When It Comes to Your Health, Your Zip Code Matters More Than Your Genetic Code

Today is the one year anniversary of the passage of the Affordable Care Act and guess what? According to a recent survey, over one half of Americans don't think health reform is actually a law.

It is folks.

I'm marking the one year anniversary by attending the National Association of Black Journalists Media Institute on Health, Health Policy and Health Disparities in Washington, DC.

I heard two very profound statements today that tell the story about rampant health disparities impacting communities of color. Those two statements were not long prognostications about the social determinants of health or the root causes of these racial and ethnic inequities.

The comments indeed were about those things, but they were short enough for Twitter but utterly profound in answering those questions.

Comment #1: "Your zip code may be more important than your genetic code when it comes to health disparities."

Comment # 2: "We have a sick system not a healthcare system."

Comment 1 struck me because it alarms me that where you live is one of the key drivers of your health. According to the World Health Organization, Report on the Social Determinants of Health, avoidable health inequities arise because of the circumstances in which people grow, live, work and age and the systems put in place to deal with illness. In turn, the conditions in which people live and die are, in turn, shaped by political, social and economic forces.

That's why I was really impressed with a new initiative by The Joint Center for Political and Economic Studies, called Place Matters, which seeks to address conditions in the natural environment, built environment and social environment that lead to poor health. The goal is to eliminate health disparities by identifying the complex underlying causes and defining strategies to address them.

I am convinced these issues play a significant role in maternal and child health.

Comment # 2 was just too simplistically truthful to ignore. Healthcare is a misnomer for our system. It takes care of your sickness but does little to protect your health. In fact, today I learned that for every $1 spent on healthcare only 5 cents goes to prevention.

This is pathetic because so many mothers wouldn't needlessly die if there were more prevention programs and community-level interventions.

New study: 400,000 infants born to depressed mothers. What can we do?

Pregnancy is supposed to be a happy time. Those glossy pregnancy magazines would make you think every pregnant woman is running through green meadows with unmitigated joy.

But we all know the real deal. Broken relationships, economic hardships, thwarted life plans or just bad timing can create so much anxiety during pregnancy and can crowd out any joy you may want to feel. We'd like to think this sadder side of pregnancy is the exception to most experiences, but a new study says otherwise.

A recent report by American Academy of Pediatrics says every year, more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most under-diagnosed obstetric complication in America.

That's big news.

With so many babies being born to depressed mothers, what does that mean for the level of early bonding and care that they receive? When you're depressed you are probably less likely to breastfeed, especially when it can be very physically and emotionally demanding in the early days and months. And what about the moms? How healthy are their eating habits, also linked to their likelihood to breastfeed, if they are depressed?

The point is, sad moms are even sadder news for babies.

What can be done? For one, there needs to be a broader dialogue about depression during pregnancy and post partum. It would be great if we didn't only portray one pregnancy experience as the "right" pregnancy experience, doing so keeps moms in the closet about their real feelings and prevents them from getting the help they need.

In our community, we need to do more talking. Black people are socialized not to air dirty laundry, so to speak, so we are often reluctant to share our problems, particularly with strangers. But talk to your doctor, a friend or trusted relative. If this is difficult, call an anonymous hotline, if you must. Just don't try to face depression alone.

If you're depressed, take off the strong black woman superhero outfit and pack it away. If your belief system says, I'm strong and I should be able to handle all situations, when the occasion inevitably arises that you can't do these things, you think of yourself as a failure. Those feelings can only lead to deeper depression.

Can you lighten your load? Cut down on your chores, errands for others, and other stressful activities. Try to do more things that will help you relax and regroup.

And there's nothing wrong with a little couch time with a culturally competent therapist--one who understands the complexities of a black woman's life.

Our babies have enough challenges in this world, let's do our part to make sure our children are born to moms who are as happy and mentally healthy as possible.

SisterSpace: I Will Not Write a Blog for Infant Mortality Awareness Month

This is not a blog for infant mortality awareness month. Something so weighty deserves more than to be relegated to web log. I will not make any witty observations. I will not use any metaphors, similes, idioms, or analogies. There will be no alliteration or onomatopoeia used to help you get it.

There will be no opinions, only facts. The jarring sort that aren't typically welcome in a blog. This will not be entertaining. You will probably not "Like" this.

This is my virtual moment of silence for the babies who needlessly die every year. This is my silent cry in the blogosphere for greater awareness in the African American community where our babies are 2.3 more likely to die before their first birthday than in the white community. This risk exists for all black women regardless of income or education.

This is my anti-blog for the unborn who deserve to live to see their first birthday and my homage to those who didn't.

• Currently, the national infant mortality rate for Black babies is 13.7 per 1,000, compared to a rate of 5.6 per 1000 for White babies, 3.5 per 1000 for Asian babies, and 5.3 to 6 per 1000 for Latino babies.




• Black babies are four times as likely to die as infants due to complications related to low birth weight as compared to non-Hispanic white infants.




• African Americans have 2.3 times the infant mortality rate as non-Hispanic whites.




• African Americans had 1.8 times the sudden infant death syndrome mortality rate as non-Hispanic whites.




• College- and graduate-school educated black mothers have a higher infant mortality rate than white moms who didn't finish high school.




• The infant mortality rate for African American mothers with over 13 years of education was almost three times that of non-Hispanic white mothers.




• Black women who get prenatal care in the first trimester have double the infant mortality rate of white mothers with first-trimester care.




• Only 17 percent of all U.S. births were to African-American families, but 33 percent of all low-birth weight babies were African-American, according to one report.




• Black women with similar levels of prenatal care as Hispanic women (generally less educated and with lower incomes than blacks) have higher rates of low birth weight, preterm deliveries, and infant mortality.




• According to Dr. Michael Lu, assistant professor of obstetrics and gynecology and public health at UCLA, researchers have found that even when they control for such varied factors as poverty, housing, employment, medical risk, abuse, social support and so on, 90 percent of the differences in birth weight between black and white moms remains unaccounted for.

"Most studies have looked at black-white differences during pregnancy, for example, differences in prenatal care utilization or maternal behavior," he says. "What we're finding is that these differences really explain very little of the disparities in birth outcomes."

The Problem with Alicia Keys. And Too Many Black Women Like Her.

I just love Alicia Keys. On any given Saturday, you'll find my children and me closing out our usual Saturday morning dance party with a stirring rendition of "If I Ain't Got You," where we substitute each other's names in the chorus. My kid-friendly traveling CD features Alicia's live-out-your-dreams anthem "Unbreakable." And when I'm feeling unstoppable, Alicia's lyrics from Superwoman: "Still ,when I'm a mess, I still put on a vest, with an S on my chest. Oh yes, I'm a superwoman," really speak to me. Oh, and please don't get me all riled up about Empire State of Mind.

But I've got a growing problem or real concern about Alicia Keys and many black women like her when it comes to our pregnancies. A few weeks ago, I held my breath as I watched Alicia Keys climbing her preggers self on top of a piano at the BET Awards, albeit during an incredible tribute to Prince. But still. And then last weekend, she fell off her 4-inch heels and landed on her backside while performing at the Essence Music Festival in New Orleans.

I'm concerned because for over five years now, I've been on a personal mission to help black women have healthy pregnancies and healthy babies. That's what the Women's eNews Black Maternal Health Project is all about. When my first book, The Mocha Manual to a Fabulous Pregnancy (Amistad/HarperCollins) came out, it was the first of its kind, a hip and funny book to really talk to a new audience of savvy black women about the lifestyle issues and unique stressors that are affecting our pregnancy and birth outcomes.

Studies show that even successful, college educated black women are still twice as likely to have a low birth weight baby, twice as likely to have a pre-term baby and nearly three times more likely to die during childbirth than their white peers. Nobody knows the exact root cause of these disparities, and why education and class don't protect black women from poor birth outcomes as it does for white women.

But one of the biggest self destructive behaviors among black women is what I call the Strong Black Woman Syndrome. The exact same problem Alicia sings about in her Superwoman song. We notoriously carry our communities, we carry our families and we carry our pain, but we put an S on our chest and project a "strong" image regardless of how broken we are inside. In our culture we are raised to view "weakness" as a character flaw. We must be strong. Period.

Having that conditioning is helpful in so many scenarios. But it can be damaging during pregnancy. In my many years talking to black women about pregnancy and championing the black female's pregnancy and parenting experience at www.MochaManual.com, I am still struck by the number of black women who don't see pregnancy as any deviation from their normal state of being. They expect to be able to continue to work just as hard, to continue to carry others, and to not take special care of themselves. We work and work and work because that's what we do. And even while taking on the most phenomenal journey known to womankind, we act like indestructible machines that can just keep going and going, and not as fragile humans charged with shepherding a new life into the world.

Alicia, we love you! But as one hard working black woman to another, I'm personally begging you to ease up on work and the piano climbing and allow yourself to be still.

Still.

Respect the journey of pregnancy. We know you are a superwoman. But your baby needs you to be super careful, super mindful and super stress free. We've got plenty of your great music to hold us over. I just want you to focus on the most important production of your life.

Text 4 Baby! : New Service Delivers Info to Moms to Be

I'm all for getting information out to expecting moms by any means necessary--especially when it's new ways to reach African American women with the information they need to have healthy pregnancies. That's why I was really excited to hear about the new Text4Baby http://text4baby.org/ service.

At first, I thought, why didn't they have this when I was pregnant? But enough of my envy. It's great to have timely information, practical tips and friendly reminders on your mobile phone. We're always attached to them anyway. Heck, we've invented a whole new texting language that leaves many of us pausing and stumped when we have to fully type out an actual word for a work-related email.

What's even more remarkable about this project is that it represents an unprecedented coming together of the government and the private sector (pause for shocking gasps!) using new technology (double gasps!) to actually help improve maternal health among underserved women (you know what to do now).

But it's true. Text4Baby is the first ever free mobile health service in the United States, and it sends free text messages to pregnant women and new moms through their first year. It also really shows the power of mobile phones and other technology to get powerful information to people who need it most. Not everyone has a home computer, but nearly everyone these days has a mobile phone.

All you have to do is text BABY to 511411 (or BEBE for Spanish) to get three free text messages each week just right for your due date or your baby's age. These messages focus on a variety of topics related to maternal and child health, including birth defects prevention, immunization, nutrition, seasonal flu, mental health, oral health and safe sleep. Text4baby messages also connect women to prenatal and infant care services and other resources, if you need them.

Please tell everyone you know. Underserved, overserved, supersized or emphasized. This service is great for all moms!

And holds great promise of things to come. " Text4Baby demonstrates the ability of mobile phones to inform and engage people to help them live healthier lives. These same tools can be applied to many of America's big health care challenges, " said Paul Meyer, chairman and president of Voxiva, the mobile health platform provider for the service.

Here's hoping.

To make this amazing resource happen The National Healthy Mothers, Healthy Babies Coalition http://www.hmhb.org/ (I'm a big fan of their work) collaborated with White House Office of Science and Technology Policy, the Department of Health and Human Services and Department of Defense Military Health System. Johnson and Johnson is a major sponsor as is Johnson Baby. Then the wireless carriers joined the party and voluntarily agreed to distribute the text messages for free. (Participating carriers include: Alltel, Assurance Wireless, ATandT, Boost Mobile, Cellular South, Cellcom, Centennial Cellular, Cincinnati Bell, Metro PCS, N-Telos, Sprint Nextel, T-Mobile, U.S. Cellular, Verizon Wireless and Virgin Mobile USA--if you're carrier isn't on this list, switch now. It's a bad message (not text) to moms, if they didn't jump on this boat! )

There's a critical mission to be taken on to improve maternal health in this country. Infant mortality rates in the U.S. are embarrassing at best and abysmal in the African American community. And if a mobile phone, fax, wooden spoon or pot and pan can help. Then I'm all in.

ConTEXTually yours,

Kimberly

Folic Acid and You—What Every Woman of Color Needs to Know

It’s the New Year! And who knows what 2010 will bring. According to recent stats approximately 50 percent of women aged 15-44 have at least one unplanned pregnancy in their lives. That means a good number of us may have an surprise in 2010.

 

That also means every woman of childbearing age, should be thinking about their health all day, every day. That’s why I wanted to tell you that this week, January 4-10^th, is Folic Acid Awareness Week. Sponsored by the National Council on Folic Acid (NCFA) http://www.folicacidinfo.org/pages/folicacid_info.php, the week is intended to educate all women about folic acid. If taken before and during early pregnancy from a multi-vitamin or fortified foods, folic acid can prevent from 50 percent to 70 percent of some forms of serious birth defects of the brain and spine, called neural tube defects (NTD).

 

Getting the right amount of folic acid is particularly important to Black and Latina women. Not only do Latinas have higher rates of NTD-affected pregnancies, they also have the lowest awareness about folic acid than women of other ethnic groups, and lower consumption of folic acid than white non-Hispanic women, according to recent studies.

 

In addition to preventing NTDs, increased folic acid has been linked to preventing preeclampsia, a form of severe high blood pressure that usually occurs after 37 weeks of pregnancy. The potentially fatal condition is more common in black women. Studies indicate that when black women have preeclampsia they tend to have a severe form of the disorder and experience it as early as six months in the pregnancy compared to the typical ninth month. 

 

Doctors have not yet pinpointed exactly why this disparity exists, however, one study found that black women had less folic acid and more of a certain amino acid than white women as a pre-existing condition, which put them at a higher risk during pregnancy. The findings suggest that black women take more folic acid before and during pregnancy and as early as possible. (http://www.msnbc.msn.com/id/4781703 )

 

The easiest way to make sure you’re getting enough folic acid all the time is by taking a multi-vitamin, B vitamin complex pill or folic acid pill and eating fortified foods like grains, pastas or breakfast cereals. Folate is found naturally in foods such as leafy green vegetables, beans, liver and some fruit. But for some reason, scientists have found that folic acid, the synthetic version of folate, is actually easier for your body to absorb than folate.

 

Even if you don’t have a planned or unplanned pregnancy in the cards, folic acid is pretty important to your healthy living. Studies show that folic acid reduces the risk of certain cancers; cardiovascular diseases including coronary heart disease and stroke; and cognitive diseases or mental conditions such as Alzheimer's disease, age-related dementia or cognitive decline and depression. We can all use that.

A National Day of Dialogue on Domestic Violence and Teen Dating Abuse

Last week, I was invited to Liz Claiborne's "It's Time to Talk Day" --a national day of dialogue on domestic violence and teen dating abuse, where leading voices come together for a day of radio and blogging about an issue that doesn’t get enough talk time. (Learn more at www.loveisnotabuse.org)

 

I couldn't help but feel a bit emotionally spent dealing with such a heavy and important issue. But there is another area of domestic violence that rarely gets discussed—domestic violence during pregnancy.  

 

It is estimated that one in five women will be abused during pregnancy. What’s worse, homicide during pregnancy now surpasses the previous leading causes of death (automobile accidents and falls), for pregnant women.

 

It is more important than ever that we know the signs of domestic violence and start talking about these issues in our community. 

 

Enter activist and philanthropist Malaak Compton Rock. The wife of my favorite comedian, Chris Rock, takes service very seriously (check out her many projects at http://www.angelrockproject.com/) .

 

But last week Malaak and I had a candid conversation about domestic violence in the Black community. And I think all black women and black men need to listen: 

 

Kimberly: How is domestic violence different for us?

Malaak: "The silence is killing us. I think the white community has done a good job showing that domestic violence is not a poor woman's problem. They have changed the face of domestic violence to show that educated, career women suffer as well. We haven't. "

 

Kimberly: I think that if you are "successful" and you have that positive black family image going on, there’s even more pressure to keep up that appearance and not break up another black family.

 

Malaak: “You're right. There's a lot of fear of breaking up the family, and we need more affluent women to come out of the closet. There is a fear that I'm alone. We have to take the stigma out of the issue and add more faces and voices to that pain. I think it needs to start in Black magazines and even websites like yours.”

 

Kimberly: What can our men do?

,

Malaak: "I will tell you this, my husband is very aware of how he treats me because he knows our two daughters are learning how to be treated by a man by his dealings with me. It all starts in the home. Fathers need to be involved with their daughters, teaching them what they deserve and should expect in any future relationship."

 

Kimberly: That's powerful.

Malaak: "I know this, women who are strong, confident and secure in who they are were raised by fathers who instilled that into them."

 

Even though our community has disproportionately high levels of single female-headed households, we can’t get around how important our black men are to saving our communities, our babies and ourselves.

Pregnancy and Swine Flu. Get Answers.

Outside of the medical community, every mama, auntie or Big Mama in your family, neighborhood or church has their own old wives tale about what to do and what not to do during pregnancy.

If that weren't enough, the recent spate of H1N1/ swine flu is a real concern for everyone especially mothers of young children and pregnant women. Who should get the vaccine? Is the seasonal flu vaccine just as effective? What's in the vaccine? You see, a lot of questions.

The CDC has recommended that healthy pregnant women get vaccinated against the seasonal flu. Yet new data shows that only 20% of those who are currently pregnant plan to get a flu vaccine this season. I'm sure that number is much higher among black women.

What gives?

Well, for one, let's face it, our community tends to distrust the medical field anyway and the government runs a close second. And the internet is full of so called experts, scary stories and more, it's hard to know what is correct and what is potentially harmful.

To help, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the National Women's Health Resource Center (NWHRC) have launched a new campaign, "Flu-Free and A Mom-to-Be: Protect Yourself, Protect Your Baby -- Get a Flu Shot!." The "Flu-Free and A Mom-to-Be" campaign aims to educate health care providers and their patients about the importance of both the seasonal flu and the H1N1 vaccines. You can check it out here, and download helpful information.

 

If you are looking for a safe place to ask questions, get live answers and talk to other parents, please click here to register for a free webinar on Thursday, November 19th at 8pm. The webinar is open to everyone and co-hosted by Heart and Soul magazine and MochaManual.com, my online parenting community.

 

The chat will feature two leading specialists from the American Academy of Pediatrics who will lead an open discussion and Q and A. Dr. Renee Jenkins, is chair of the Department of Pediatrics and Child Health at Howard University and immediate past president of The American Academy of Pediatrics. Dr. Meg Fisher is a pediatric infectious disease specialist and chair of the infectious disease section of the Academy. Both of these amazing women are committed to giving our community the answers they need to make their own decisions.

Get all the info you need to protect yourself and keep you, your growing baby or newborn infant healthy. You owe your little one that much.