HONOLULU (KHON2) — October is Pregnancy and Infant Loss Awareness Month, and unfortunately, Hawaii has one of the worst statistics for infant loss among Black and African American women. 

Women’s health, especially among Black and African American communities, is growing traction across the country due to high numbers of infant mortality, pregnancy complications and more.

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America’s Health Rankings came out with a study ranking states based on the number of infant deaths per 1,000 live births to Black or African American mothers.

Hawaii had one of the worst infant mortality rates among Black mothers based on their findings. However, it is important to note not all 50 states were included in their report. 

According to the Hawaii State Department of Health, from 2017 to 2018, the infant mortality rate among Black mothers was drastically higher than the national average at 25.3 out of 1,000. 

According to the Center of Disease Control and Prevention, the average infant mortality rate in the United States in 2020 was 5.4 deaths per 1,000 live births. 

In Hawaii during that time frame (2019-2020) the infant mortality rate among Black mothers was higher than the national average at 6.1 per 1,000 but lower than previous years. 

Overall, the infant mortality rate among Black mothers is decreasing from its worst year in 2017 at 25.3 per 1,000 to now 6.1 per 1,000 in 2020. 

However, when looking at Hawaii as a state and not including race, Hawaii is below the national average sitting at 4.88 per 1,000. 

The Hawaii Maternal Mortality Review Committee reviews all maternal deaths in Hawaii. A maternal death is defined as a death that occurs during pregnancy or within one year of giving birth. Recommendations are made by the committee to address the factors which contributed to the death.

The health department suggests because of the small sample sizes of infants where the mother’s race is Black, the infant death rates show a high variability resulting in wider confidence intervals with larger margins of error.

But when looking at the population of Hawaii residents over the past five years, there hasn’t been much of a shift.

March of Dimes is an online perinatal statistics website that gives information on population for all 50 states that can be broken down by race, ethnicity, class and more. 

According to their research, the Black and African American population in Hawaii has stayed below 2.5% for the past five years. So why are there years with more infant deaths among Black mothers than in other years?

Matthew Shim, PhD, MPH; Chief of Family Health Services Division, said for Hawaii it is very difficult to identify a cause of infant mortality where the mother’s race is Black because of the small sample sizes of infants where the mother’s race is Black.

“This infant death rates show a high variability with larger margins of error than infant mortality of other race/ethnic categories with larger samples sizes,” said Shim. “In the future, DOH can review all infant deaths over a longer time span — such as 10 years or more — to better describe infant mortality in Hawaii across all race and ethnicity categories that represent the diversity of our population.”

Shim adds without in-depth research and analysis of each infant death, it is unknown if any of the infant deaths due to natural causes between 2017 and 2019 were preventable.

“For the period 2017-2019, there were a total of 239 infant deaths due to natural causes across all races. Prematurity was the cause of death for 85 (36%) infants,” said Shim. “Respiratory complications were the cause of death for 82 (34%) infants. Infection was the next highest cause of death for 24 (10%) infants.”

He said cardiac conditions were the cause of death for 18 (8%) infants and hemorrhage/congenital conditions/other causes accounted for the remaining 29 infant deaths due to natural causes.

According to Shim, they recently had a partnership with the University of Hawaii’s John A. Burns School of Medicine where they offered implicit bias training through a talk titled “Contextualizing Maternal Health in Hawaii: Historical, cultural, and social determinants of health for Native Hawaiians and Pacific Islanders.” 

He said this talk provided important context to the maternal health disparities that many of our public health and other health professionals observe in their work. 

Hawaii isn’t the only state dealing with high infant mortality rates among Black women which is why many women are seeking prenatal services outside of a traditional medical field. 

Chelsie Moore, who goes by Aura, founded Lifted Auras on Oahu as a way to help heal herself and friends.

She opted to have a homebirth on Oahu rather than a traditional medicated hospital birth after doing her research and reading up on natural births at home. 

“Statistically, Black women have a higher possibility of complications in the hospital,” said Aura. “It’s unfortunate and the numbers are disturbing to look at. Having a home birth was in alignment to my birthing vision.”

She said with her first child she had a regular hospital birth but wondered if it would have been less stressful birthing at home with a team of providers she got to choose. 

“Plus, after my first child I started studying to become a doula. After learning more about pregnancy, birth and postpartum, I was more comfortable having a home birth,” said Aura. “I also had experience with water home births by that time.”

She said during her prenatal appointments she would get some pushback from doctors who questioned her choices. But because her first birth in a hospital setting was overwhelming, she wanted to hire a doula and do what was best for her and her family. 

“We also switched hospitals for the closest experience to home birthing. It was one of the best decisions,” said Aura. “My second pregnancy we found an amazing holistic doctor and doula that aligned to our birthing vision. They educated us so we felt comfortable, we read different books, watched videos and taught labor techniques.”

She said when it comes to birth, a mother needs to do what is best and what feels right. She encourages any mom-to-be to ask questions at prenatal appointments and find the best team they feel comfortable with. 

The health department promotes TheParentLine.org, a free statewide confidential telephone line and Hawaii’s premier resource on child behavior, child development, parenting, caregiver support and community resources.

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“Your birthing team is here for you! Communication is key,” said Aura. “If you are still feeling unsure about your care provider, look for someone that resonates with you and your birthing vision.”