Even after 15 years, Ruth Richardson still remembers a prenatal visit to the doctor that left her outraged. It was her second pregnancy, and a white physician made a startling assumption about her.
"He looked at my arm and asked me, 'How long have you been an IV drug user?'" she recalled. "That caught me a little off guard, and he said, 'Well, you have track marks on your arm.'"
The experience convinced her that the kind of judgment she endured can chase women away from health care. And the memory helps motivate her now as she works to improve birth outcomes for African-American families.
A stark and persistent disparity puts a stain on Minnesota's measure of health: Babies born to African-American women are more than twice as likely to die during infancy as babies born to white women.
• Across the nation: Racial and ethnic disparities persist in sudden infant deaths
Now Richardson is co-chairing a group advising the state Department of Human Services on how to reduce the disparity. She's helping organize a summit Thursday in St. Paul that'll bring together health care providers, social workers and community members.
During that prenatal checkup 15 years ago, Richardson explained to the doctor that she suffered from hyperemesis, a serious complication that involves severe vomiting. She was so sick she needed to be fed nutrients through an IV, and that left scarring.
"He didn't seem to believe that was what was going on," she recalled. She found another provider.
Richardson and her husband were middle-class and educated, and their pregnancies were planned. But the visit to the doctor demonstrated to her that as a black woman — even one with socioeconomic advantages — she would be subject to stereotyping within the health care system.
One puzzling thread of research shows that the gap in infant mortality persists regardless of the mothers' education levels. In Minnesota, babies born to black moms with college degrees have roughly the same risk of infant death as babies born to white women who dropped out of high school, according to health department officials.
• In 2015: Infant mortality higher among MN blacks, Indians
One emerging theory might explain why: Black women experience more stress, and that can have a weathering effect on their bodies.
"We know that there are stressors associated with race, and with how people are treated because of their race," said Jeff Schiff, the medical director for the state's Department of Human Services.
"Stress, just physiologically, causes people to have higher cortisol, higher stress hormones," said Schiff, who is also a pediatric emergency-room doctor. "Those are the things that lead to premature birth."
On top of that, he said, if a woman is struggling with homelessness, domestic violence or substance abuse, that can affect the baby's health, too.
Minnesota has one of the highest disparities in the nation for infant mortality between white and African-American babies. That's not because the African-American rate is higher than in the rest of the nation — but because the white rate in Minnesota is so low.
"Our feeling is that if we can do well for the rest of the population, we should be able to do well for this community," said Schiff, who is also involved with similar efforts to improve Native American birth outcomes.
Schiff said other states have closed the infant mortality gap by identifying and treating mothers of color early in their pregnancies and providing them with social supports. His department is allocating $1.3 million to medical and community providers in Hennepin and Ramsey counties to develop models that integrate medical and social service for better birth outcomes.
Approaches like this already exist around Minnesota, but state officials would like to see them scaled up.
And they're listening to people like Clara Sharp, who runs Ahavah BirthWorks, a doula organization in north Minneapolis. The doulas follow the moms to doctor visits and bring them together with other new moms. Sharp, who's African-American, says she wants to provide what she calls "village support."
"The mothers actually give each other advice," she said. "It's not so much us doing it. It's that peer-to-peer support."
But with so much focus on engaging black mothers, medical providers and community workers shouldn't ignore black dads, said Samuel Simmons, who sits on the DHS advisory group and works as a behavioral consultant. He remembers hearing from a visiting nurse who took notice of a young man in the home of a pregnant patient she was visiting. It turned out he was the father-to-be. The nurse took the unusual step of taking his blood pressure.
• Related: Focus on infants during childbirth leaves U.S. moms in danger
"It just made him feel included," Simmons said. "Nobody had ever asked what he thought and how he was doing."
Simmons said informed dads can help their partners stay on top of their prenatal visits and make sure the home life is as calm as possible.
At Thursday's summit, Simmons will share his perspective with clinicians and community workers who are determined to bring healthier black babies into the world.