This story is part of our series Unhealthy Wisconsin, which examines areas where Wisconsin falls short in well-being. When her daughter was born weighing just 1 ½ pounds, Dr. Jasmine Zapata experienced firsthand the danger she now spends her professional life battling: Wisconsin’s stubbornly high rate of preterm birth and mortality, especially among Black babies. Zapata works at the University of Wisconsin School of Medicine and Public Health as a pediatrician and public health researcher. For the last two years, she also has served as the state epidemiologist for maternal and child health and chronic diseases at the Wisconsin Department of Health Services (DHS). Her second child, born prematurely at just 25 weeks of gestation, faced several life-threatening illnesses in the neonatal intensive care unit. As Zapata knows better than most, complications caused by prematurity are the leading cause of Black infant mortality in Wisconsin. Do you have feedback on Milwaukee NNS's reporting? Take our survey to let us know how we're doing! “She was almost a statistic,” Zapata said. “I was a statistic with my birth outcome … the one about college-educated Black women having higher rates of preterm birth compared to white women who don’t finish college.” Her daughter is now 13 years old and “thriving,” but the experience still fuels her passion for combating inequities in maternal and child health. Wisconsin has one of the highest mortality rates for Black infants in the United States. The two main causes of death within the first year of life for Black infants are low birthweight and sudden unexpected infant death, according to a 2023 DHS report. The report calls for more parental education around safe sleeping habits (babies alone on a surface on their backs, free from soft objects and loose bedding), prioritizing breastfeeding when possible and better access to prenatal and postpartum care. Research, including at the University of Wisconsin, has highlighted societal factors — including stress caused by poverty and racism — as major causes of negative outcomes for Black babies. Wisconsin is home to outsized Black-white disparities across society, including in education, wealth, health, housing and the justice system. In 1990, Black infants in Wisconsin were 2.7 times more likely to die within a year of birth than white infants in the first year of life, according to DHS. Three decades later, Black infants in the state are three times more likely to die than white infants. “This isn’t new news,” said Theresa Duello, a reproductive cell and molecular biologist who researches misconceptions of race, a social construct, in genetic studies. The overall rate at which infants die during the first year of life in Wisconsin in 1990 was 8.4 deaths per 1,000 live births. By 2021, that number dropped to 5.3 deaths per 1,000 live births, similar to the national rate. Negative birthing outcomes for Black infants have not improved as quickly as those for white babies. Among white infants, the rate dropped from 7.2 to 4.4 deaths per 1,000 births between 1990 and the 2019-2021 period — a 39% decrease. Among Black infants, the rate dropped from 19.7 to 13.2 deaths per 1,000 live births over the same period, a 33% drop and still triple the rate for white infants. “I think we should reexamine how we take responsibility for this,” Duello said. Preterm birth, those occurring before 37 weeks of pregnancy, is the leading cause of newborn mortality. Wisconsin’s rate of neonatal deaths due to preterm birth was 21% above the national average in 2018. That year, 15.6% of Black births were premature, compared to 9% of white births. Low birth weight — infants less than 5 pounds, 8 ounces — and prematurity are both associated with infant mortality, Duello noted. Low birth weight is often associated with intrauterine growth retardation (IUGR), when the fetus is smaller than expected for the number of weeks of pregnancy. Researchers hypothesize that an increase in the hormone cortisol during pregnancy may harm blood flow to the placenta, compromising access to nutrients and impairing fetal growth. When low birth weight babies are born in consecutive generations, some may incorrectly assume the issue is genetic, Duello said. But if pregnant women in the same family face great stress over the generations, such as poverty, lack of health care and racism, they will more likely have high cortisol levels — and likely deliver a small baby. Addressing such stressors could improve pregnancy outcomes, research shows. Mothers of color disproportionately live in areas with fewer resources and thus may face greater stresses that increase the odds of negative birth outcomes, DHS says in a 2018 report.