Updated: Jun 2
The Star Ledger - March 14, 2022
Gaps plague Hispanic maternity data. N.J. officials say better data would mean better outcomes.
As New Jersey forges ahead with its sweeping plan to eliminate racial and ethnic disparities in maternal and infant health, gathering critical data on one group continues to pose a challenge, says first lady Tammy Murphy. Murphy, the force behind the Nurture NJ Maternal and Infant Health Strategic Plan, said data on Hispanics often does not reflect the whole picture in the community. “I think we all would readily agree that we have really good data on white moms. We have really good data on our Black moms,” Murphy told NJ Advance Media. “But we don’t have great data on our Hispanic moms.”
She is not sure why the data on Hispanics — who die of pregnancy-related causes at a rate 2.7 times that of whites — is not on par with other groups. Black women die of pregnancy-related causes at 7.6 times that of white women. “I would be speculating, but my guess is that their outcomes historically have been better than those for Black moms, so they [perhaps] haven’t come under as much scrutiny,” Murphy said. “But I also think if you factor in that most of our Black moms are U.S. citizens, you might find that some of our Hispanic moms may be nervous about sharing their information or having their data recorded.” In New Jersey, Hispanic women had the highest birth rate between 2018 and 2020, 68.2 per 1,000 women, followed by white women at 57.1, Asian/Pacific Islanders at 57.1 and Blacks at 56.9, according to the March of Dimes Foundation. Black women suffered hemorrhaging — one of the leading causes of maternal deaths — at a rate of 60.6 per 1,000 deliveries in 2019, slightly more than in 2018, according to the New Jersey Report Card of Hospital Maternity Care, released last year by the state Health Department. Hispanic women saw a bigger increase in complications, with a hemorrhaging rate of 53.2 per 1,000 births, compared with 48.1 in 2018. White women saw a small decline — 46.7 per 1,000 deliveries, compared with 47.4 the previous year. Data on maternal and infant health in New Jersey, as well as elsewhere in the United States, has long been slowly gathered and analyzed. And it sometimes has been fractured, with organizations not sharing information. Murphy said one her goals is to improve the gathering and coordination of data to pinpoint problems. “As a general matter, data has historically been siloed,” the first lady said. “Part of what we have done through Nurture NJ is not only break a lot of that [data] out and share it with people, but also scream it from the rooftops, ‘This is what’s going on. It’s got to be changed.’ “It’s enabled different departments and agencies to say, ‘We’re having a problem in that area as well.’” Streamlining data and making it accessible statewide not only would lead to a better overview of maternal and infant health, she said, but it also could raise awareness about efforts that improved outcomes and help others replicate them. Community-driven outreach is one way to improve data on Hispanic maternal and infant health, Murphy said. She cited Nurture NJ’s grassroots engagement programs, such as expanding Medicaid recipients’ access to doulas — people trained or certified to be coaches during labor and childbirth. Another pathway could be through Universal Home Visiting, a voluntary program in which a registered nurse visits parents and their newborn during the first two weeks following a birth. More visits are available during the baby’s first three months if the parents wish. “These people are on the ground, they’re embedded in the community,” Murphy said. Maternal health experts in New Jersey agree that efforts to gather data on Hispanic moms and infants has been a struggle across the state and nation.
A big part of the challenge is the sheer diversity among Hispanics, said Helen Hannigan, director of administration for the Southern New Jersey Perinatal Cooperative, which serves hospitals and communities in South Jersey. It ranges from their ethnic origin to whether they were born and raised in the U.S. or were born outside the country. Such distinctions can influence their experiences. “One of the issues is the way we collect information on identity and race and ethnicity,” Hannigan said. “It doesn’t always give people the opportunity to select how they identify. “Our data systems have not kept up with them.” Many Hispanics they serve, she said, don’t identify as either white or Black when it comes to selecting race. Some prefer to self-identify according to their ancestral country of origin. “They identify as ‘Hispanic,’” Hannigan said, “or ‘multiracial’ or they might say ‘Dominican.’” The U.S. Census notes that “Hispanic” is not a race. Hispanics may be of any race. Hannigan said it’s important to understand that foreign-born Hispanics often face different dynamics during and after pregnancy than U.S.-born Hispanics. Non-Hispanic Blacks and U.S.-born Hispanics were 70% less likely than foreign-born Hispanics to initiate breastfeeding, according to a New Jersey Department of Health report comparing pregnancy outcomes between U.S.-born and foreign-born Hispanics. Non-Hispanic white mothers were 80% less likely to do so, according to the report, which used data from 2012 to 2015. Foreign-born Hispanic mothers had more favorable pregnancy-related outcomes than other racial and ethnic groups, despite having high rates of Medicaid or no insurance for prenatal care, the report said. Experts have theorized that the immigrant mothers may have healthier habits — particularly during pregnancy — that wane with acculturation. “Similar to African American moms, Hispanics are not a monolith,” said Dr. Lisa Gittens Williams, director of obstetrics at University Hospital in Newark. “You have multigenerational families — some moms are themselves immigrants. We have patients who are first- or second-generation. And then the statistics are not necessarily the same for those varying populations.”
Some national studies show disparities in outcomes within Hispanic subgroups, as well. Infant mortality rates varied among Hispanics groups, according to a Centers for Disease Control and Prevention report using 2018 data. Infants of Puerto Rican women had the highest mortality rate (5.6), followed by Mexicans (4.8), Central and South Americans (4.0) and Cubans (3.8). More efficient data-gathering, combined with ongoing efforts to reduce maternal and infant mortality, could result in significant improvements, Williams and Hannigan said. “These initiatives are going to be game-changing,” Williams said. “We do need more data, and we do need to identify what are the barriers to accessing care, and what are the constraints and other things that have not been captured?” Our journalism needs your support. Please subscribe today to NJ.com. Elizabeth Llorente may be reached at ELlorente@njadvancemedia.com. Follow her on Twitter at @Liz_Llorente.