It wasn't until Nandi Hill's son was born too early and too small that she learned how perilous pregnancies can be for black mothers and their infants.
"That fueled my passion to do this work," says Hill, the only black midwife in New Mexico licensed to assist in live births at her office and in homes. "I did not know when I birthed my son 16 and a half years ago that he was a statistic; that that is common."
Hill sees mothers of all races at her office in Albuquerque, but recognizes that black women have particularly dire needs. While there are only around 52,000 black people in the whole state of New Mexico, comprising 2.5 percent of the overall population, black infants die at a rate at least twice as high as all non-black infants, mirroring national trends. These trends cut across income and education levels for black women, undermining antiquated and racist ideas that their lifestyle choices are to blame for pregnancy problems.
More recent studies have pinned higher rates of infant mortality and black mothers' deaths on environmental factors like barriers to health care and racism-induced stress. Across the country, in response to a growing rate of infant mortality and pregnancy-related deaths among black mothers, reproductive advocates are working with local health providers and getting the word out to mothers who could benefit from prenatal services that research shows lead to healthier birth outcomes.
In a legislative sense, New Mexico has been slightly ahead of the curve than other states, in part thanks to lobbying from the state's Office of African-American Affairs. In 2014, the Legislature passed a law directing the OAAA to create a pilot program to track and address infant mortality and maternal health in Bernalillo County. Sunshine Muse, the pilot program leader, says the reason that black infant mortality in New Mexico is on par with other parts of the country is because similar anti-blackness sentiment exists here, and is exacerbated by their small population size.
Structural racism, she says, is "such a rampant part of our American culture, and I think sometimes when you add invisibility to that, which can happen with such a small population, it's experienced even as another layer of [oppression]."
The law didn't specify how the OAAA should deliver prenatal care to mothers nor did it track its use, and no money was initially allocated for it. It took prodding from constituents for the governor's office to finally pony up $50,000 to fund the study directly. An additional $35,000 was put up by the OAAA, totaling far less than the $250,000 the office had originally requested.
Muse explains that the original intent of the pilot program was to enroll mothers of any race into a program informed by the CenteringPregnancy model, which emphasizes prenatal care in group settings for women to come and meet with each other and medical staff.
Recruitment efforts proved more difficult than anticipated; despite outreach efforts and numerous institutional partnerships, including with the University of New Mexico and March of Dimes, only six mothers wound up participating, one of whom was a black mom who drove down to Albuquerque from Santa Fe.
"It's hard enough to find black people, because think about how many you've seen in the last week," Muse says. "Then you got to find black women, then you got to find black pregnant women. Every iteration makes the number smaller and smaller."
One silver lining to the low number of participants was that it revealed how few people are aware of disparities in birth outcomes. Based on that insight, the pilot program team administered an online survey to gauge women's knowledge of prenatal services and pregnancy experience. In total, 65 pregnant women responded, a little over half of whom identified as black or African American.
The team found that, among other things, a disparity exists between black and non-black women in knowledge of prenatal services. For example, black pregnant women were less likely to know about doula services than their white counterparts, despite a long history of midwifery and other pre- and post-natal care provided by black women in the South. Women of all races were unaware that some prenatal services are covered by insurers, including Medicaid.
Rongal Nikora, an assistant professor of political science at Beloit College who served as the lead research consultant for the pilot program, told lawmakers at a recent meeting of the interim Legislative Health and Human Services Committee that any program to reverse the outcomes for black mothers in New Mexico could serve as a model for other regions. He admitted the sample size of the survey was too small to draw definitive conclusions, but expressed confidence in future efforts.
"If we had the will to get our arms around this small population and figure out what might be happening, New Mexico might be a template for other communities struggling to figure out what's going on there," Nikora told state senators at the hearing.
Sen. Gerald Ortiz y Pino (D-Albuquerque), who sponsored the original bill, asked OAAA Executive Director Yvette Kaufman-Bell to prepare a budget for a follow-up program by Nov. 17. The team wants to expand the CenteringPregnancy model to other parts of the state and interview black mothers who have lost infants during childbirth, among other goals.
Muse, who was also at the hearing, says any future funding will illuminate critical information about a population too often overlooked.
"Having our [population] numbers delegate us to a place of statistical insignificance is not an option," she says.