Black Infant Mortality in Muskegon More than Doubles in Eight Year Span

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Source: Michigan League for Public Policy, 2017 Right Start Annual Report on Maternal and Child Health, Muskegon Community Report

According to Kids Count data, released August 9th, 2017, the Black infant mortality rate, or B-IMR, in the City of Muskegon has more than doubled in an 8-year time span. The infant mortality rate measures the number of infants who died per 1,000 infants born. This makes it possible to compare places with different population sizes, or groups within a population. The data in the report compares a “rolling average” or the average of a 3-year time span, 2008 – 2010 and 2013 – 2015. For a relatively rare event like an infant death, years are combined to get enough numbers to make sure the statistics are not related to chance.

The community report for Muskegon points to the Maternal Infant Health Programs (MIHP) at Muskegon County’s two Federally Qualified Health Centers, Muskegon Family Care (MFC) and Hackley Community Care (HCC) and several programs through Catholic Charities of West MI as examples of efforts. Policy recommendations in the full report include:

  • Reducing disparities by race and ethnicity
  • Protecting the Affordable Care Act and the Healthy Michigan Plan
  • Expanding home visiting programs to support vulnerable women and infants
  • Addressing the social determinants of health

Here is a timeline of some significant events that impacted reproductive, maternal and infant healthcare services in Muskegon during the time covered in the report:

Important Events Impacting Reproductive Health in Muskegon County from 2008 to 2016

Muskegon County experienced a 131% increase in infant mortality during the time these events occurred. Did they have an impact?

These events may impact infant mortality in the following ways:

Despite promises by administrators that reproductive health services would not be impacted, the hospital system, now operating under the Ethical and Religious Directives for Catholic Health Systems (ERDs), eliminated insurance coverage for family planning under its health insurance plans. Although some providers violate the ERDs by prescribing birth control for preventing pregnancy, there is now institutional support for providers who, because of their own religious beliefs, refuse to insert an IUD immediately postpartum, prescribe hormonal contraceptives, or emergency contraception; or perform a tubal ligation during a cesarean, for example. The merger also meant an end to all abortions, except to save the life of the mother, which, as the court case Means vs. the US Conference of Catholic Bishops shows, is up for interpretation by the local Bishop. The ban on abortions includes terminations for fetuses known to have birth defects incompatible with life, even when the pregnant person has health conditions that can make pregnancy dangerous for them.

As I stated this past May, when I was invited to speak to congressional staffers by the National Women’s Law Center (NWLC) on the impact of religious restrictions in healthcare in Washington, DC, unenforceable policies open the floodgates to discrimination based on provider biases.

Muskegon’s Fetal Infant Mortality Review (FIMR) findings showed an increase in both unintended pregnancies among women experiencing an infant or fetal loss and a sharp increase in Black infant mortality following the loss of Title X family planning services.

The new Muskegon Planned Parenthood clinic reopens inside of Public Health – Muskegon County , providing services in Muskegon for the first time since the Peck St. clinic shut down in 2007. Title X – funded clinics are unique in that federal guidelines prohibit discrimination, religious refusals on the part of the provider and can provide more confidential services to minors than state law requires.

The Birthing Center at the former Mercy Hospital was a favorite among local women. As an in-hospital birthing center, it was physically detached from the hospital, but still run by it. During construction, some women who gave birth complained to me of noise and crowding. Some women who had given birth prior at the Mercy facility and then had to deliver subsequently at the new facility, preferred the later.

Centering Pregnancy is an evidence-based group prenatal care model shown to decrease the incidence of preterm births, with the best improvements among African American women.

Regardless of the reasons of the clinic’s closing, Muskegon County women now must drive to Grand Rapids’ Heritage Clinic, currently the closest abortion clinic, to obtain an elective abortion. For those who lack transportation to Grand Rapids or the addition time for travel, this clinic closure creates an additional barrier to obtaining services. Research has linked increases in abortion access to declines infant mortality rates.

  • Oct 2013: Public Health – Muskegon County (PHMC) Eliminates the FIMR Program

Despite successfully reducing the B-IMR in Muskegon County, PHMC eliminates the FIMR program after a “Know Your Rights” event is held at Muskegon Community College. The event, co-sponsored by the ACLU of Michigan was held to educate local women about how other communities had been impacted by mergers with Catholic healthcare systems.

Planned Parenthood takes over the job of STD testing, despite being open fewer hours, when PHMC decides to focus on partner notification. At the time, we had the third highest rate of Chlamydia among all counties in the state of Michigan. Chlamydia and Gonorrhea are major contributors to prematurity and infant mortality.

Now, both of the FQHCs offer Centering Pregnancy group prenatal care, although the midwives at HCC stopped catching babies that same year, leaving MFC the only place in Muskegon to receive continuous care from a Certified Nurse Midwife throughout labor and birth.

Research shows that racially inequities in incarceration rates are directly related to racial inequities in STD rates. When the former jail was being used, the racial disparities was 5.9, meaning an African American in Muskegon County was nearly 6 times more likely to be in jail than a White resident. Muskegon County FIMR participated in at least two efforts to address this injustice: The Disproportionate Minority Contact (DMC) Coalition and a Health Impact Assessment (HIA) on the funding of the new jail. The DMC Coalition, which was making some progress in collecting data to identify key points in the juvenile detention system where discrimination occurred, had its leadership derailed by a vote electing Judge Pittman as the new president and never again convened. The HIA was sabotaged by inadequate funding and refusal to approve a research project initiated by a professor at Grand Valley State University to inform service providers of the unmet psychosocial needs of current inmates.

Muskegon is about to have its second birthing unit in five years built away from the city center to be more convenient to out-of-town patients. According to the head of obstetric nursing, community input for the birthing unit was obtained, although the public was not invited.

While the causes of infant mortality and the inequalities expressed in rates are complex, one thing is clear, Muskegon stands out in Michigan as having the largest increase, 131%, in an eight-year time span at the same time as infant mortality statewide is decreasing. This is not an accident, nor are the multiple contributing factors a mystery. What remains unasked is why aren’t the home visiting and other programs in place not making more of a difference? And moving forward, if Public Health and Mercy Health aren’t doing a good job of ensuring the survival of our county’s Black infants, is anyone paying attention and will anyone be held accountable? Who will spearhead our efforts toward improvement? Whoever that is, I wish them the best of luck in their endeavors, will follow their lead and hope that they don’t become demoralized and without a job. The needed change will not come without stepping on a few toes.

Opioid Addiction in Pregnancy: Ending the Stigma

On Friday, May 8th 2015, I attended Pine Rest’s Annual Perinatal Mood Disorders Conference in Grand Rapids. The topic was “Perinatal Substance Use and the Journey to Wellness.” I learned so much and want to share some reflections on a subject so near and dear to my heart.

The first time I taught childbirth education classes was to the pregnant inmates at the Rose M. Singer Center, A.K.A. Rosie’s, on Riker’s Island, the largest penal colony in the world. There were so many pregnant and postpartum inmates at Rosie’s that they had their own unit. There were two reasons for their high numbers. First of all, New York State, unlike Michigan, has laws that require correctional facilities to accommodate newborns. So long as the mom doesn’t have a conviction that involves harming a child, she can apply to keep her infant with her for one year (or 18 mo., if she will be released within that time) or bring her breastfeeding infant with her during her incarceration. Studies done at Bedford Hills Correctional Facility, which houses one of the oldest prison nurseries in the country, show that there are no harmful effects on the children. Many of the women at Rosie’s are either already participating in or planning to be a part of their on-site nursery.

The second reason has to do with opiate addiction. Riker’s, a jail, housed a methadone treatment program. Withdrawing from opiates during pregnancy can be deadly for both the mother and the fetus, so opiate-dependent women who would otherwise be transferred to a prison to serve a longer sentence remained at Riker’s during their pregnancy to receive methadone maintenance. (At the time I taught there, methadone was the drug of choice for the treatment of opioid addiction during pregnancy. Since other treatments are now available, this may no longer be the case).

There is so much stigma surrounding moms who use during pregnancy, making it even less likely that these women will seek help. Many people believe that a mom who is addicted to an opiate should stop using during pregnancy. Discontinuing opiates during pregnancy is not the standard of care. One of the speakers at the conference, Dr. James Nocon who is both an obstetrician and an attorney, had this to say about providers who encourage women to withdraw during pregnancy, “In my retirement, I want to sue doctors whose patients suffer negative outcomes because they receive improper treatment during pregnancy.” He can be contacted at

My heart breaks every time I hear someone say an infant is “born addicted.” Addiction, by definition, is continuing to use a substance (or repeat a process) despite negative consequences. An infant can be born dependent, but cannot be an addict. I know that many people have personal experiences caring for the children of parents who could not themselves care for them due to substance abuse disorders, resulting in strong emotions. However, vilifying parents with addictions will not help these children. As a Certified Substance Abuse Prevention Specialist, I know that if we want to help infants and children, we need to look at the underlying causes of why women use. The vast majority of women who use during pregnancy are self-medicating due to the effects of trauma and abuse. This is true whether the substance is cigarettes, alcohol, crack or heroin.

If we are truly dedicated to helping children prenatally exposed to substances, we should focus not just on treatment, but prevention. Gender-based violence is the result of oppression, which stems from inequality. When we fight for gender equality (e.g. pay equity, paid parental leave, paid sick time, LGBTQ rights, etc.), we are working to elevate the status of women and end the trauma of abuse.

Developed by Larry Cohen, based on the work of Dr. Marshall Swift. Available at:

Developed by Larry Cohen, based on the work of Dr. Marshall Swift. Available at: