TexProtects Stands Up | Disproportionality in Maternal and Child Health Care

TexProtects’ vision is one where every child is safe, nurtured, and resilient — no matter the color of their skin. This vision cannot be realized while families of color continue to be wounded by systemic racism and injustice. As part of our effort to speak out and stand up against injustice, this blog is part of a series to highlight existing inequalities in our child protection systems. A deepened understanding of these issues can help us know better and do better so that Texas is a safe place to be born – where families can thrive and where every individual is seen and valued equally.

TexProtects takes a comprehensive approach to the prevention of child abuse and neglect and recognizes the Center for Disease Control’s Essential for Childhood framework which includes the following strategies: strengthening economic supports for families, changing social norms to support parents and positive parenting practices, providing quality care and education early in life, enhance parenting skills to promote healthy child development and intervening to lessen harm and prevent future risk and occurrence.

As our communities have been challenged by COVID-19, Texas families of all kinds have had to find enormous strength and resilience. This moment is an opportunity to reflect upon how our own wellbeing is related to the health of everyone in our community.

Evidence shows that children and mothers of color have long faced stark health disparities, which now may be worsened by the effects of COVID-19. Black and Native American babies have a much higher risk of birth complications, low birthweight, and death within their first year of life in comparison to white babies. Black mothers face even more pronounced health disparities: maternal mortality among Black mothers is more than three times higher than among their white peers. These disparities are driven in part by the fact that families of color often have less access to healthcare. According to Zero to Three’s 2020 State of Babies, 7.7% of Latinx/Hispanic women and 9.9% of Black women in the United States receive late or no prenatal care whatsoever compared to 4.5% of white women. In Texas, these disparities are particularly pronounced: 15.1% of Black women and 10.5% of Latinx/Hispanic women receive insufficient prenatal care compared to 6.3% of white women.

Racial discrimination is a distinct factor that drives both low healthcare access and poor health outcomes for families of color. Researchers from Zero to Three affirm that racism accounts for huge differences which cannot be explained by other contributing factors such as poverty, lack of local resources, or low education levels. As a result, mistrust of medical systems is common among people of color. According to Zero to Three’s State of Babies, nearly 1/3 of Black Americans report that they have personally experienced racial discrimination during a healthcare visit and 22% report sometimes avoiding care because they fear discrimination. These fears are warranted. Rates of maternal mortality and delivery complications demonstrate that minority women and children often receive lower-quality hospital care. Racial health disparities have persisted over multiple decades and are not improving over time. In fact, the racial health divide may actually be deepening because of COVID-19.

New mothers often rely upon a trusted network of family and friends. Robust social supports such as these are a crucial protective factor for families of color. Unfortunately, due to social distancing, mothers of color currently have less access to social support. Black women in particular have an elevated risk of postpartum depression and more severe postpartum conditions including postpartum post-traumatic stress disorder (PTSD), which can develop if childbirth is especially traumatic. Low social support is a significant risk factor for such conditions and isolation has negative impacts on overall health. These facts suggest that pregnant women and mothers of color have a heightened risk of serious physical and mental health complications during this pandemic.

As communities come together to take care of each other, we must ensure that Black, Latinx/Hispanic, and Native American families are not left behind. To achieve the strongest possible outcomes for all, we must meaningfully address health disparities in our communities, beginning with the earliest days of each child’s life. TexProtects is proud to be a part of the Prenatal to Three (PN-3) Collaborative which works to ensure more young Texas children benefit from effective and well- funded programs that promote healthy beginnings, supported families, and quality early care (learn more).

COVID-19 has forced us all to reimagine what normal looks like on an individual level. Our health systems are also reimagining how they will protect us through and beyond this health crisis. Although that process will be challenging, it has the potential to foster new innovations. Now is the time to overturn the status quo of a system which has failed to provide equal care to all children. TexProtects is committed to a future where equality in child and maternal healthcare is the new normal. 

TexProtects Stands Up | Disproportionality in the Child Welfare System

 TexProtects’ vision is one where every child is safe, nurtured, and resilient — no matter the color of their skin. This vision cannot be realized while families of color continue to be wounded by systemic racism and injustice. As part of our effort to speak out and stand up against injustice, this blog is part of a series to highlight existing inequalities in our child protection systems. A deepened understanding of these issues can help us know better and do better so that Texas is a safe place to be born – where families can thrive and where every individual is seen and valued equally.

TexProtects’ mission and vision are to prevent children from the trauma of abuse and neglect and to keep families together when children can be kept safe. However, due to various circumstances impacting child safety and risk, some children and families come into contact with the child protection system. Unfortunately, data shows that from intake (recognizing and reporting abuse) to permanency, Black families and children are disproportionately represented and disparities in outcomes are present in the child protection system in Texas.

Black children are 1.8 times more likely to be reported as abuse victims, 2 times more likely be investigated, and 1.7 times more likely to be removed from their home than their White counterparts due to biases and racism at personal, community, and systemic levels. The stakes are higher the further Black children move through the system. They experience more placements, wait longer to be adopted, and are more likely to age out of care.

Tackling disproportionality in the child protection system cannot be done in isolation. Families often interact with so many other systems: healthcare, education, juvenile justice, criminal justice, and more. Therefore, it is crucial we collaborate across systems when addressing disproportionality. Unfortunately, targeted efforts to do this in a thoughtful, systematic way were defunded in Texas in 2018.

The Office of Minority Health Statistics and Engagement was initially created in 2010 to work in the context of Child Protective Services (CPS) but later recognized the value of working across systems so it expanded to include other state agencies. Housed within the Texas Health and Human Services Commission (HHSC), the office was tasked with studying and solving the issue of racial inequities and providing context to the issue of disproportionality. After it was disbanded, CPS subsequently created the role to continue the work within their own agency (Department of Family and Protective Services). Tanya Rollins, the State Disproportionality Manager, now leads the agency’s efforts to address institutional racism. CPS continues to provide its workforce with training on racial and ethnic identity and cultural awareness, as well as poverty simulations.

Despite these activities, the system clearly continues to produce more negative outcomes for Black families and their children. To do better, to create long term change, there must be increased dedication, support, and resources toward both describing and solving the problem. 

We all have a part to play and plenty of areas for growth and change: on an individual level, on a policy and practice level, and on a systems level. TexProtects will continue to speak up and stand up against injustice and inequality, and we commit to addressing inequities through our policy and programmatic work to help ensure that the child welfare system no longer disproportionately produces outcomes that negatively impact Black children. We call on you to participate in and support this work too. 

TexProtects Stands Up | The Disproportionate Impact of COVID-19

TexProtects’ vision is one where every child is safe, nurtured, and resilient — no matter the color of their skin. This vision cannot be realized while families of color continue to be wounded by systemic racism and injustice. As part of our effort to speak out and stand up against injustice, this blog is part of a series to highlight existing inequalities in our child protection systems. A deepened understanding of these issues can help us know better and do better so that Texas is a safe place to be born – where families can thrive and where every individual is seen and valued equally.

We will only be able to grasp the full negative effects of COVID-19 once the pandemic is behind us, but the disproportionate affect the virus is having on children and families of color is already apparent. The onset of this health crisis has further exposed how systemic racism is creating harmful disparities between white communities and communities of color. The ways in which Black and Latinx or Hispanic communities are negatively affected by the fallout from COVID-19 translate into potentially negative outcomes for their children.

Instances of COVID-19 cases and deaths are disproportionately affecting Black and Latinx/Hispanic communities. Based on the COVID Racial Data Tracker by the COVID Tracking Project, the nation has lost at least 25,932 Black lives to COVID-19 to date. Deaths of Black people from COVID-19 are nearly two times greater than what would be expected based on their population percentage. Latinx/Hispanic people also make up a greater share of confirmed cases than their share of the population. In Texas, 15% of all COVID-19 cases and 16% of all deaths were Black people, when Black people make up just 12% of the total state population. For Latinx/Hispanic people, cases are also disproportionately higher, making up 47% of all COVID cases, when Texas is 39% Latinx/Hispanic.

But these are just the tested and reported numbers available in Texas. Of all tested cases and instances of deaths, Texas has only reported race data for 11% of positive cases and 23% of deaths. This means that the percentages of Black and Latinx/Hispanic deaths could be much greater than what is reported.

But it is systemic racism, not race, that is the risk factor for these communities.

Racism is playing out during the pandemic through examples like a disproportionate number of COVID-19 testing sites in predominantly white communities compared to Black and Latinx/Hispanic communities, and yet they are still disproportionately impacted. One data analysis found, for example, that Dallas had 15 more testing sites in whiter areas and Austin had 7 more. Experts are saying these testing disparities are problematic – if we aren’t testing our most marginalized people, we could miss pockets of infection and have new large areas of virus outbreak. 

Given that there is a higher prevalence of chronic health conditions like hypertension and diabetes in communities of color, Black and Latinx/Hispanic communities are especially vulnerable to COVID-19. These chronic health conditions are a result of centuries of intergenerational trauma and a lack of resources inflicted on these communities. A lack of health insurance, poor access to medical care, and other systemic inequalities also undermine virus prevention efforts in these communities.

Living conditions (e.g. food deserts, minimal nearby medical facilities) in predominantly Black and Latinx/Hispanic areas may also contribute to underlying health conditions. These underlying health conditions may complicate people’s ability to follow health guidelines to prevent getting sick with COVID-19.

The likelihood that a person will test positive for COVID-19 increases in areas where the population of Black residents is higher.  This may be attributable to higher concentrations of Black people living in densely populated areas, which are due to institutional racism in the form of residential housing segregation and fewer access to services. This is also known as redlining — a racist practice denying or putting up barriers to services like for residents of certain areas based on their race. These circumstances make guidelines for social distancing almost impossible to follow safely.

Black and Latinx/Hispanic individuals are also more likely to hold jobs that are deemed “essential”. Essential workers are continuing to work outside the home, putting themselves and their families at risk. According to the CDC, nearly a quarter of Latinx/Hispanic and Black workers are employed in service industry jobs compared to just 16% of non-Hispanic whites nationally. Latinx/Hispanic workers make up 17% of total employment in the U.S. but constitute 53% of agricultural workers. Black workers account for 12% of all employed workers nationally but make up 30% of licensed practical and licensed vocational nurses. Both sectors are areas of work that have continued outside the home during the pandemic.  

These barriers not only make people of color more vulnerable to COVID-19, they also impact how families are able to care for their children during this crisis. This systemic racism apparent in our healthcare and housing systems trickles down to Black and Latinx/Hispanic children. Placing more stressors on parents and caregivers in turn places stressors on children, who are then less able to cultivate protective factors that build resilience.

Protective factors — including social connections, concrete supports for basic needs, knowledge of parenting and child development, social and emotional development of children, nurturing and attachment, and resilience — provide the key to ensuring that risk and adversity in childhood are not predictive of negative outcomes later in life.

We have a lot of work to do to ensure all children and families stay healthy through this pandemic and into the future. The state of Texas is making a small start:  the Texas Health and Human Services Commission has recently announced that it is seeking to remedy the lack of information about how Black and Latinx/Hispanic communities are being affected by the virus  and will work to study this. But answers must also come from communities themselves so that those of us working toward child protection can learn how to best empower community work and strengthen families to ensure they have access to the right supports at the right time. We must use a holistic approach to ensure that their access to resources is distributed equitably.

Another way we can help is through supporting the Texas Prenatal to Three (PN-3) Collaborative (learn more). Through PN-3, TexProtects, Children At Risk, and Texans Care for Children – along with many other organizations across the state – have come together to urge policymakers to ensure all Texas children have equitable access to healthy beginnings, family supports, and high quality early care and education.