Saving Texas lives: How HSC Healthy Start helps mothers and babies

July 13, 2021

By Diane Smith-Pinckney

Amy Raines Milenkov, Drph Asst. Professor Obstetrics & Gyneology

When experts delve into data on infant and maternal mortality, they find troubling trends. 

In Texas, Non-Hispanic Black mothers and infants “have significantly higher rates in infant mortality preterm birth, low birth weight, pregnancy-related depression and severe maternal morbidity than do other racial or ethnic groups,” according to the Texas Health and Human Services’ 2020 data on mothers and babies. 

This is what health disparities look like, said experts and students at The University of North Texas Health Science Center at Fort Worth (HSC). Eliminating barriers to health care for mothers and babies – an endeavor that will help save Texas lives – is the focus of much work at HSC. 

“If their health is not in order, then the community’s health falls apart,” said Brittany Ajoku, a recent graduate from HSC School of Public Health. “It is very important for us to take care of our mothers and our children.”  

Taking better care of Texas mothers, babies and families is the mission of HSC’s Healthy Start, a federally funded home visitation program. Community health and social workers partner with mothers and families to help them stay healthy. 

“Our goal is to ensure that our mothers are able to access any system they need,” said Misty Wilder, MSW, director of HSC’s Healthy Start program. “We try to remove any barriers they may face so they can move from just surviving to thriving.” 

Infant mortality: A critical issue in Texas

Accomplishing the Healthy Start mission means educating communities about infant and maternal mortality.  

Infant mortality is when a baby is born alive but dies before the first birthday, Wilder said. 

In Texas, the 2018 infant mortality rate reached “a historic low” of 5.5 deaths per 1,000 live births, according to the state’s 2020 Healthy Texas Mothers and Babies Data Book. 

But the data reveals how disparities persist. The infant mortality rate for Non-Hispanic Black mothers was 10.9 deaths per 1,000 live births. 

The data indicates that causes of death for Texas babies are congenital malformations, short gestation and low birth rates, maternal complications during pregnancy and Sudden Infant Death Syndrome (SIDS). 

Wilder said they have focused reducing infant mortality in Texas by helping Tarrant County families. Healthy Start focuses on four key areas while helping families: preconception, pregnancy, postpartum and parenting. 

Still, infant mortality remains a critical issue, she said, adding that there several reasons why Black families are more vulnerable during a mother’s pregnancy and a baby’s first year, including poverty, discrimination and racism. 

“We have made huge strides, but we still see huge disparities in birth outcomes between Black and White babies,” Wilder said.

HSC is working to eliminate health disparities

HSC, driven by its core value to Serve Others First, is committed to helping deliver health care and improving access to all Texans through service and education.

‘Something that people don’t recover from’

When health experts talk about maternal mortality, they are referring to the death of a woman during pregnancy or one year following the end of a pregnancy. 

“Maternal mortality is a tragic event in and of itself,” said Dr. Amy Raines-Milenkov, DrPH, assistant professor in the Department of Pediatrics and Women’s Health at Texas College of Osteopathic Medicine. “It’s a time when you are bringing new life into this world – this time is supposed to be joyous and a celebration. It’s a tragedy when this happens to a family. It’s something that people don’t recover from.” 

Dr. Raines-Milenkov, who is an appointed member of the Texas Department of State Health Services Maternal Mortality and Morbidity Task Force, said African American mothers are three to four times more likely to lose their life during pregnancy or one year following pregnancy than their white counterparts. 

“The most tragic part of all of this is that up to 80 percent of the maternal deaths are preventable,” Dr. Raines-Milenkov said, explaining that heart disease and strokes cause many of these deaths. 

“The causes of maternal death have changed over time,” said Dr. Raines-Milenkov. “Most people when they think about maternal death they think about hemorrhaging. That is still a cause of death, but one of the leading causes of death for maternal mortality is cardiovascular conditions.” 

Other reasons why Black mothers are vulnerable are delay in care and simply not being taken seriously by health care providers, she said. 

“She is not listened to,” Dr. Raines-Milenkov said, adding that they work to arm mothers with information they can use to deal with health emergencies. They also advocate for better hospital care, screening and identification of health issues for new mothers. 

Too often, the post-partum care of mothers isn’t addressed, she said 

“Often what happens is that women will take care of their infant but ignore their own health issues and concerns,” Dr. Raines-Milenkov said. 

An example of how mothers are not taken seriously was the focus of efforts at Healthy Start recently, Dr. Raines-Milenkov said. 

She described how a client complained about severe chest pain, but was sent home when she went to a nearby clinic. The pain persisted so a Healthy Start midwife encouraged the mother to push ahead in seeking health care. That mother was hospitalized for a week, Dr. Raines-Milenkov said.

“She was ignored and dismissed when she went to the clinic,” Dr. Raines-Milenkov said. 

“It was revealed that she had a pulmonary embolism,” she said. “We know that every day women die of pulmonary embolisms during pregnancy. If not for Healthy Start, I’m convinced that woman would have died.” 

Dr. Raines-Milenkov said their work helping mothers continues. They want to keep helping mothers bridge health disparities while expanding the program into rural communities. They also want to study and address how COVID-19 has impacted new mothers and families.


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