On Tuesday, officials from the U.S. Department of Health and Human Services announced more than $558 million in funding for maternal health across the country and in Michigan, including more than $440 million from the Health Resources and Services Administration to expand home visiting services for expectant mothers.
The new funds are part of President Joe Biden’s agenda to reduce maternal mortality and morbidity rates and reduce disparities in maternal health care, HRSA Administrator Carole Johnson told parents and health care workers during a roundtable discussion at Wayne State University.
Michigan health care officials told Johnson at the roundtable that the incoming funds and expanded home visit opportunities were money well spent.
Staff at the Institute for Population Health in northeast Detroit have learned that it takes more than one approach to provide effective, holistic care to expectant parents and their families, says CEO Gwendolyn Daniels.
From coordinating with local churches to connecting parents with food assistance programs and public transportation, Detroit residents and parents across the state all have different backgrounds and needs, she said.
“We know we have to continually engage our moms and meet them where they are,” Daniels said. “And that means something because everyone learns parenting differently. Everyone has different needs.”
A focus of IPH is to address postpartum depression and the stigma associated with it in various Detroit communities, she said. Representatives from the Oakland County Health Division, Starfish Family Services, the Inter-Tribal Council of Michigan and the Great Lakes Bay Health Center also said postpartum depression is a critical issue.
Pregnancy can be an overwhelming experience for parents and families, especially when they’re already struggling to access food, safe housing, employment and basic medical care, officials say. That’s why home visits from trained nurses can be lifesaving: In the exam room, health care professionals often don’t get a comprehensive overview, says Khalia Hill, a home visit nurse with the Oakland County Health Department.
“You can learn a lot from a parent’s perspective,” Hill said. “I love being able to help a parent. I say, ‘I’ll take you where you are and take you to where you want to be.'”
An unprecedented, tough climb in Michigan
Detroit’s infant mortality rate fell to a historic low in 2019, a success Mayor Mike Duggan attributed at the time to collaboration between organizations and programs, such as free Lyft rides, that made prenatal programs more accessible to expectant parents.
But between 2018 and 2020, pregnancy-related deaths in Michigan skyrocketed. According to the Michigan Maternal Mortality Surveillance Program, the rate of pregnancy-related deaths in the state rose to 43.2 at that time.
The data classifies pregnancy-related deaths as deaths resulting from conditions related to or exacerbated by pregnancy. According to MMMSP, pregnancy-related deaths, which include deaths that can occur for any reason during pregnancy or within one year after the end of pregnancy, also increased between 2017 and 2018.
Michigan’s racial disparities in pregnancy-related mortality are also notable. Black mothers die more than 75 percent more often than white mothers, and American Indian and Alaska Native women have twice the pregnancy-related mortality rate as white women.
The Centers for Disease Control and Prevention also announced Tuesday a $118.5 million investment in public health infrastructure to detect and prevent pregnancy-related deaths.
Tackle problems directly from home
Monique Whittaker was 22 years old and ten weeks pregnant when her gynecologist recommended food assistance programs and a home-visiting nurse.
The Detroit resident, now 25, said she was overwhelmed by the circumstances in her life at the time and expressed this passionately to Hill as soon as she returned home.
“The only thing she said after I was done was, ‘It’s going to be OK,'” Whittaker said Tuesday. “And those three words meant a lot to me in that moment.”
Hill was there for Whittaker every week for the rest of her pregnancy and during her fourth trimester to support her when she suffered from postpartum depression, she said.
Learning about postpartum depression through Hill and gaining access to other resources sparked Whittaker’s desire to help other expectant parents, she says.
Mishon Moore, 37, of Warren said she was especially grateful that a nurse from the Starfish Nurse-Family Partnership made home visits to help her overcome her own postpartum depression after the birth of her son.
Moore had a place to stay but was effectively homeless for part of her life, she said. A nurse who visited her at home and helped her find clothes, books, diapers and job boards enabled her to keep going, she said.
Her home health nurse is still caring for her, Moore said.
“It was wonderful to have someone to lean on,” she said. “Overall, it’s a real blessing to have this program in the inner city, or in Oakland County or wherever. I just want everyone to know that their contribution matters. This program, this foundation has really changed my life.”
Rebecca Hibbs, a home visiting and mental health nurse at IPH, said working with an expectant mother and her family had given her new perspectives on life.
It takes a lot of effort to get families to trust medical staff in the first place, but welcoming them into their homes is another leap of trust, Hibbs says.
Sitting next to the mother Hibbs had worked with and her newborn son, she said she was grateful for that trust.
“When we start doing this work, I don’t really think about the impact we have on families,” she said. “And then when we come into people’s homes, we become family in that way. And that vulnerability is sacred work.”
