Eliminating Infant Mortality through Every Baby Guilford
Guilford County, North Carolina devoted $500,000 of its allocated $104 million ARPA recovery funds to Every Baby Guilford (EBG)—a collective action partnership between County government and community organizations that addresses health disparities in infant mortality rates, specifically among Black mothers. Every Baby Guilford’s goal is to reduce infant mortality disparities in the county by 50 percent by 2026 and to eliminate disparities by 2031. Program Manager Jean Workman explains that by focusing on improving outcomes for those most vulnerable, they can improve health for all in Guilford County. “If we improve the birth outcomes for our Black infants in our community, we’re going to improve health outcomes for all babies and all families,” Workman says.
Why this investment?
Guilford County has an infant mortality rate of 7.6 per 1,000 births: more than 10 percent higher than the state of North Carolina’s average, and 40 percent higher than the national average. Black women are disproportionately impacted by infant deaths, with infant mortality rates 2 to 6 times higher than those for white, Hispanic, and Asian mothers.
To address these disparities, County public health staff and concerned residents formed the Guilford County Coalition on Infant Mortality in 1988. Their focus was primarily on connecting uninsured women to prenatal care. In 2021, the coalition relaunched as Every Baby Guilford, with a new strategic focus on collective action, racial equity, and systems-level change.
Jean Workman, who joined Every Baby Guilford in 2019, explains that the new direction came from a recognition that the organization needed to focus on the disproportionately high infant mortality rates among Black mothers. “If I was going to lead it, I wanted to lead it with the intent of focusing on the disparity rates for Black families and communities in Guilford,” Workman said. “My vision was to center the community around the disparity rates, not infant mortality reduction, and identify a community-driven process for the community to embrace.” At the relaunch, Every Baby Guilford named racism a public health crisis and placed dismantling structural racism at the top of their agenda.
With a renewed focus on improving community health by eliminating racial disparities, Every Baby Guilford was one of the first three ARPA investments Guilford County authorized in July 2021. The County had named infant mortality reduction as a strategic priority in 2019, and when the ARPA funding became available, the County Manager asked Workman if there was a relationship between COVID-19 hospitalization risk factors—such as cardiovascular disease, hypertension, and diabetes—and infant mortality disparities. Workman found there was a strong correlation: a majority of infant deaths are due to prematurity, often attributable to preeclampsia caused by hypertension. In this way, investing in Every Baby Guilford was addressing the underlying conditions that caused COVID-19 disparities.
What is this investment?
Every Baby Guilford describes itself as a “collective action movement, building collaborative solutions within the community to disrupt long-standing health outcomes and racial disparities in Guilford County.” EBG is a public/private partnership, with the County serving as the backbone entity supporting and coordinating programmatic activities, and Every Baby Guilford providing community voice, strategic direction, and collaborative partnership with county and local funders.
Through a series of convenings and community focus groups with women who’ve experienced or are at risk of infant loss, Every Baby Guilford set a goal to reduce the infant mortality disparity rate in Guilford County by 50 percent by 2026, and to eliminate disparities by 2031. To realize this goal, Every Baby Guilford is implementing four strategies: 1) advancing health equity by addressing systemic racism and implicit bias within maternal and infant health care; 2) centering the community through radically inclusive engagement to collectively create equitable solutions; 3) strengthening healthcare as a continuum of reproductive care by ensuring equitable access to quality care; and 4) promoting infant wellness and positive child development through collaborative programs.
Every Baby Guilford has launched several programs aligned with these strategies including a community doula program, a Health Ambassador program, and the Amplifying Every Voice community-based participatory research project.
Centering equity in the program
Engaging the women who’ve experienced infant loss or managed chronic health conditions that affected their pregnancies is central to how Every Baby Guilford works—from understanding the drivers of disparities to setting priorities and developing programmatic solutions. Through its community-engaged approach, Every Baby Guilford is working to grow the collective voice of Black mothers. As Workman explains, “Collective action is all about shifting power from the folks who have historically held the power to the community members that should have the power.”
This type of deep community engagement is embedded in Every Baby Guilford’s projects. In July 2021, Guilford became the first county in North Carolina to conduct a Fetal Infant Mortality Review in which a case review team made up of community members alongside medical professionals reviewed individual death certificates to understand the causes of infant deaths—and work to identify solutions. The team has reviewed 14 cases and made 39 recommendations to a community action group of leaders poised to implement the recommendations. Equitable pay is also a large part of Every Baby Guilford’s doula program, as doulas of color were initially consulted in the programs’ development and voiced the need for higher pay in order for the work to be sustainable.
Through its Amplifying Every Voice project, Every Baby Guilford collected narratives from 27 women who had given birth within the past three years and who demographically reflect the community. Through a community-based participatory research framework, the County trained community members on how to conduct interviews for the project and basic research practices. The themes that arose from these interviews were similar to those seen across the country, that is, many Black mothers feel dismissed when they state a concern in healthcare settings.
Every Baby Guilford is now working to transform the healthcare system to meet community needs. Every Baby Guilford has partnered with Dr. Kimberly Harper at North Carolina Agricultural and Technical State University who is using the Amplifying Every Voice project learnings to create a case-by-case training manual for healthcare providers. EBG is also partnering with RIOTT for Change to target this training manual to two hospital systems in the community and private obstetrics providers. RIOTT for Change also plans to work with local hospital systems to perform organizational assessments to identify practices, policies, and procedures that lead to implicit bias and discrimination in maternal healthcare practices.
Outcomes to date
Every Baby Guilford was honored in May 2023 by the National Association of Counties with a 2023 Achievement Award Best in Category Recognition for Health for the program's work to end infant mortality disparities. Every Baby Guilford is working with Six Dimensions LLC to evaluate the County’s Collective Action Strategic Plan.
To offer weekly breastfeeding support and resources, Every Baby Guilford has launched a Baby Cafe in a high-impact zip code area for birthing people. EBG has also allocated funds to the YWCA of Greensboro, a community-based organization that aids in supporting a breastfeeding support group tailored for young mothers within another high-impact zip code area.
Workman describes how she can see their programs building community. For example, twelve patients attended the Mothers and Babies program that addresses maternal and postpartum depression. Through the course of the program, the patients were able to form connections and bond with one another. “They've got support that they can lean into, and it was all because somebody invited them to a seat at the table to come and learn more about postpartum depression and deal with a little bit of that and now they've got a community, a sense of community,” Workman said. “And I think that's power in the work.”
Every Baby Guilford has also partnered with two local colleges to implement the Preconception Peer Education program and engaged community members as Community Health Ambassadors to act as social influencers. This program has significantly expanded EBG outreach on perinatal health messaging within the community.
Toward transformative change
Every Baby Guilford has learned that to support a broader movement, it does not always need to be the lead entity. Through this idea, Every Baby Guilford has supported organizations like the Black Pearls Society— a think tank of politically engaged Black women committed to addressing structural and institutional racial inequities that impede the overall health and well-being of the Black community. The Black Pearls Society hosted a maternal health conference in Guilford County which was attended by over 125 individuals and is growing into a statewide conference. Guilford County plans to continue this project through alternative funding sources after ARPA funding is spent.
Through collaborative funding efforts, Every Baby Guilford has introduced nine evidence-based strategies to Guilford County, encompassing an integrated Community Health Worker model, a Preconception Peer Education program, the Mothers and Babies initiative, a County-wide community-based Doula program, expanded CenteringPregnancy, Triple P, community-based participatory research via Amplifying Every Voice, FIIMR, and a Health Ambassador model.