Suzanne Ellis, a 39-year-old mother from Port Richmond, needed emotional support when she found out she was pregnant. Not money, not diapers, not baby food. She needed to know she wasn’t alone, that she had someone in her corner.
“I didn’t know where to turn or what to do, but my sister-in-law sent me a website link to Maternity Care Coalition and I’m so glad I reached out to them,” Ellis said.
Maternity Care Coalition (MCC) is a community-based nonprofit organization with 11 locations regionally. They serve pregnant and postpartum women and families in underserved communities through home visits, prenatal care, parenting and life skills education, school readiness support, and referrals to medical care.
Philadelphia has one of the highest infant mortality rates in the United States, according to the PEW Charitable Trust’s “Philadelphia 2019: State of the City” report. In light of this glaring fact, organizations throughout the city, like MCC, are working to bring necessary care to expecting and new mothers.
“Don’t forget about the babies,” said Karen Pollack, vice president of MCC. “That’s what we want policymakers to know, and that’s why MCC was created [in 1980].”
According to the PEW report, Philadelphia’s infant mortality rate (IMR) is 8.4 deaths per every 1,000 births, towering well over the national average of 5.9. Although infant deaths in Philadelphia steadily declined for a decade — from 286 in 2007 to 178 in 2017 — the rate has slowed since 2014, continually plaguing the same neighborhoods it did back when MCC was founded.
“In a city like Philadelphia, there’s a parallel between race and socioeconomic status, which causes substantial differences in infant mortality rate based on race,” Pollack said.
Dr. Robert Fischer, co-director at the Center on Urban Poverty and Community Development and associate professor at the Jack, Joseph and Morton Mandel School of Applied Social Sciences at Case Western Reserve University (CWRU) in Cleveland, Ohio, agrees.
“In Cleveland — specifically Cuyahoga County — our infant mortality rate is startlingly high at 16 per 1,000 births in black communities versus 2.5 per 1,000 in white communities,” he said.
Given the socioeconomic correlation, it’s no surprise that since 27 percent of African-Americans in Philadelphia live in poverty, infant deaths among African-Americans are significantly higher than those among other racial and ethnic groups, according to the PEW report.
“But nationally, it’s race and status,” Fischer said. “The white communities in Appalachia and Arkansas have high IMR, too.”
Although poverty is not a medical condition, many of the factors associated with poverty and living in an impoverished neighborhood — the disparity in income, crime, employment, housing, health care, and education compared to other parts of the city — correlate to heightened infant mortality.
“Even if you’re one of the luckier ones in your neighborhood — for example, one who has a job or is primarily healthy — you’re still at higher risk for IMR just by living there because of all the surrounding stress,” Fischer said.
In addition to the stress of living in poverty, Pollack said there’s something else pregnant women, especially pregnant women of color, have to deal with in underserved communities: systemic racism.
“Some of the more recent analysis is starting to look at the impact of racism and the stress that the people of color experience due to their environment,” she said. “Dealing with institutional racism, living in communities where there’s more likely to be violence and drug use, not having access to support and resources.”
Organizations like MCC design programs and interventions that try to understand the toll poverty and racism have on a woman’s body. To do this, MCC staff meet their clients to discuss these challenges where they are and feel most comfortable, whether that’s in their homes, parks, or community centers.
One way MCC meets clients where they are is through their MOMobile program, an outreach on wheels introduced in 1989.
The MOMobile is filled with a variety of resources on health education, as well as social services and medical care. Staff use the MOMobile to support pregnant women by connecting them to other programs in their community, whether that’s housing, domestic violence counseling, or other behavioral and health resources.
“What makes us successful is building a strong relationship between our advocates — that’s what we call our staff who do home visits — and the mom,” Pollack said. “If we’re visiting the woman in her home, it creates a very different dynamic and different level of closeness with our clients in a positive way.”
Ellis’ case worker, Millie Ofray, goes to her house every two weeks to check in, hang out, talk, and play with Kaleb, her 14-month-old son.
“She does these tests with him to evaluate his learning and development every few months, and he always scores a little bit above average,” Ellis tearfully explains. “So I thank her for that, and she says, ‘No, that’s because of you! That’s a testament to your love and work as a mother.’ And I just love her! She’s my cheerleader.”
That closeness does wonders, especially for women of color and low socioeconomic status, as research shows they are several times more likely to suffer from postpartum depression, but less likely to receive treatment.
“What’s also really interesting is that there’s also a genetic impact,” Pollack said. “So when you have this experience of toxic stress, it changes your genetic makeup which gets passed down. So it’s a cumulative impact, a cycle of racism.”
What’s more, when they are in pain and need treatment or have questions about their changing bodies, they often choose to stay quiet out of fear — fear of not being believed or taken seriously and fear of having their children taken away by child-welfare services.
“When a woman goes to a doctor’s office for care, it’s on the doctor’s turf,” Pollack explained. “But since we recognize the limitations our clients have — financially, economically, physically — we have our staff go into the community so we can bring support to women and facilitating connections.”
MCC has also began to specialize beyond the MOMobile in order to further assist in providing access and meet women where they are, wherever that may be.
“We are now working with women who are incarcerated at the women’s correctional facility in Philadelphia,” Pollack said. “We also have a program that specifically works with women whose families are impacted by opioid use and one that works specifically with women to address maternal mortality.”
MCC also advocates for their clients somewhere other than their homes and communities: city hall. MCC staff often lobby politicians at the state and local level about the need for more funding, more attention, and more conversation about Philadlephia’s high infant mortality rate.
“We want to start the conversation and keep it going, especially with the next generation,” Pollack said.
For clients like Ellis, working with MCC has meant everything. More people should know about and utilize MCC as a resource, Ellis said.
“With Kaleb, I get a second chance, and MCC helps me do that,” Ellis said. “When my daughters were younger — they’re 17 and 20 now — I partied and drank and spent some time in prison and just put so much of their upbringing on my mom. Now I’m different. Millie helps me be a better mother.”
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