Housing may be key to high infant mortality numbers in Tennessee

Medical professionals and affordable housing leaders point to overcrowding in homes

a shower hosted at Nashville's Cathedral of Praise by Meharry Medical College.
Jayne Greenlee with her baby girl, Skylar, nine months old, attended the event,a shower hosted at Nashville's Cathedral of Praise by Meharry Medical College in March.

For decades, the Bordeaux community has been home to many of Nashville’s working and middle-class Black families, but the neighborhood’s quiet exterior hides efforts by the Metro Public Health Department (MPHD) to reduce infant mortality. 

The latest maternal mortality report published by the Tennessee Department of Health revealed racial inequities when addressing why Black children die at higher rates than other races. Compared to the national rate of 5.8 deaths per 1,000 live births, Tennessee infants are dying at a rate of 6.9 per 1,000 live births, and Black infants were twice as likely to die than white ones.   

Dr. Kimberly Wyche-Etheridge (Photo: Meharry Medical College)
Dr. Kimberly Wyche-Etheridge (Photo: Meharry Medical College)

Bordeaux’s zip code is one of seven zip codes being targeted as part of Nashville’s efforts to reduce infant deaths.  Through Nashville Strong Babies, Dr. Kimberly Wyche-Etheridge, a Meharry Medical College faculty member, and other Metro health officials support expectant mothers through education, healthcare and other social services. 

While the program has experienced some success, and there were 38 fewer infant deaths in 2019, officials couldn’t help but notice that infants were dying in situations where large groups of people were living together in inadequate housing. Officials found that large families were not living in these conditions by choice, but for necessity. 

D’Yuanna Allen-Robb, MPHD director of maternal, child and adolescent health, said she is well aware of the affordable housing crisis. 

“What we hear from a lot of our families that are participating in our home visiting programs across Davidson County, housing is the number one issue they face,” said Allen-Robb.

The rising cost of housing and property taxes are displacing local residents, primarily Black and brown folks, into the far corners of Davidson County, where they have less access to healthy food and healthcare facilities.  As affordable housing for low to middle income families became more scarce, multiple people and generations of families  have been forced to move into smaller housing and pool their finances to afford the rent.   

State health officials found that approximately 20% of infant deaths each year were due to unsafe sleeping conditions, and in 2016, more than a hundred infants died due to sleep-related death.

As a result, state health officials  launched the Safe Sleep program to reduce sleep-related deaths through parental education. Infants from birth to six months old are unable to turn onto their stomachs and remove blankets from their face, leading to suffocation. This is why infants need to sleep alone in their own crib, said health officials.

But the reality of the situation is another thing. In crowded housing conditions, infants are sharing spaces with multiple other members of their family, who may not even have room for a crib.  

“It is the number one issue that is frustrating for staff because it’s the one asset that they don’t have to offer for families,”said Allen-Robb. 

While these deaths were avoidable, there was little she could do to prevent them, she added.

In crowded housing conditions, infants are sharing spaces with multiple other members of their family, who may not even have room for a crib. Housing is the number one issue many families face, said D’Yuanna Allen-Robb, MPHD director of maternal, child and adolescent health.  

So Metro Nashville health officials looked into other preventative measures. The Barnes Housing Trust Fund—named after the late affordable housing advocate Rev. Bill Barnes—offers competitive grants to nonprofit housing developers as a way to promote affordable housing options. Among the several organizations awarded the grant, the  nonprofit developer Be a Helping Hand teamed up with Nashville Strong Babies about providing multi-family housing. 

Mark Wright, director at Be a Helping Hand, had long noticed there was a problem with the amount of affordable housing needed versus what was actually available. His organization initially built units in North Nashville to house recently released inmates and to counteract gentrification in areas that were previously Black neighborhoods, including Lafayette Street.  Efforts to revitalize these areas created property values that rose beyond what local residents could afford, and developers tended to favor single-family units instead of multi-family units because they could build more, which pushed large families out. 

“We noticed large families were left out. No one was building houses for families,” said Wright. 

Once he learned that housing was connected to infant mortality, his focus turned to making multi-family housing units for low income families.

Currently in development in North Nashville are four-bedroom units starting at  $1,250 a month. These units would normally go for $5,000, said Wright. 

Nashville Strong Babies network sends applicants to see if they meet the requirements. Families cannot make more than 60% of the average median income and it helps if they already qualify for public housing vouchers. 

In order to keep the homes affordable, 30 year restrictions will keep prices low, and Wright jokes that by that point the next generation may find a better solution. 

“Affordable housing doesn’t mean poverty level. It doesn’t mean concentrated poverty, it means affordable housing for the people that actually do work in the city of Nashville,” said Wright. 

The Barnes Grant includes funding to preserve long term affordable housing and rental units. It has invested more than $54 million in affordable housing development that led to the construction of 2,500 housing units.

Other nonprofit organizations offer affordable housing for other groups of people, such as the Housing Fund, which specializes in first time buyers and preventing foreclosure, but this is just a drop in the bucket. 

“What are we doing that allows us to be able to create more housing and what is being done to improve incomes for individuals so they can afford the type of housing that is being built or the type that currently exists?” asked Marshall Crawford, president of the Housing Fund.Nashville Strong Babies

Gentrification hasn’t overtaken  Bordeaux, but it’s getting there. With the completion of highway US-41A South almost finished, the rest of Nashville has noticed the community and calls from real estate agents happen so frequently that “It actually gets kind of annoying after a while,” said Wyche-Etheridge, who lives in Bordeaux. She’s even got a name for them, and as the Bordeaux population ages, these “obituary crawlers” have made all kinds of offers to buy up properties. 

This is very worrisome, Wyche Etheridge said. . Soon enough, and especially after a living through COVID-19, these offers start to sound good.

“Having a little bit of money in front of you sounds really good, but when that’s flipped and turned into a $700,000 profit, it’s a little maddening,” she said. 

The rest of the community will pay the cost. Property taxes rise, rents rise, wages stay the same, and people get pushed out even further out of Nashville and away from easier access to the support needed for a healthy pregnancy.

“It turns into a cycle,” said Wyche-Etheridge. 

Although housing is the number one issue, Nashville Strong Babies offers comprehensive care, and every little ounce of it helps to reduce stress and have better health outcomes.

There’s an African proverb Wyche-Ethridge likes to use,  in which a man continuously  saves people from drowning in a stream before deciding to go upstream and find the cause of the problem.

“We spend all this time doing intervention and pulling people out of the river, but at some point we have to go upstream and fix what’s causing them to fall in,” she added.