WHEN ROBERTA HUNTE, social work faculty, talks to Black people who have given birth she hears about painful and alienating experiences with healthcare providers and worries about deliveries. “That was one of my biggest fears,” one woman told her. “You know, dying while giving birth.”
Hunte is one of a slate of Portland State researchers working to identify factors—from racism to inadequate parental leave—that can make pregnancy, birth and parenting extra tough—and what can be done about it. Together these researchers highlight how tackling hard societal issues like structural racism, parental leave, child care and affordable housing may help pull the most vulnerable parents away from the brink and set up the next generation for a thriving future.
HUNTE and fellow social work faculty member Susanne Klawetter are examining the Healthy Birth Initiatives (HBI), a Multnomah County home-visit program that provides individualized care to Black families during pregnancy and for 18 months after birth.
If you’re Black in the United States, delivering a child is a dangerous proposition. According to the Centers for Disease Control and Prevention, Black women are three times more likely to die from pregnancy-related causes than white women—a gap that widens with age and education.
“What is incredibly important to note about HBI is that it is a program of Black birth workers. I think that’s its key intervention,” says Hunte, who was also a participant in the program. “It’s run by Black people, it’s for Black people, and it is engaging with the broader medical system and asking it to be better.”
The study found that racism-related stress was a chronic experience for participants with a direct impact on their parenting. In focus groups, they described traumatic birth experiences, struggles paying for housing and worries about the safety of their children in school and around police. As a result, the program focuses on well-being within and beyond medical appointments, offering conversation, transportation, child care, housing assistance and even intervening if Child Protective Services gets involved.
Data shows the approach is working. Black mothers who go through the program are less likely to encounter unexpected health complications following delivery than Portland mothers of any other racial group.
KLAWETTER is also researching how to support parents with children in the neonatal intensive care unit, or NICU, which she experienced first-hand when her triplets were born 15 years ago. Roughly 10-15% of babies require this high level of medical care after birth. Their parents often deal with multiple additional stressors—from caring for older children to juggling jobs so they can maintain employment and housing—and show increased rates of depression, anxiety and post-traumatic disorder. Klawetter has identified several ways to better support them, for example by screening for depression and anxiety throughout their babies’ NICU stay and at discharge. But there’s one intervention the healthcare system alone can’t provide, Klawetter says.
“We have great evidence from all around the world for decades that shows us that having a parent present in the neonatal intensive care unit is a driver for positive outcomes; babies need their parents in the NICU,” says Klawetter. To make that possible, she says, parents need paid leave.
JULIA GOODMAN, OHSU-PSU School of Public Health faculty, studies family leave policies that could make a difference when NICU and other working parents face difficult times.
She and colleagues Dawn Richardson and David Hurtado looked at the effects of a Multnomah County policy started in 2015 to provide employees six weeks of fully paid parental leave. The researchers found that while the new program did not dramatically change the amount of leave mothers took, it definitely improved their finances. For dads, the policy actually increased their leave.
In 2019, Oregon passed one of the most far-reaching paid family and medical leave policies in the nation, set to begin September 2023, which will provide 12 weeks of full pay for low-wage workers.
That’s progress, Goodman says, but to see many health benefits for babies and parents, “We need to be thinking more like six months of leave.”
Still, the pandemic has opened many people’s eyes to the importance of both sick leave and paid family leave. “There’s a growing recognition that these are really important issues and that we need structural solutions,” she says.
MELISSA THOMPSON, sociology faculty, and Summer Newell MPH ’05 PhD ’18 have been examining another precarious juncture for mothers—the return from incarceration.
For their 2021 book Motherhood after Incarceration, they interviewed 39 mothers in the Portland area. While women are more likely to have been in an active parenting role prior to their incarceration than men, there’s little research about them.
Many grappled with intense guilt and anxiety and were eager to reunite with their children. “That’s what’s motivating them, that’s what’s driving them forward,” says Thompson.
But to regain custody, they often had to prove to the Department of Human Services and their probation or parole officers that they were ready. That meant finding not only a job, but also a safe place to live. With affordable housing scarce in Portland, this proved difficult.
The stress of jumping through these hoops helps explain one of the key findings in the book: Mothers who regained custody of their children right away tended to do worse.
“In the long term, generally getting custody was good for these women,” says Thompson. “In the short term, it was an added stressor.”
Thompson and Newell’s research points to resources that could help ease this transition, including child care, employers willing to hire people with felony records, housing assistance, and accessible mental health and substance use treatment.
Though this could prove expensive, Thompson says, “Especially when it comes to things like crime and criminal justice, we would actually be saving money by intervening more now and saving ourselves some pain, agony and money in the future.”
“The more we head off these problems, the less likely we will be to see the cyclical nature of crime and incarceration,” she says, noting that children with a parent who goes to prison are significantly more likely to eventually end up in prison themselves.