About The Initiative

The Los Angeles County African American Infant and Maternal Mortality (AAIMM) Initiative is a coalition of the Los Angeles County Health Agency (Departments of Public Health, Health Services, and Mental Health), First 5 LA, community organizations, mental and health care providers, funders, and community members. We are united in one purpose: to address the unacceptably high rates of Black infant and maternal deaths in Los Angeles County and ensure healthy and joyous births for Black families. Through a series of comprehensive coordinated strategies, we aim to reduce the county's gap in Black/White infant mortality rates by 30% by 2023.

The Initiative launched in 2018, spurred by the LA County Department of Public Health’s 5-Year Plan to address the Black-White infant mortality gap, and in partnership with First 5 LA. A fellowship funded by the Pritzker Foundation also seeded the effort, informed by emergent research and focus groups of over 100 Black women.

The Crisis

Black/African American babies in LA County are two to three times more likely to die before their first birthday than babies of other races
Black/African American women in LA County are four times more likely to die as a result of pregnancy complications than women of other races
Harmful stress from the trauma and humiliation of racism and prejudice that Black women face daily is a root cause

Root Cause

The AAIMM Initiative approaches its work from a frame that the root cause of the mortality disparity is the stress caused by a Black person’s exposure to racism and the impact of that stress on a Black woman/birthing person’s body, compounded by structures in society that perpetuate racism, and the presence of implicit and overt bias in the systems of support that interact with Black families.

The Advocates

The African American Infant and Maternal Mortality Steering Committee guides the implementation of the LA County Department of Public Health’s 5-Year Action plan to address African American and infant mortality as well as informs the development and implementation of strategies to compliment the plan. This group also comes together to advance advocacy, awareness and policy change.

Community Action Teams in Service Planning Areas 1 (Antelope Valley), 2, 3, and 6/8 (South LA/South Bay) – those areas of the County with the highest rates of African American infant mortality countywide have already begun bringing together community members and community organizations to address African American infant and maternal mortality in their communities.

The Solutions

We believe we can stop this injustice by working together to ensure that Black women have access to safe and joyous births.

Quality health care delivered with respect and dignity
Sister circles and prenatal groups providing encouragement and support
Mommy visits at home
Connection to resources and programs
Birthing coaches and advocates
Laws that place power in the hands of families and address unfair treatment
Birth plans and a way of advancing them

Our Shared Values

STRATEGIES AND ANCHOR EFFORTS

Steering Committee

The LA County African American Infant and Maternal Mortality Steering Committee guides the implementation of the LA County Department of Public Health’s 5-Year Action Plan to address African American Infant and Maternal Mortality as well as informs the development and implementation of strategies to complement the plan. This group also comes together to advance advocacy, awareness and policy change.

Community Action Teams

The AAIMM Community Action Teams (CAT) are regionally based collaborative partnerships between the Los Angeles County Health Agency, community-based organizations, health care providers, community residents, faith-based organizations, birth workers (doulas, midwives, etc.) , allies and community businesses that consult, inform, and engage the community on all AAIMM strategies and create locally based actions.

There are CAT’s in the following Service Planning Areas:

Service Planning Area 1- Antelope Valley/Palmdale

Service Planning Area 2- Santa Clarita/San Fernando Valley

Service Planning Area 3- San Gabriel Valley/Pasadena

Service Planning Area 6 and 8- South LA/South Bay

Each Community Action Team has various workgroups including Policy, Engagement, Fundraising, and Family Centered Models of Care.

Perinatal Equity Initiative

The Perinatal Equity Initiative (PEI) was established in the state legislature's Budget Act of 2018 as the Department of Public Health’s response to the alarming statewide gap in Black infant mortality. PEI is designed as a complement to the state's Black Infant Health (BIH) Program, a group-based service, information and social support program for Black mothers to buffer the negative effects of racism on their health. The goal of PEI is to improve birth outcomes and reduce preterm birth and mortality through interventions implemented at the county level that are evidence-based, evidence-informed or reflect promising practices.

The evidence based programs implemented by the LA County’s AAIMM Initiative are:

Group Prenatal Care

Our Group Prenatal Program in partnership with Charles Drew Universities Black Maternal Health Center for Excellence provides evidence based group prenatal care from Black community midwives exclusively for Black women/birthing people. As Alameda County’s BEloved Birth Black Centering program perfectly states, “Group perinatal care by, for, and with Black people is an innovative new program designed to provide culturally attuned and racially concordant care for Black birthing people.”

Father Engagement

The Fatherhood component of PEI promotes the importance of having fathers/partners engaged in and navigating pregnancy alongside their partner, which bolsters mental, emotional and physical health both during pregnancy and post-delivery. Our Fatherhood program includes social support in a group atmosphere and technical assistance to service and medical providers to best serve African American fathers from pregnancy through postpartum.

Preconception Health

Our Pregnancy Intent/Preconception Health intervention is designed to increase women's health by focusing on their ability to make informed decisions about if and when to become pregnant and on their health-affirming behaviors both prior to conception and between pregnancies. We promote reproductive health care and pregnancy intention screening as fundamental, standard components of primary care. In partnership with Essential Access Health, we provide training and technical assistance to clinicians and service providers on culturally respectful reproductive health care and pregnancy intention communication that centers Black families.

In addition to the interventions, the AAIMM initiative is using PEI funding to collaboratively support several other anchor strategies, including:

The Village Fund

The Village Fund is a public private partnership to support community-led efforts that reinforce the broad goals of the AAIMM Initiative. In the spirit of “it takes a village to raise a child,” the Fund partners with organizations, service providers and networks that provide valuable support and services to Black birthing mothers and their families but are not often on the radar of/funded by foundations and public entities. The Fund is administered by the LA Partnership for Early Childhood Investment and capitalized by a combination of public and private philanthropic dollars, inclusive of PEI funding and First 5 LA.

The first cohort of AAIMM Village Fund grantees are:

Cherished Futures for Black Moms & Babies

Cherished Futures is a multi-sector, collaborative effort, aligned with the comprehensive AAIMM initiative, to reduce infant mortality and improve maternal patient experiences and safety for Black moms and babies in South Los Angeles and the Antelope Valley.

With sponsorship from Health Net, and in partnership with the Public Health Alliance of Southern California, Cherished Futures unites key decision-makers from local birthing hospitals, public health, health plans, community-based organizations, and advocates to implement systems-change interventions at three levels: clinical, institutional and community.

Cherished Futures also contracts with the March of Dimes and BreastfeedLA for hospital Quality Improvement work through PEI and First 5 LA funding.

Social Determinants of Health

AAIMM is currently addressing the social determinant of financial inequities on Black pregnant peoples' health by providing education and hands-on support for families eligible for Paid Family Leave and Earned Income Tax Credit. There is strong evidence that the Earned Income Tax Credit (EITC) increases employment and income for participating families and improves birth outcomes. Paid leave also improves birth outcomes, maternal mental health and family bonding, while increasing employee retention. Data indicate that California families who could benefit the most are not claiming their EITC and that Paid Family Leave is similarly underutilized.^[1]

Paid Family Leave (PFL)

In partnership with the California Work & Family Coalition, we have recruited and trained African American parents, healthcare professionals, doulas, faith-based members, and others who provide support and services to Black families in Los Angeles County to provide education and PFL support in their communities. Selected community members will be compensated to share Paid Family Leave information and assist members of their community with applying.

Earned Income Tax Credit

In partnership with the Department of Consumer and Business Affairs, First 5 LA, CAL EITC and the United Way, we have created a public awareness campaign and are providing 30 African American families who are eligible for the Earned Income Tax Credit with free tax preparation from certified tax preparers.

AAIMM Doulas

In addition to the PEI funded strategies, the AAIMM Initiative has also recognized doulas as a key part of the solution. Doula support can reduce medical interventions, including c-sections, improve mental health, increase satisfaction with the birth experience, and increase breastfeeding success.

On September 30,2020 Los Angeles County Department of Public Health, Division of Maternal Child and Adolescent Health responded to the California Department of Public Health (CDPH), California Home Visiting Projects (CHVP) Request for Supplemental Information (RSI) funded by the $5M in State General Funds set aside for innovation in home visiting to sustain the African American Infant and Maternal Mortality (AAIMM) Doula Pilot Project. The AAIMM Doula Pilot Project was a part of the broad AAIMM Initiative to address racism as the root cause of health disparities during the pregnancy and postpartum periods and to reduce infant and maternal mortality.

On November 10, 2020 CDPH issued an award notification for the maximum annual amount of $1M. The newly funded CHVP AAIMM Doula Program provides free, culturally congruent doula support to Black/African American pregnant people countywide through June 2023. Priority will be given to the SPAs 1,6, and 8 (Antelope Valley, South LA, and the South Bay) where Black infant mortality rates are highest. Clients will receive educational, emotional, and physical support from one of a team of ten (10) experienced Black/African American doulas.

The AAIMM Doula Program's African American/Black doulas are trained professionals who provide physical, emotional and informational support to a laboring person and family before, continuously during, and after childbirth to help them achieve the healthiest, most satisfying experience possible. Doula support is unconditional and non-judgmental. Doula care has been shown to reduce preterm birth, reduce cesarean sections, increase breastfeeding, maternal satisfaction, and family/community bonding. AAIMM doulas are all trained in full spectrum support (miscarriage, abortion) and trauma-informed care, as well as lactation education.

Communications and Public Awareness

Funded in part by PEI and the AAIMM Doula Program, Communications efforts are focused on fostering awareness and action around the racial disparities in perinatal health outcomes, interventions to address the disparities, what families can do, and the role stakeholders have to play in ending it. This Initiative’s theme of "a joyous and healthy birth takes a village" invites birthing families to activate a village of support and stakeholders to be a village of support to end the disparities.

Implicit Bias and Anti-Racism Trainings of all County Staff

^[1] 1 NCSL-EITC - National Conference of State Legislatures (NCSL). The state of the Earned Income Tax Credit (EITC). 2018.NBER-Neumark 2018* - Neumark D, Shirley P. The long-run effects of the Earned Income Tax Credit on women's earnings. National Bureau of Economic Research Working Paper. 2018. NBER-Hoynes 2016 - Hoynes H, Rothstein J. Tax policy toward low-income families. National Bureau of Economic Research (NBER). 2016: Working Paper 22080.Strully 2010 - Strully KW, Rehkopf DH, Xuan Z. Effects of prenatal poverty on infant health: State Earned Income Tax Credits and birth weight. American Sociological Review. 2010;75(4):534–62.