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Cleveland's Infant Mortality Rate, Especially Among African-Americans, Ranks As Poorly as Third World Nations. Christin Farmer and Her Team are Working to Change That

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The non-profit Birthing Beautiful Communities is housed in a two-room suite on the second-floor of the Agora Complex at Euclid Avenue and East 55th. It looks like a cross between a yoga studio, a daycare center and a community development corporation.

BBC was founded three years ago by a woman named Christin Farmer. Armed with a "super small grant" ($4,200) from Neighborhood Connections and a team of volunteers, Farmer set out on a mission: providing education and care to area women of color during their pregnancies.

The mission was critical. Cleveland has long suffered the ignominy of infant mortality rates equal to (and in some neighborhoods, in excess of) Third World nations. And while the region's leaders have devoted increased funding and attention in recent years — the establishment of the First Year Cleveland initiative was aimed specifically at curbing infant mortality rates — the problem persists and worsened. In 2015, the Ohio Department of Health released an alarming report that showed mortality rates had risen that year, and that black babies were dying at three times the rate of white babies.

Christin Farmer ran the Greater Circle Living program at University Circle Inc. from 2011 to 2016. She was born and raised in Hough and currently lives in Glenville, the adjacent neighborhood to the east. Sitting at a desk across from a multi-colored playmat earlier this month, Farmer told Scene that BBC grew out of her own fascination with and passion for prenatal care — she'd wanted to be a nurse-midwife since she was a teenager, when a reality show upended the stereotypical hysterics of birth she'd seen on TV until that point — and out of a dire community need.

When Birthing Beautiful Communities first started, Farmer said, the ambitions were small: She'd planned to host a series of workshops in Glenville about healthy pregnancies and birth outcomes.

"We did a baby belly retreat," Farmer said. "We did a movie night. We did a baby-wrapping event. And we did something for the dads — a pop-up event at a local restaurant to talk about their experiences around infant mortality and loss."

The workshops were an enormous success, Farmer said, and it so happened that the Cleveland Foundation was looking to direct funding toward lead poisoning and infant mortality programs in response to high-profile community health problems. They decided to fund a pilot program in Hough that would to train five to 10 women as doulas — birth workers who assist mothers before, during and after delivery. Farmer said that the doulas provide social (not medical) support during labor and delivery, and are friends and advocates until the end of the "fourth trimester," when a child celebrates its first birthday. (And sometimes long after.)

At the State of the County Address last month, Farmer appeared in a video that explained the work of her organization. She said that over the past 18 months, BBC doulas have attended 70 births with no infant deaths. The goal of BBC, as relayed in the video and in a later interview, was to utilize a "village approach," where an expectant mother is "part of the family" and BBC is part of hers.

"I'm always a little shocked when people say, 'Christin, this is so innovative,'" Farmer told Scene. "I'm like, 'I guess maybe it's retro-innovative. Women supporting women? This is nothing new.'"

BBC receives its funding through the Ohio Department of Medicaid, via First Year Cleveland, and through grants from the Cleveland Foundation and GUCCHI, the Greater University Circle Community Health Initiative.

BBC finished a training session in March and certified nine new community birth workers. It was a comprehensive training that included all nine components of BBC's holistic training model, a model that doesn't focus exclusively on the pregnancy. Farmer said that there are a number of factors that can affect a woman's birth outcome, and many of these factors are particularly acute in communities of color.

In fact, one of the big reasons Farmer felt compelled to start BBC was because of the observable lack of black birth workers in the region. This was in spite of the fact that Cleveland is home not only to the Cleveland Clinic and University Hospitals, but one of the country's seven nurse-midwifery programs, at Case Western Reserve University.

"It's a disparity," said Farmer. "And considering the fact that low birth weight and infant mortality disproportionately affect African-American women ... I don't know if you want to use the term 'appalling' or just 'ridiculous.'"

But having doulas of color makes a difference for expectant mothers in the black community, Farmer said. The city's lack of black birth workers has resulted in a lack of cultural care and sensitivity at the major health institutions.

"In the black community, we often have to resort to our own organizations and circles, so that we can ensure that we get the care that we're most comfortable with," she said. "That's why all of BBC's training and classes have a cultural context to it."

Farmer was a first-generation college student. She attended Kent State University and initially enrolled in the nursing program. She found the curriculum — and the college lifestyle — much more rigorous than she'd anticipated and ended up switching majors. But her birth work continued informally and on a volunteer basis as she prepared to re-apply to midwifery school later in life.

"When I wanted to form [BBC], I literally couldn't find any black doulas in Cleveland," Farmer said. She sent out messages on Facebook and said that "slowly but surely," she met a couple of them. "Ironically, we all lived in the same neighborhood."

They discovered that they had all already been serving women on a volunteer basis. This led to another emergent issue that Farmer (with her experience in community development and her abiding interest in bridging the gap between economics and health) thought was important to address: the inability to make a comfortable living in birth work, especially serving the African-American community.

"The women who can't afford a doula are the ones who are more likely to need a doula," Farmer said on that issue.

That's why an additional component of BBC is training women who ultimately work on a contract basis for the organization. Many of the organization's clients go on to train as doulas because of their positive experience, which is why the "village" analogy is especially apt.

Doulas are paid $20 per hour and can spend upwards of 100 hours with women who need the most support — the lowest income clients with limited family support and low access to nutrition and transportation. (Farmer said that traditional doulas may charge anywhere from $500 to $2,500 just for their presence during the delivery and for a couple of prenatal visits.) The BBC doulas are much more engaged in the life of the pregnant mother, focusing not only on the physical health but on the emotional and mental health of the client as well.

"For many of these women, they finally find a place of acceptance," Farmer said, "where they can talk to people who know what they've been through and who can relate to them. It's a sister circle. It's a village, and everyone has a role."

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