A Search For Clues For Boston's Black Infant Mortality Problem

A black baby born in Boston today is four times more likely than a white infant to die before the first birthday, according to the Boston Public Health Commission. We begin our look at why this is happening with the story of one mother.

Twenty-three-year-old Naralis De Jesus lost a 6-month-old son, Deyon, three years ago. Now she has a 7-month-old baby girl. This is the story of what went wrong with Deyon and what De Jesus is doing to make sure her daughter, Deyana, thrives.

Let’s go back to the spring of 2007. De Jesus has a 2-year-old. She gets pregnant, her boyfriend goes to jail, and she becomes a homeless teenager looking for help from the state.

"They put me in a shelter in Brockton, then a shelter in Lynn, then back to Brockton, then back to Lynn," De Jesus says, her head rocking from side to side with each remembered move. "These are all emergency rooms — that’s what they’re called, emergency bed — so you’re only allowed to stay there two weeks."

De Jesus missed most of her prenatal visits at a community health center in Boston while she was bouncing from one shelter to the next.

"They never found out that I had high blood pressure so with everything that happened it was kind of a surprise," she says.

'When Too Much Is Thrown On You...'

The surprise started on a steamy Friday morning in August. De Jesus is worried about seeing the abusive boyfriend who’s out of jail and she’s in a rush to get to work, but the shelter manager says she has to finish some chores her roommate left undone.

"I just remember going downstairs and telling them, 'I’m not doing those chores, they weren’t mines [sic] and I need to leave'." De Jesus rushes through that memory and pauses. "I ran to the bathroom and big blood clots were coming out. They said that my blood pressure got so high it made my placenta erupt. When too much is thrown on you..." — there's another long pause — "you explode."

De Jesus has an emergency C-section, almost four months early. Doctors say they aren’t sure her 1-pound baby boy will survive; he does, in intensive care. The hospital releases the baby in November. De Jesus unites her small family (2-year-old Dyara and baby Deyon) at a shelter in Brockton. Three weeks later, she has to move again, this time to a motel in Dedham with intermittent heat. She calls ambulances several times when the baby has trouble breathing.

"He was so used to being in the little incubator where it’s warm and for us to be moving everywhere, I know that was too much," De Jesus says in a shaky voice.

In January De Jesus gets an apartment with pretty much everything she needs, but no cribs. She puts the baby and the toddler in bed with her every night.

"I remember going to sleep. I gave him his bottle, I burped him and he was fine," she says, her gaze fixed on the floor. "I woke up that morning. I gave him a kiss and he didn’t move or anything." A long pause. "He felt cold." Her voice drops and she takes a few slow breaths. "It’s a hard thing to go through, especially when you’re only 19."

“I would wake her up in the middle of the night, just to make sure that she was breathing."

Naralis De Jesus, of her 7-month-old

In the emergency room, doctors tell De Jesus that 6-month old Deyon was a victim of Sudden Infant Death Syndrome. Those words haunt her now, three years later, as she cares for a baby girl she named Deyana.

"I would wake her up in the middle of the night, just to make sure that she was breathing," De Jesus says. "Like if she was still for too long, I would shake her."

'...She's alive.'

De Jesus takes Deyana to the doctor once a week, even though the pediatrician tells here she doesn’t need to worry. Deyana was born full term after regular, normal prenatal visits and home visits from a social worker.

De Jesus has a Section 8 apartment. She ended the abusive relationship soon after getting pregnant with Deyana and is now involved with a woman who plans to adopt the two children. De Jesus is back in college, aiming for law school, and has a job offering sample foods at grocery stores. But despite all these positive changes, De Jesus slid into a deep postpartum depression after Deyana's birth.

"I didn’t want to be around her," De Jesus says. "I didn’t want to get close. I kept thinking, 'Why get close if she’s going to die anyways?' "

De Jesus checked herself into a hospital. Now, she’s in therapy and is taking medication for depression, anxiety, to control her blood pressure and to help her sleep. De Jesus is finally enjoying her baby.

"See, she's always happy." De Jesus nuzzles Deyana and they both giggle.

Deyana had passed the 6-month length of her brother’s life.

"I know it seems silly," De Jesus admits. "Like OK, what if she passes away at 7 months or 8 months, because it's always within the first year that they're at risk? But my son didn't make it to 6 months, and she’s alive."

Bob Oakes: Naralis De Jesus has been getting help from a city-funded program for women raising children up to the age of 5. Nurses and social workers visit women, such as De Jesus, during and after pregnancy. They provide assistance, not just with health care but also with other concerns, such as housing.

The program is overseen by Deborah Allen, director of the Bureau of Child, Adolescent and Family Health at the Boston Public Health Commission, and she spoke with us after listening to De Jesus' story.

I wonder if we can talk about that statistic that we heard at the beginning of Martha Bebinger's story, that a black baby born in Boston is four times more likely than a white baby to die within the first year of life. Do we know why?

Deborah Allen: We believe we're beginning to understand why, we've had some theories and they've not proved correct. A lot of programs have focused, historically, on what I think the average person would think is relevant, which is, let's get this woman prenatal care, and we're doing that actively, with this program that Naralis is in and with other programs. Well, it turns out it doesn't make that much difference.

We'd never discourage people from getting prenatal care, but very often, by the time a woman enters pregnancy, her health may already be compromised. Naralis referred to having high blood pressure. When you entered pregnancy with your health already compromised, you're facing an uphill battle of trying to stabilize her health during pregnancy. And some of the other things people have tried very hard to do turn out to be useful, but they don't close the gap.

For example, we've done a huge amount of work to get women to stop smoking. Smoking is absolutely linked to pre-term births and low birth weight, we know that. But it turns out that white women smoke more than black women so you don't close the gap. Now, a very interesting and surprising statistic is that black birth outcomes are healthier for younger women. We don't see that in other populations.

Oakes: Do you know why?

Allen: The theory is what's called "weathering." The stresses associated with being black, I mean when you have a young woman, from Naralis's story she had her first baby at 17 or 18, by the time she's 22, when white woman are in a more stable position to have a baby, Naralis is going to have worsening hypertension unless we've done something to reduce the stress in her life and get her blood pressure under control. So the data tell us that unlike other women all over the world, black women have worse birth outcomes as they get older.

Oakes: Are you saying that culture is playing into this? Is racism and the stresses of decades of racism playing a role in this gap?

Allen: That is exactly what we've come to believe and there's beginning to be research that shows that the experience of racism, played out on a day-to-day basis, some of it in the jobs people can get, poverty in their community, violence in their neighborhoods, and some of it, just in walking into the store where someone looks at you suspiciously, that all of those experiences turn into spikes in blood pressure. That cumulative effect of weathering, of accumulated stress over time, has a deleterious effect on the woman's ability to bear a healthy child.

Oakes: Dr. Martin Luther King addressed this when he said, "Of all the forms of inequality, injustice in health is the most shocking and the most inhumane." Will we have to erase racism before we can eliminate health disparities?

Allen: I think as long as there is racism there will be health disparities. But I think by targeting health disparities we can go a long way to eliminating racism. The strategies we need to use to address Naralis's experience have to do both with assuring that there's housing, assuring that there's food, assuring that there's social supports for women who are pregnant and assuring that there's better health care for young women before they become pregnant.

I think it also means helping women deal with stress. And part of that, including the stress of racism, part of that includes giving it a name, with saying to a woman in Naralis's situation, the stress you're experiencing is not unique to you, it's not your fault, it's an experience that's shared both as members of your community and as individuals dealing with their own health.

Oakes: So are you hopeful or are you distressed as we look forward into 2011?

Allen: I'm hopeful because the other things we've looked at have, frankly, been the things that are easy to wrap our brains around, they don't disturb us too much, prenatal care and so on, have been easy to do without having to look too deep into our hearts as a society and too deep into the ways wealth and power are allocated. Looking at racism, very directly, through the lens of what it does to babies, seems like a healthy place for our society to go.

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Note: To read more about the black infant mortality rate in Boston, click to page 19.