In Cuyahoga County, the infant mortality rate for African-American babies is 15.1 per every 1,000 live births—compared to 3.8 for white babies—as of 2018. In other words, Cleveland's black babies are approximately four times more likely to die before their first birthday than white babies.

Christin Farmer is laser-focused on doing something about it. In 2014, Farmer founded Birthing Beautiful Communities (BBC), a grassroots group of birth workers serving pregnant women at high risk of infant mortality during the perinatal period (which starts at 22 weeks of gestation and ends seven days after a woman gives birth). 

In the five years since, BBC has helped almost 600 families and grown from a small team of volunteers to 26 paid staff members across two offices (Cleveland and Akron). Its annual operating budget has grown exponentially from $4,000 in 2014 to $1.7 million in 2019, and the nonprofit organization counts the Ohio Department of Medicaid and Cleveland Foundation among its list of funders.

In June 2020, Farmer anticipates breaking ground on a new birthing center in the Hough neighborhood (where BBC is based), in partnership with Famicos Foundation.

“I had a dream of being able to have a doula collective of women of color,” says Farmer. “To be able to expand is something that is beyond what I really imagined.”

BBC’s services have also expanded beyond simply providing doula services to a comprehensive perinatal support program. It's all part of the "holistic birth equity model" that Farmer has developed around nine different areas affecting birth outcomes—from maternal mental health to housing to education. Free birthing and parenting education are provided, and all participants are offered transportation, food, and childcare to remove any potential barriers to seeking help.

“To be very clear, infant mortality is only about 20 percent a clinical problem, and 80 percent a social problem,” says Farmer, citing widely shared research about the importance of social determinants of health. “Inequity is what is causing disproportionate outcomes. If inequities didn’t exist—particularly racial—then we would not see these poor birth outcomes.”

Farmer points to the Hough neighborhood as a prime example, citing its functional illiteracy rate of approximately 95 percent in comparison to Cleveland’s overall rate of 66 percent. “Think about the stress caused by not being able to read or write at a fourth-grade level,” urges Farmer, who says it is no coincidence that Hough’s infant mortality rate as twice as high as Cuyahoga County overall (with 22.1 infant deaths per 1,000 live births).

According to an external evaluation prepared by Cyleste C. Collins, Ph.D. of Cleveland State University's School of Social Work, approximately two-thirds of BBC’s clientele report a moderate to high level of stress overall. 96 percent of BBC clientele are black, 78 percent are single, and 50 percent are unemployed.

To further establish the connection between social stressors and poor birth outcomes, Farmer recently conducted an 18-month study in tandem with a research team led by Kent State University professor and psychologist Angela Neal-Barnett (and funded by the Ohio Commission on Minority Health, Sisters of Charity, and Mt.Sinai Foundation).

“Our theory was proven correct—African-American women do have higher levels of cortisol than white women at the same age of gestation,” says Farmer. “That’s why we need to offer serious programming on how black women in particular can address their stress. As difficult as life can be, to walk through it without that support is a death sentence.”

At Birthing Beautiful Communities, that support can range from “blactation” classes to cooking demos to co-parenting education to “Sisters Offering Support (SOS) Circle” support groups led by Neal-Barnett. It's an intentionally wide array of programming geared at addressing the social determinants of health that impact infant mortality, which can range from domestic violence to poverty to depression.

And it’s working: out of 600 births given by BBC clientele, only one infant has died—translating to a more than 99 percent infant survival rate. BBC clients’ rates of prematurity, low birth weight, and C-section are lower than other local, state, and national rates for African-American women, and their breastfeeding rates are higher. (Pretty impactful stuff, considering that the CDC counts preterm births and low birthweight among the top five causes of infant mortality.)

That’s why other cities are taking notice and enlisting Farmer to provide consulting on her holistic birth equity model, including Cincinnati, Akron, Toledo, as well as cities in Michigan, Indiana, and North Carolina. Farmer was also recently contacted by the City of Milwaukee after its recent declaration of racism as a public health crisis.

“I’m really intent on Cleveland being the model city around this and using this as leverage in order for us to create more equitable spaces and places,” says Farmer, who also sits on First Year Cleveland's executive committee.

Farmer believes her consulting work is what will ultimately help her affect systemic change on a larger scale. She distinguishes her holistic birth equity model as being designed to offer micro-level interventions and directly assist families, while consulting other cities and organizations on that model can make a big difference at the macro level. Ultimately, both approaches are designed to address the root causes that lead to poor birth outcomes for African-American women.

It’s a lot to take on, but Farmer is deeply passionate about her work, and she’s incredibly excited for the new birthing center to take shape. Says Farmer, “It’s been my lifelong goal at least since I was 16 to be a midwife and open my own birthing center.”

Furthermore, it’s an opportunity for Farmer to make an impact and help right societal wrongs that are leaving black moms behind.

“Figuratively, we’re helping to inspire a new way of thinking about how we address disparities and inequities,” says Farmer. “Infant mortality is one symptom of a much larger problem. In order to address it, we have to birth a new way of being in this society.”

CLE Means We: Calls to Action
Three things you can do to advance equity and inclusion after reading this article

• Donate to the East Cleveland Recreation Center renovation project being led by BBC and the City of East Cleveland.

• Read more about the Hough neighborhood and why it was designated one of nine Best Babies Zones around the country.

• Train to become one of BBC's perinatal support specialists.

This article is part of our "CLE Means We: Advancing Equity & Inclusion in Cleveland" dedicated series, presented in partnership with Jumpstart, Inc., Greater Cleveland Partnership/The Commission on Economic Inclusion, YWCA of Greater Cleveland, and the Fund for Our Economic Future.