KALAMAZOO, MI — Kalamazoo is literally the land of The Promise, where a child who calls this city home can attend a Michigan college for free.

But for all that is good, Kalamazoo also is a city in the midst of a health crisis defined by this statistic — from 2006 to 2010, a black infant born here was five times less likely than a white baby to make it to his or her first birthday.

“This is a disgusting problem,” said Catherine Kothari, a senior clinical research scientist for the Western Michigan University School of Medicine. “I think it’s shameful."

The disparity between black and white infant mortality lessens when looked at from a countywide level, but it is no less telling. In that five-year span, a black infant was almost four times as likely to die before age 1 than a white infant in Kalamazoo County.

“I will tell you that a lot of it has to do with poverty, that being poor and socioeconomic factors lead to a stressful life. When you add in being black or Hispanic to that, it’s not just additive ... the combination is lethal," Kothari said.

There are several different lenses through which to view the infant mortality rate in the city of Kalamazoo and in Kalamazoo County.

For instance, statistics from the Michigan Department of Community Health show that from 2008 to 2010, in no Michigan city was the disparity between white-infant deaths and black-infant deaths greater than in Kalamazoo.

During that time, a black infant living in the city was 6.3 times more likely to die than a white infant. The city of Battle Creek ranked second with a ratio of 5.2.

And Kalamazoo’s overall black-infant mortality rate from 2008 to 2010 – 16.9 deaths per 1,000 births -- ranked fifth highest in the state behind Battle Creek, Saginaw, Pontiac and Lansing, respectively, but above eight other cities, including Detroit, Flint and Grand Rapids.

Kalamazoo County’s ratio of white-infant deaths to black-infant deaths ranked fourth highest in the state at 3.4.

Six years ago, local health officials saw hope when state figures showed the county's black-infant mortality rate had dropped to 16 deaths per 1,000 births for the years 2004 to 2006, from 17.9 deaths per 1,000 births for 2003 to 2005. But for the three-year span from 2007 to 2009, the rate climbed to 19.1 and from 2008 to 2010, it rose further to 19.5, second highest among the 16 Michigan counties where a rate could be tallied.

“In Kalamazoo County, if you have this rate of deaths with babies ... at a number that should be shocking, it should spark something in all of us, and why isn’t there a spark for action?” said Karika Phillips, director of the county’s Center for Health Equity.

“Why aren’t we asking these young women about their experiences?”

'It becomes part of you'

Behind all the figures and statistics are the mothers and fathers left to pick up the pieces after their infant dies. The emotional toll can be devastating, even decades later.

Sandra Compton lost her nearly four-month-old daughter in April 1992, and to this day cries and struggles for the words to describe the experience.

"All I have left of her is the memories, the smiles, the mornings that I woke up and looked into her eyes," Compton said. "The spirit that was coming from her was just so much joy. She would allow any stranger to hold her and she would just smile."

Compton had a 5-year-old son and young twins when her daughter, Amanda Nicole Dozier, was born in January 1992. Compton said she had become overwhelmed caring for the children and that on the day Amanda died she had taken her boyfriend up on an offer to take care of her baby and three older siblings while she visited a neighbor and relaxed.

Less than an hour after she left, Amanda was dead inside the Staples Avenue home.

"I see my baby's daddy running down the street because we didn't have a phone in our home and all I could hear was, 'Call 911' ... When I got (to the house) she was laying there in the crib and ... I picked her up and immediately went to doing CPR.

"... She took one last breath after that and I remember feeling this sense of loss and when she exhaled her last breath, I fainted," Compton said.

She said doctors told her later that Amanda died from Sudden Infant Death Syndrome, or SIDS, which is referred to today as Sudden Unexplained Infant Death.

SIDS, according to the Centers for Disease Control, is an infant death that "cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and review of the clinical history."

While Amanda's death occurred without explanation, Compton talks candidly two decades later about her actions while pregnant that put Amanda at risk.

The prospect of having another infant -- her twins were 6 months old when she found out Amanda was on the way -- depressed her, she said, and she turned to drugs, specifically cocaine. She said she had no family support at the time and worried about how she and her boyfriend -- Amanda's father -- would care financially for what would be her fourth child.

Amanda was born about a week before her due date in 1992, and had cocaine in her system, her mother said.

Compton said the birth helped her get over her depression and called it "the best day of my life."

"It was the most joyful time in my life when I had her," she said.

But Amanda's death just months after her birth was heartbreaking and led to Compton and Amanda's father separating, she said.

Now, 21 years later, she said a newfound faith in God that came in 2001, help from a family friend and her work then with Wendy Fields, now a caseworker for Healthy Babies Healthy Start in Kalamazoo, brought her out of the darkness that came with losing an infant.

She says she learned from the experience and has talked regularly with her children about the dangers of smoking around their own children. She used to regularly sleep with her children on a couch when they were little, but now reminds them that co-sleeping is not a safe practice.

All of Compton's children, a son and three daughters, have graduated from high school -- something she never accomplished -- and are attending or have attended college. Three of her children were able to use The Kalamazoo Promise scholarship to further their educations.

Compton owns a home in Kalamazoo's Vine neighborhood and takes joy in her two grandchildren, including 4-month-old Layla Simpson, whose smile reminds Compton of Amanda.

"To me, you can get past it with time. That I have found out," Compton said of losing a baby. "With time, with support, you can get past this, but you never forget. You never forget that child, you can never replace that child.

"They're always in your heart and your mind. There is not a day that has gone by that I have not thought about Amanda, wished I could kiss her, touch her. And I'll probably always carry that."

At the state level

The alarming infant mortality numbers locally aren’t occurring in a vacuum. As a state, Michigan’s infant mortality rate was 7.5 deaths per 1,000 births from 2006 to 2010, compared to the national rate of 6.5 for that same time period.

Statistics show Michigan also ranked among the worst 20 states in each of those years for its overall infant mortality rate.

And, like in Kalamazoo County, black infants statewide fared much worse in terms of birth outcomes — 15 deaths per 1,000 births from 2006 to 2010 — than did white infants, at a rate of 5.5 deaths per 1,000 births.

Last year, Gov. Rick Snyder tasked the Department of Community Health with lowering the state’s infant-mortality rate and reducing the racial disparity. The state agency has since implemented an 8-step Infant Mortality Reduction Plan.

Matthew Davis, a primary care doctor in pediatrics and internal medicine at the University of Michigan and chief medical executive for the Department of Community Health, said reasons for the racial disparity in infant deaths can vary by community. But common factors are higher rates of premature births and lower birthweights of babies born to African-American mothers.

Additional factors, Davis said, are unsafe sleeping locations and higher rates of maternal health problems before and during pregnancy for black women.

“It is critically important across the state and within each county to understand the reasons why African American infants are more likely to not reach their first birthday than white infants born in the same communities,” Davis said. "These are areas that we are focusing on in the Department of Community Health in order to bring levels of infant mortality in Michigan down toward the national average and one day help them be among the lowest in the nation."

State numbers on infant mortality are not yet available past 2010.

An MLive/Kalamazoo Gazette review of death certificates filed in the Kalamazoo County Clerk’s Office show 11 infants residing in the county — five white and six black – died in 2011. If that tally is confirmed by the state, the rate of infant deaths for both whites – 2.1 per 1,000 – and for blacks – 11.4 per 1,000 – would be at their lowest single-year levels in years for the county.

Still, the disparity between white infant and black infant deaths persists. Based on the death certificate data, a black infant in the county was more than five times less likely than a white infant to make it to age 1 in 2011.

Davis said state officials know a key element to success of the eight-part plan put forth by MDCH is “community level programs that focus on early childhood nutrition, infant development and home safety.”

Healthy Babies Healthy Start, a federally funded program focused on reducing racial disparities in infant mortality, is one such effort.

WMU's Kothari, who is an evaluator for Healthy Babies Healthy Start, said since its implementation in the late 1990s the program has had a great deal of success in improving birth outcomes among black mothers in the communities it serves.

Caseworkers serve about 300 mothers and children through in-home visits and assistance that focuses on a mother’s health, the health of her baby and education on topics ranging from nutrition to safe-sleeping habits. Healthy Babies Healthy Start serves clients in three zip codes in Kalamazoo County that encompass Kalamazoo’s poorest neighborhoods, among them Edison, Eastside and Northside.

Figures from Healthy Babies Healthy Start show that among residents who live in the three zip codes who are not clients of Healthy Babies Healthy Start, the black infant mortality rate was 25.7 deaths per 1,000 births from 2006 to 2010. For white infants, the rate was 5.2.

“This is a problem,” said Carmen Sweezy, director of Healthy Babies Healthy Start. "It’s not solved. All we’re doing is a limited intervention.”

Sweezy said increased poverty and a lack of education, proper housing and good jobs among more vulnerable residents of the city and county are issues that must be addressed. She calls the non-medical issues the roots to the tree of infant mortality.

“You can’t do anything about infant mortality unless you do something about quality of life in general," Sweezy said.

“We have done nothing about the infrastructure that’s causing it. Infant mortality is about jobs, it’s about housing, it’s about education, it’s about race. The least important thing is medical.”

Racism as a factor

Dr. Arthur James, formerly an obstetrician and gynecologist at Borgess Women’s Health in Kalamazoo, pioneered efforts here to reduce infant mortality and racial disparities. James, who now works at Ohio State University’s Wexner Medical Center, contends that racial disparities in infant deaths are linked to the chronic stress of experiencing racism.

“Probably some of the biggest contributors to infant mortality are non-medical issues, things that we can’t write a prescription to treat or put people in the hospital to cure,” James said in 2011 during a presentation on infant mortality in Ohio.

“It’s things that happen in our everyday life that make significant contributors to why babies die.”

James said national statistics show that, regardless of whether a black mother, among other things, chooses not to smoke during her pregnancy or receives proper prenatal care, her chances of losing her baby are still greater than for a white mother who takes the same steps.

Even more telling, he said in 2011, was that national statistics showed black mothers who have obtained a college degree as high as a doctorate are more likely to lose their baby than a white mother who did not graduate high school.

“Genetics is not the explanation for the disparities we see in birth outcomes,” James said. “I suggest that biologically black babies and white babies die for the same reasons, so the differences that we observe in infant mortality rates among different groups in this country ... is a reflection of the different lifetime circumstances experienced by those different groups.”

Phillips said that for local health officials to fully understand infant mortality, an approach that looks at a woman’s entire life cycle from the time of birth to the time of her pregnancy is paramount. Additionally, she said the medical establishment needs help from “non-traditional partners from the business community, the philanthropic community.

“We need to come together to see what’s happening," the director of Kalamazoo County's Health Equity Center said. "When we have the mindset that every baby matters, race shouldn’t even play into it."

“Because of the glaring number, we have to ask the question, why. Why Is this happening?” Phillips said.

Compton said she believes a key factor is a lack of education for young mothers, as well as lack of desire for that knowledge. She said losing Amanda prompted her to seek assistance when she became pregnant again.

Compton also said that families have to be more supportive of each other and openly discuss health histories. It was only after losing Amanda, she said, that she learned other family members had lost babies to SIDS.

Additionally, Compton said she believes there are more opportunities for support for white women when it comes to pregnancies, both within their own families, and within the health system.

"The system is only working for a certain group of people," Compton said. "It isn't working for everybody."

While Kothari said that both race and poverty play roles in the disparity in infant deaths, she is not certain that she and other local health officials know enough to pinpoint exactly why it has become such a problem in Kalamazoo County.

“Infant mortality is sort of the white-glove test of a community, the most sensitive indicator of how well a country or a community is taking care of its most vulnerable populations,” she said. "I think we have a big problem and I don’t understand why Kalamazoo has such a big problem ... Those are really brutal numbers."

“We have to stop blaming the victim here,” Kothari continued. “It’s our problem. I think we try to explain these inequities by ... looking at this person who had this horrible experience and what she did and we really need to look at what we didn’t do.”

Rex Hall Jr. is a public safety reporter for MLive/Kalamazoo Gazette. You can reach him at rhall2@mlive.com. Follow him on Twitter.