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As Mayor Mike Duggan touts Make Your Date's success, Detroit's preterm birth rate spikes
Despite recent claims that the City of Detroit’s handpicked program to fight preterm birth is uniquely successful, the city’s preterm birth rate is now at a 13-year high, according to the latest statistics from the State of Michigan.
The newest state data comes on the heels of Mayor Mike Duggan's vigorous public defenses of the Make Your Date program's efforts to fight preterm birth. The mayor was compelled to defend the program after a critical inspector general's report found that the mayor gave Make Your Date preferential treatment when teaming up five years ago.
This week, the March of Dimes ranked Detroit the second-worst city nationally for its preterm birth rate in 2017, earning the city an "F" grade.
Reacting to the spike in the city's preterm birth rate, a city official and an academic researcher said Make Your Date isn't operating on a large enough scale to make a significant impact.
Yet Duggan has publicly touted the achievements of Make Your Date as confirmation that the program was worth his special consideration. On two occasions — at a news conference and on a local TV news appearance — Duggan said that moms who participated in Make Your Date had a 37% reduction in preterm births.
“We picked the right program,” Duggan said at a news conference in late October after release of the OIG report. “The program has worked and there is no finding anywhere in this report that says Make Your Date doesn’t work, that a dollar was misspent or says that this wasn’t the right program.”
Make Your Date's success also was included in an official response to the inspector general that requested a reversal of findings that were critical of the city's support for Make Your Date. "Women who received services from WSU via the Make Your Date program experienced a reduction of up to 37% in preterm births," Eli Savit, who serves as senior adviser and counsel to Duggan, wrote to Inspector General Ellen Ha on behalf of Duggan and others.
The mayor's claims about Make Your Date's impact can be traced to a Wayne State University study announced in September that analyzed data from 1,945 women who participated in the program in 2014 and 2015. According to a Wayne State news release, the study found that Make Your Date participants were 37% less likely to deliver at less than 32 weeks than women who gave birth at the same hospital but were not served by Make Your Date.
"Our study showed evidence that the Make Your Date program reduces the rate of early preterm delivery in the population studied," Wayne State professor of obstetrics and gynecology Adi Tarca said in a statement to the Free Press. "However, the Make Your Date program has only reached a fraction of women in the city. In order to make a significant impact on the rate of preterm birth in the entire city of Detroit, the program would need to be expanded."
The Free Press asked Wayne State for a copy of Tarca's study showing Make Your Date's effectiveness. Wayne State did not provide the study, explaining that it has not yet been published.
Maternal health experts said Detroit’s high preterm birth rate cannot be attributed to any single factor and the causes of premature delivery are vast and complex. Premature birth can be caused by chronic health conditions such as diabetes or high blood pressure.
But many health professionals agree Detroit women also face socioeconomic determinants such as lack of access to prenatal care and health insurance and implicit bias in the medical field.
Other systemic issues such as inequity, poverty, racism and discrimination also are driving factors, according to Michigan’s Mother Infant Health and Equity Improvement Plan.
Detroit's preterm birth rate rose to 15.3% in 2018 — the highest since 2005. The 2018 figure represents a "significant increase" from 13% in 2013, according to the state health department.
Of the 9,476 births in Detroit last year, 1,451 babies were born prematurely — before 37 weeks — according to state data.
Michigan's preterm birth rate dropped slightly from 10.2% in 2017 to 10% in 2018. The state's lowest rate since 2000 was 9.7% in both 2013 and 2014. Nationwide, the preterm birth rate has increased for the last four consecutive years to 10% in 2018.
Health educators and physicians who spoke with the Free Press in a series of interviews said the city's preterm birth rate — as well as infant mortality and maternal health — has long troubled professionals.
"It is is very concerning," Dr. Ray Bahado-Singh, chair of Obstetrics and Gynecology for Beaumont Health, said about the city's rate. "But changing those dynamics is a decades-long and generational commitment. So, I believe progress will continue to be incremental and, in my view, explains why the prematurity rate is so high in Detroit because as everyone knows, there's really a significant disparity in Michigan, most particularly in Detroit."
This week, the March of Dimes released its annual preterm birth report card, which grades all 50 states and the 100 largest cities with the most births. The 2019 report card analyzed 2017 local and state data from 2018.
At 14.3%, Detroit had the second-highest preterm birth rate among the 100 cities that the March of Dimes studied. Cleveland was No. 1 with a preterm birth rate of 14.5%.
Although Detroit nearly topped the list, the March of Dimes noted it's encouraged by the amount of organizations coming together to jointly dedicate resources to the problem.
Kara Hamilton-McGraw, director of maternal child heath and government affairs for March of Dimes in Michigan, said the organization is also pleased with Make Your Date's efforts.
"These rates are not acceptable but I believe we can find a rejuvenated hope," Hamilton-McGraw said. "What I see in WIN Network and and other programs such as Make Your Date, the Black Mothers Breastfeeding Coalition in Detroit, these programs are looking to provide wraparound services. And we're seeing that addressing the woman as a whole, and not just a pregnancy, is really having fantastic outcomes."
Dawn Shanafelt, director of the Division of Maternal and Infant Health at MDHHS, declined to comment specifically on Make Your Date's impact, but said the state is closely watching Detroit's preterm birth rate.
"Premature births and low birth weight babies are the primary drivers to infant mortality," she said. "So, it’s a critical focus area and a serious public health concern."
Shanafelt said infant mortality rates in Detroit and southeast Michigan are among the state's highest.
The problem
The City of Detroit has historically struggled to address its high rate of preterm birth, which is an issue that disproportionately impacts African American women across the country. Detroit has one of the nation’s largest African American populations — 78% of its residents are black.
African American women are 42% of the city's total population, according to 2018 Census estimates.
“I think it's hard to not be concerned about living in a state that has only a C grade for preterm birth but also for our primary city, Detroit, to have such a high preterm birth rate,” said Dr. Marjorie Treadwell, University of Michigan’s director of the Fetal Diagnostic center and a maternal-fetal physician. “I can't think that anybody would think that was acceptable or would be comfortable with that."
Premature birth is defined as a live birth before 37 weeks.
"There are certain things that just set out your life course and your gestational age at delivery is one of those things that has the potential to impact the rest of your life," Treadwell said. "We need to provide mothers and their babies with the best possible start to their life and being able to improve their condition and their health at birth is probably one of the major ways we can do that.”
Babies that are born too early can face several issues, including cerebral palsy, visual and hearing impairments, heart problems and more. Preterm birth complications are also the leading cause of death among children under the age of 5, according to the World Health Organization.
“I think the entire medical community continues to be frustrated with the health disparities that we continue to see,” Dr. Courtney Townsel, a University of Michigan maternal fetal medicine specialist, said. “I think it’s highlighted by cities like Detroit and the top 10 cities which have high rates of African American patient populations. So, really trying to understand how we reduce these health care disparities is really at the heart of this.”
Dr. Kimberlydawn Wisdom, the senior vice president of Community Health & Equity for the Henry Ford Health System, said a lot of work has been done over the past decade to address premature birth and infant mortality, but challenges remain.
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