but not planned. I was scared.”
Pregnancy and childbirth still pose higher risks for Black women than other ethnicities. While Asian and Latino women had a 30% higher chance of premature birth than white women over the last 10 years, the risk was 200% higher for Black women, according to city public-health officials.
Black women are also more likely to die in childbirth, at nearly 70 deaths per 100,000 live births, 2.6 times the rate for white women, according to the U.S. Centers for Disease Control and Prevention. The risk for pregnancy complications — such as hypertension, preeclampsia and the need for Cesarean sections — is also higher for Black women than for white women.
Statewide, Black infant-mortality rates are two to four times higher than other ethnicities. Nationally, Black infant-mortality rates are the highest of any ethnicity group, at more than 10 per 1,000 births, according to the CDC. White and Asian infant mortality rates were the lowest, at 4.4 and 3.7, respectively.
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The BIH Program, located at 1290 Fillmore St. and also open to women in Marin and San Mateo counties, offers a lifeline to clients such as Arevalo. It aims to serve 130 women a year, but organizers “often exceed that goal,” according to public health officials.
The program offers two 10-week support groups: Prenatal for expectant mothers, and postpartum for mothers who have already given birth. Arevalo did both.
“I know I’m still going through it,” she said. “But I would have gone through it way worse if I did not have them by my side and helping me navigate my child, my feelings, my emotions, getting things out.”
Each group has anywhere from eight to 12 women following a state-designed curriculum meant to address toxic stress during pregnancy and mitigate stressful outcomes following birth, Armstrong said. Participants also discuss more general topics such as birth plans, breastfeeding and nutrition.
“They talk about empowering each other,” she said. “Each participant also comes to those groups with their own stories.”
The BIH Program also assigns expectant mothers a public-health nurse and a family-health advocate with social-work backgrounds if the pregnancy is considered high risk, Armstrong said.
“During that time, the social worker or the public-health nurse will develop a relationship, building trust so that the clients can open up and share what their needs are,” she said.
Some of the services go beyond just maternal and infant care.
“During the group, we provide nutritional food for them when they’re here,” Armstrong said. “One of the incentives we provide is a car seat [and] stroller combo, as well as a $25 Safeway gift card, which is to help address food insecurity.”
Arevalo said she tried sharing her experiences during pregnancy in other spaces, but she didn’t feel the same level of support. In the BIH Program, she said she felt most heard.
“No matter where I went, they just didn’t understand,” said Arevalo. “I felt like a nutcase in another setting, but in this setting, everyone got it.”
