The Los Angeles County African American Infant and Maternal Mortality (AAIMM) Initiative is a countywide coalition dedicated to addressing the disproportionately high rates of Black infant and maternal deaths and ensuring healthy and joyous births for Black families in L.A. County. Led by the L.A. Department of Public Health (DPH) in partnership with First 5 LA, AAIMM was launched in 2018 as part of DPH’s 5-Year Plan to address the Black-White infant mortality gap in L.A. County.
Black mothers are four times more likely to die from pregnancy complications than their white counterparts, while Black infants are three times more likely to die within their first year of life when compared to white babies. Through a series of comprehensive, coordinated strategies, AAIMM’s goal is to reduce the gap in Black/white infant mortality rates by 30 percent by 2023.
AAIMM members include the Los Angeles County Health Agency, First 5 LA, community-based organizations, mental and health care providers, funders, and community members. A fellowship funded by the Pritzker Foundation seeded the effort, informed by emergent research and focus groups of over 100 Black women.
Central to the Initiative’s approach is a new understanding of the pathway from the mother’s lived experience to infant health. In this framework, the root cause of birth disparities has been identified as the stress caused by a Black person’s exposure to racism and the impact of that stress on a Black woman/birthing person’s body. This stress is further compounded by social, economic and political structures in society that perpetuate racism, as well as the presence of implicit and overt bias in the systems of support that interact with Black families.
The L.A. County African American Infant and Maternal Mortality Steering Committee guides the implementation of DPH’s 5-Year Action Plan and informs the development and implementation of strategies to complement the Plan. Committee members also work to advance awareness and policy change related to AAIMM.
Steering Committee members include representatives from:
- California Black Women’s Health Project
- LA County Department of Public Health
- First 5 LA
- Antelope Valley Partners for Health
- Black Women for Wellness
- Black Mental Health Taskforce
- Charles Drew University of Medicine and Science
- Cherished Futures/Hospital Association of Southern California
- LA County Department of Health Services
- LA County Department of Mental Health
- Essential Access Health
- Growth Mindset Communications
- Healthy African American Families
- iDREAM for Racial Health Equity
- Kaiser Permanente
- AAIMM Doula Advisory Board
- LA Partnership for Early Childhood Investment
- Long Beach Department of Health and Human Services
- March of Dimes
- PHFE WIC/CinnaMoms
- AAIMM Community Action Teams
COMMUNITY ACTION TEAMS
The AAIMM Community Action Teams (CAT) are regionally based partnerships between the Los Angeles County Health Agency and local community-based organizations, health care providers, residents, faith-based organizations, birth workers (e.g., doulas, midwives), businesses and other allies. CATs consult, inform and engage their community on all AAIMM strategies and create locally based actions.
CATs currently operate in the following Service Planning Areas (SPAs):
- Service Planning Area 1 – Antelope Valley/Palmdale
- Service Planning Area 2 – Santa Clarita/San Fernando Valley
- Service Planning Area 3 – San Gabriel Valley/Pasadena
- Service Planning Areas 6 and 8 – South LA/South Bay
Each CAT has various work groups focusing on issues such as Policy, Engagement, Fundraising, Family-Centered Models of Care and more.
PERINATAL EQUITY INITIATIVE
The Perinatal Equity Initiative (PEI) was established in 2018 as the California Department of Public Health’s response to the alarming statewide mortality rate for Black infants. Designed as a complement to the California Black Infant Health (BIH) Program, PEI improves birth outcomes and reduces mortality for Black infants through county level interventions that are evidence-based, evidence-informed or reflect promising practices.
The evidence-based programs implemented by the AAIMM Initiative include:
Group Prenatal Care. Offered in partnership with Charles Drew University’s Black Maternal Health Center for Excellence, this program provides evidence-based group prenatal care from Black community midwives exclusively for Black women/birthing people. As Alameda County’s BElovedBirth Black Centering program states, “Group perinatal care by, for, and with Black people is an innovative new program designed to provide culturally attuned and racially concordant care for Black birthing people.”
Fatherhood Initiative. This new initiative promotes the importance of having fathers engaged in the process, bolstering mental, emotional and physical health during pregnancy and post-delivery. The Fatherhood program includes social support in a group atmosphere and technical assistance that enable medical providers to best serve fathers from pregnancy through postpartum.
Preconception Health. Pregnancy Intentionality, Preconception and Interconception Care Intervention (Preconception Health) is designed to increase women’s health by focusing on their ability to make informed decisions on whether and when to become pregnant, and promote health-affirming behaviors both prior to conception and between pregnancies. The Preconception Health program seeks to promote reproductive health care and pregnancy intention screening as a fundamental, standard component of primary care. The program also provides technical assistance to clinicians and service providers, as well as culturally respectful reproductive health care and pregnancy intention communication that centers Black families.
In addition to the interventions, the AAIMM initiative is using PEI funding to collaboratively support several other anchor strategies, including:
The Village Fund. A public-private partnership to support community-led efforts that reinforce the broad goals of the AAIMM Initiative. In the spirit of “it takes a village to raise a child,” the Fund partners with organizations, service providers and networks that provide valuable support and services to Black birthing mothers and their families but are often not funded by — or even on the radar of — foundations and public entities. The Fund is administered by the LA Partnership for Early Childhood Investment and seeded by a combination of public and private philanthropic dollars, including PEI funding and First 5 LA.
Cherished Futures for Black Moms & Babies. A multi-sector, collaborative effort to reduce infant mortality and improve maternal patient experiences and safety for Black moms and babies in South Los Angeles and the Antelope Valley. With sponsorship from Health Net and in partnership with the Public Health Alliance of Southern California, Cherished Futures unites key decision-makers from local birthing hospitals, public health agencies, health plans, community-based organizations and advocacy groups to implement systems-change interventions at the clinical, institutional and community levels. Cherished Futures also contracts with the March of Dimes and BreastfeedLA for Hospital Quality Improvement work through funding from DPH-PEI and First 5 LA.
SOCIAL DETERMINANTS OF HEALTH
AAIMM currently addresses the social determinant of financial inequities on Black pregnant people’s health by providing education and hands-on support for families eligible for Paid Family Leave and Earned Income Tax Credit (EITC). There is strong evidence that the EITC increases employment and income for participating families and improves birth outcomes. There is also data that shows some families who could benefit the most from the program are not claiming their EITC.
Paid Family Leave. In partnership with The California Work & Family Coalition, we have recruited 50 community members to provide education and Paid Family Leave (PFL) support in their communities. The program will train African American parents, healthcare professionals, doulas, faith-based members and others who provide support and services to Black families in L.A. County. Selected community members will be compensated to share PFL information and assist families with applying.
Earned Income Tax Credit. In partnership with the Department of Consumer and Business Affairs, First 5 LA, CAL EITC and the United Way, AAIMM has created a public awareness campaign and are providing 30 African American families who are eligible for EITC with free tax preparation from certified tax preparers.
In addition to the PEI-funded strategies, the AAIMM Initiative also recognizes doulas as a key part of the solution. Doula support can reduce medical interventions such as c-sections, improve mental health, increase satisfaction with the birth experience and increase breastfeeding success.
Funded by L.A. County DPH’s Division of Maternal Child and Adolescent Health through a $1 million award from the California Home Visiting Program (CHVP), the AAIMM Doula Program will provide free, culturally congruent doula support to 500 Black/African American pregnant people countywide through June 2023. Priority will be given to families in SPAs 1,6 and 8 (Antelope Valley, South LA and the South Bay), where Black infant mortality rates are highest.
The AAIMM Doula program features 14 African American/Black doulas — trained professionals who provide physical, emotional and informational support to a laboring person and/or family before, continuously during, and after childbirth to help them achieve the healthiest, most satisfying experience possible. AAIMM doulas provide unconditional and non-judgmental support and are trained in full-spectrum and trauma care as well as lactation education.
COMMUNICATIONS AND AWARENESS
Funded in part by the PEI grant and Doula project funding, AAIMM communications efforts focus on fostering awareness and action around racial health disparities in birth outcomes among Black women, the interventions to address them, and the role families and stakeholders can play in ending them. Communications activities underscore the theme, “a joyous and healthy birth takes a village,” and educates birthing families to activate a village of support, while inviting stakeholders to be a village of support for Black mothers, infants, and families.
IMPLICIT BIAS AND ANTI-RACISM TRAININGS FOR ALL COUNTY STAFF
Co-Creating an Oasis: A New Context for Care of African American Mothers – First 5 LA Commissioned a focus group of 100 black women about their experiences with the health care system as well as pregnancy to further understand the impact of racism on a black woman’s well being.
AAIMM PARTNER WEBSITES & RESOURCES FOR BLACK FAMILIES:
- L.A. County AAIMM Initiative website: Blackinfantsandfamilies.org
- Home Visitation Programs (https://edirectory.homevisitingla.org/Home/Programs)
- Black Infant Health (http://www.publichealth.lacounty.gov/mch/BIH/bih.htm)
- Breast Feed LA (http://breastfeedla.org/)
- Black Women for Wellness (https://www.bwwla.org/)
- California Black Women’s Health Project (https://www.cabwhp.org/)
- Cinnamoms (https://www.cinnamoms.org/)
- Essential Health Access (www.essentialaccess.org)
- Healthy African American Families (https://www.haafii.org/)
- iDREAM for Racial Health Equity (www.idreamnow.org)
- Los Angeles County Health Agency (http://healthagency.lacounty.gov/)
- March of Dimes (www.marchofdimes.org)
- Maternal Mental Health Now (https://www.maternalmentalhealthnow.org/)
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