Current Initiatives

“WHEREAS, race is a social construction with no biologic basis; and

“WHEREAS, racism is a social system with multiple dimensions: individual racism is internalized or interpersonal; and systemic racism is institutional or structural, and is a system of structuring opportunity and assigning value based on the social interpretation of how one looks, that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources; and

“WHEREAS, racism causes persistent racial discrimination in housing, education, employment and criminal justice; and an emerging body of research demonstrates that racism is a social determinant of health; and

“WHEREAS, more than 100 studies have linked racism to worse health outcomes5; and WHEREAS, in Wisconsin, the highest excess death rates exist for African American and Native Americans, at every stage in the life course and our infant mortality rate for infants of nonHispanic black women is the highest in the nation; and

“WHEREAS, the American Public Health Association (APHA) launched a National Campaign Against Racism; and

“WHEREAS, Healthiest Wisconsin 2020 states that, “Wisconsin must address persistent disparities in health outcomes, and the social, economic, educational and environmental inequities that contribute to them”; and

“WHEREAS, the Wisconsin Public Health Association has adopted in 2010 the resolution “Achieving Health Equity” and in 2014 the resolution “Promoting a Health in all Policies (HIAP) Framework to Guide Policymaking” and in 2017 convened a Racial Equity Workgroup; and

“WHEREAS, public health’s responsibilities to address racism include reshaping our discourse and agenda so that we all actively engage in racial justice work; and WHEREAS, while there is no epidemiologic definition of “crisis”, the health impact of racism clearly rises to the definition proposed by Galea: “The problem must affect large numbers of people, it must threaten health over the long-term, and it must require the adoption of largescale solutions”.

Read the full Anti-Racism Declaration from the Wisconsin Public Health Association here.

For more information on the declaration and the Wisconsin Public Health Association’s Racial Equity Committee, please visit: https://www.wpha.org/page/RacismDeclaration.

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Racial Disparities in Wisconsin’s Birth Outcomes

Wisconsin has one of the worst racial disparities in birth outcomes in the nation (WI Council on Children & Families 2013). According to the Wisconsin Department of Health Services, infants born to African American women are 3 to 4 times more likely to die in their first year of life than white infants. Much recent literature argues that racial disparities in birth outcomes are rooted in the physiological impacts of the lifelong stress of racism on African American maternal bodies. (Lu and Halfon 2003; Lu et al 2010; Giscombé and Lobel 2005; Harrell et al 2011). The profound lack of culturally appropriate maternity care providers exacerbates the difficulties that people of color have in establishing trusting relationships with providers and maintaining essential continuity of care. To date, the Milwaukee and Madison communities combined have fewer than 8 doulas of color and only three out-of-hospital midwives of color.

The Wisconsin Guild of Midwives (WGOM) is a 501C6 volunteer organization, founded in 1975, representing Licensed Midwives and Certified Nurse Midwives who practice in the out-of-hospital setting. The Guild has a commitment to partnering with allied organizations to engage in birth-related social justice efforts, especially in communities with clear health outcome disparities.

References

1. Altfield S. (2003). The Chicago Doula Project Evaluation Final Report. Chicago, Ounce of Prevention Fund.
2. Breedlove G. (2005). Perceptions of social support from pregnant and parenting teens using community-based doulas. J Perinat Educ 14(3):15–22.
3. Giscombé C., and Lobel M. (2005). Explaining Disproportionately High Rates of Adverse Birth Outcomes Among African Americans: The Impact of Stress, Racism, and Related Factors in Pregnancy. Psychological Bulletin 131(5): 662-683.
4. Gruber K., Cupito S., Dobson C. (2013). Impact of doulas on healthy birth outcomes. The Journal of Perinatal Education 22(1), 49-58.
5. Harrell, CJ., Burford T.I., Cage B. N., Nelson, T. M., Shearon S., Thompson A., Green S. (2011). Multiple Pathways Linking Racism to Health Outcomes. Du Bois Review. 8:1,143-157.
6. International Center for Traditional Childbearing. http://ictcmidwives.org/. Website. Accessed March 17, 2014.
7. Kozhimannil K, Attanasio L, Hardeman R, O’Brien M. (2013). Doula Care Supports Near-Universal Breastfeeding Initiation among Diverse, Low-Income Women. J Midwifery Womens Health 58:378–382.
8. Kozhimannil K, Hardeman R, Attanasio L, Blauer-Petersen C. Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries.(2013). Am J Public Health 103(4):e113-e121.
9. Lu M., and Halfon N. (2003). Racial and ethnic disparities in birth outcomes: a life-course perspective. Maternal and Child Health Journal 7(1):13–30.
10. Lu M., Kotelchuck M., Hogan V., Jones L., Wright K., Halfon N. (2010). Closing The Black-White Gap in Birth Outcomes: A Life-Course Approach. Ethnicity and Disease 20:10 Suppl 2: s2-62–s2-76.
11. Wisconsin Council on Children & Families. (2013). Race to Equity: A Baseline Report on the State of Racial Disparities in Dane County. Madison, WI.

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Wisconsin Critical Congenital Heart Disease Screening Demonstration Program

Representatives from the Wisconsin Guild of Midwives are collaborating with the University of Wisconsin Medical Center and the State of Wisconsin Department of Health Services (DHS) to implement and study pulse oximetry screening for critical congenital heart defects in all settings, including the out-of-hospital (OOH) birth setting.

Death or re-hospitalization of infants due to a missed diagnosis of critical congenital heart disease (CCHD) occurs in approximately 1:25,000 Wisconsin births. Pulse Oximetry (POX) screening can detect CCHD prior to the onset of symptoms and is currently performed in more than one third of babies born in Wisconsin. However, POX screening is not performed uniformly and its results are not linked to the Wisconsin Birth Defects Registry (WBDR) or systematically evaluated.

In this project we have provided caregivers in Wisconsin the necessary education, administrative assistance, and technical support needed to implement universal POX screening in all birth settings. Included in the study is an OOH screening protocol and data collection mechanism for all newborns born in the OOH setting. Given that midwives in this state care for many plain clothed families who potentially have an increased risk of having an infant with a congenital heart defect, as well as caring for families who do not elect routine ultrasound screening in pregnancy, inclusion in the study may detect infants with CCHD that may otherwise go undetected.

Licensed Midwives and Certified Nurse Midwives practicing in the OOH setting began receiving hand-held pulse oximeters to extend POX screening to home birth and birth center settings in January 2013. This is the only CCHD POX screening study nationwide that includes Licensed Midwives practicing in the home or birth center setting. If you have any questions, please visit the SHINE project website at http://www.wisconsinshine.org/home-births/

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