Community-based approaches to infant mortality reduction: What works

Background: Since 2001, the Racial and Ethnic Approaches to Community Health partnership in Flint, Michigan has conducted a multi-program intervention which features sustained efforts to address racism as a social determinant of African American health inequities across the lifespan. During the intervention period, there was a noticeable average decline in African American infant mortality. However, there is a dearth of public health research to validate how community-based and anti-racism focused strategies can result in improved health for African American women and infants. Method: In an effort to build the evidence-base for how anti-racism interventions may contribute to reducing adverse infant health outcomes, we undertook a systematic qualitative evaluation to document components of the REACH intervention that would logically contribute to reduced infant mortality rates, including intermediate outcomes on individuals, families, and the health system. Our innovative use of community-based participatory research and grounded theory analysis of over 30 in-depth interviews ensured that the authentic voices of program participants and community stakeholders were represented in the evaluation. Results: Preliminary findings revealed culturally-relevant health promotion strategies among African Americans and health system improvements in high-risk antenatal assessment and coordination of care. We will share these and other findings which demonstrate evidence of innovative and replicable practices to reduce maternal and infant health disparities with an emphasis on multiple strategies to combat racism. The findings and lessons learned in this evaluation are intended to benefit both healthcare and community-based initiatives directed to reducing racial disparities in African American infant mortality.