Note: This is the first story in the Cap Times series Deadly Divide, investigating Wisconsin’s ongoing Black infant mortality crisis. This reporting is supported through a National Fellowship from the USC Annenberg Center for Health Journalism.
Click here to read highlights from the story
- Wisconsin’s Black infant mortality rate was 12.5 deaths per 1,000 live births in 2024, compared with 4.8 for white babies; nearly 850 Black babies died before age 1 from 2015 through 2024.
- Preterm birth and low birth weight are the leading causes of death among Black infants, and Black mothers in Wisconsin are 50% more likely to give birth early than white mothers.
- Experts say income, education and health care access alone do not explain the disparity, pointing instead to the lasting health effects of systemic racism, chronic stress, segregation and generational trauma.
- State health leaders say improving outcomes will require support before and beyond pregnancy — including more time and trust in health care settings, culturally informed care and efforts to address housing, child care and other stressors.
For generations, Black families in Wisconsin have buried babies at rates far higher than their white neighbors — a disparity that has withstood medical advances, public health initiatives and decades of promises to close the gap.
The numbers have remained stubbornly consistent, with Wisconsin regularly ranking the worst in the nation when it comes to the rate at which Black babies die before reaching age 1. In 2024, the most recent year for which the Wisconsin Department of Health Services has publicized data, the state had an infant mortality rate of 12.5 deaths for every 1,000 live births among Black babies. For white babies, that rate was 4.8.
Between 2015 and 2024 nearly 850 Black babies died in Wisconsin before turning 1, according to state data. Over the first half of that decade, nearly 25% of the deaths of Black infants were caused by being born into this world too early and too small to survive.
Researchers and health experts say the crisis cannot be explained by lack of access to quality health care alone. They point to the cumulative effects of systemic racism, chronic stress and generational trauma that shape maternal health long before pregnancy begins and influence birth outcomes from one generation to the next.
That these disparities transcend socioeconomic factors like income or level of educational attainment show the root cause lies elsewhere. Black babies are dying at higher rates even when their parents make a decent living. Black babies are dying at higher rates even when their moms are well-educated.
For Dr. Jasmine Zapata, Wisconsin’s state epidemiologist for maternal and child health and chronic diseases, the numbers have never just been numbers.
Every chart tracking premature births, every report on infant death and every statewide trend carries the memory of her own pregnancy, when she unexpectedly delivered her daughter at just 25 weeks.
As a second-year medical student at the time, she knew something wasn’t right when she felt sharp pain in her lower abdomen. Her due date was not until Jan. 2. It was Sept. 20.
Zapata’s pain was repeatedly dismissed by doctors as Braxton Hicks contractions — a type of contraction that typically takes place earlier in a pregnancy and doesn’t result in cervical dilation or labor.
“I called about two, three times and I was just brushed off,” Zapata said.
But when Zapata began bleeding, she rushed to the hospital where providers found her cervix was already 10 centimeters dilated, the threshold typically required to give birth.
“They told me ‘You’re going to meet your daughter today,’” Zapata said.
Though she was nearly 15 weeks out from her due date and her baby was barely beyond the point of viability, Zapata gave birth to her little girl.
“When my baby came out, she was not crying. It was quiet, because her little lungs were too fragile to even breathe,” Zapata said. “I knew that complications of prematurity, this little baby fighting for her life … I was right there at the verge of being one of the infant mortality statistics.”
Zapata’s experience with preterm birth, even though her pregnancy was not categorized as high-risk, is common in Wisconsin, where Black mothers are 50% more likely to give birth before their due dates than white women.
Preterm birth and low birth weight are the leading causes of death among Black infants, defined as younger than age 1.
National experts on health and development say there’s a painful and deep-rooted reason these statistics persist despite medical advancements.
‘This is the world you’ll be born into’
Dr. Tony Iton, a nationally recognized public health leader and advocate for health equity, has spent much of his career studying how chronic stress related to discrimination puts people’s health at risk. Iton is the CEO of The Health Trust in California.
Decades of research, he said, shows that living in a society built on a legacy of structural racism can result in consistently elevated levels of cortisol, the body’s stress hormone. Those levels increase the risk of pregnancy complications like preeclampsia (pregnancy-related high blood pressure) and early labor.
“We don’t have a preterm crisis, we have a chronic stress crisis,” he said in an interview with the Cap Times.
Those effects don’t disappear when a pregnancy ends. They accumulate over a lifespan and, in many cases, across generations.
Research has shown that prolonged exposure to adversity can influence fetal development through changes in the mother’s body and health, said Nicole Bush, a clinical psychologist and director of the Division of Developmental Medicine at the University of California San Francisco.
The science, she said, increasingly shows that a mother’s environment and experiences across her lifespan can affect a child’s health before birth, with consequences that can then extend into that child’s adulthood.
Those intergenerational effects can happen through epigenetic changes. Different from genetic mutations, epigenetic changes don’t alter core DNA sequences but instead perform like chemical switches that can turn specific genes on or off, Bush said. That switch affects how genes activate processes in someone’s body.
“Our epigenetic marks can be influenced by nutrition. They can be influenced by sleep. They can be influenced by social experience,” Bush said. “Epigenetic changes related to experience can be stable for a long time after they’ve been changed, and so major stressors can have a long-standing impact on our bodies. They can affect our perceptions, our brain chemistry, our physiology.”
As a result, trauma and stress that someone experiences as a child can alter how their body responds later in life and, during pregnancy, influence how a fetus develops and preemptively trains an infant in utero to expect more stress in life.
“In addition to placing the mother and her uterus and her pregnancy functions at immediate risk for challenges such as preterm birth or postpartum depression, it can also send certain chemicals and signals to the baby in utero that then program that baby to come out ready for a strong fight or flight and reactive immune system,” Bush said, “because the mom’s biology is trying to communicate to the baby ‘This is the world you’ll be born into, come out as prepared as you can.’”
Where Wisconsin stands
Nationally, the Black infant mortality rate is 11 per 1,000 live births, according to 2024 data from the National Center for Health Statistics, an agency that is part of the U.S. Centers for Disease Control and Prevention.
The national infant mortality rate for white babies that same year was 4.4 deaths per 1,000 births.
Also that same year, Wisconsin health data showed Black women were five times more likely than white women to die from pregnancy-related complications.
According to a 2025 study published in the Annals of Internal Medicine, Americans are living longer than ever and the difference in mortality between Black and white Americans has shrunk over the last half century, except when it comes to infants, where the disparity in mortality between Black and white babies has grown.
That Wisconsin ranks so poorly for Black infant and maternal mortality is not new. In 2009, Black babies were almost four times more likely to die within their first year of life than white babies.
The year before that, Dr. Richard Allan Aronson submitted a white paper to the University of Wisconsin School of Medicine and Public Health highlighting racial disparities in the state’s birth outcomes. Aronson served as medical consultant and chief medical officer for family and community health at the Wisconsin Division of Public Health from 1988 to 2002.
The Wisconsin Department of Health Services publicizes infant mortality statistics going back to 1985. In the four decades since, the mortality rate among white babies has consistently decreased in line with medical advancement. The rate among Black babies has remained largely stagnant, with the state having a higher rate of mortality among Black infants in 2023 than it did in 1991.
In his 2008 paper, Aronson identified segregation and disparate access to services as key factors in the racial gap in birth outcomes.
“Since infant mortality is a sentinel indicator of a community’s overall well being, the factors that contribute to racial and ethnic birth outcome disparities relate to all sectors of society. The neighborhoods in Wisconsin with the highest rates of black infant mortality are characterized by hypersegregation, unemployment, economic hardship, and inadequate housing,” Aronson wrote. “Systems that serve children and families in these communities are often fragmented, burdensome, culturally and linguistically disrespectful, and deficit-based.”
Aronson’s assessment of the situation in Wisconsin is as true today as it was nearly two decades ago. And from the year he issued his report to 2024, nearly 1,500 Black babies in Wisconsin died before their first birthday, according to data from the Wisconsin health department.
Had the rate been the same as it was for white babies, more than 970 of them would have survived.
Gaps in access to care and a lack of culturally competent medical services still play a key role in how Black Wisconsinites interact with the health care system, particularly during and after pregnancy, Zapata said.
Wisconsin’s largest cities still carry the spectre of racial segregation and redlining, policies that separated whole populations from necessary services.
Milwaukee, Wisconsin’s largest city with the highest population of Black residents and the highest total annual number of Black infant deaths, has also been consistently ranked as one of the most segregated cities in America.
Madison, which has a far lower population of Black residents, also faces notable racial and subsequently connected socioeconomic segregation.
“If you were going to design a strategy to adversely impact the well-being of a population, you couldn’t come up with a better policy than racial residential segregation. It’s actually brilliantly evil in its manifestations,” Iton, with The Health Trust in California, said.
‘It shouts racism’
Poor health outcomes are often explained away by poverty or low educational achievement, Iton said. But disparities in maternal and infant health outcomes for Black women and babies are shown to transcend both of these factors. This shows that something else is at work, he said.
National data shows Black mothers with a college degree still have higher infant mortality rates than white women who drop out of high school.
“It shouts racism,” Iton said. “If you’re not protected by income and social status from this outcome, that suggests that it’s not just material poverty or lack of resources, but it’s also your situatedness in society and what you perceive to be essentially a pervasive, large-scale devaluation of you as a human being.”
Those effects become clearer looking at data that show Black immigrants have better health outcomes when they come to the United States but exhibit poorer health outcomes the longer they are here, Iton said.
“The birth outcomes are so much better in the African immigrant women, and then as they acculturate, spend more time in America, their birth outcomes get worse,” he explained. “So the suggestion is that it’s really something in the environment in the United States.”
‘Preventing the fire in the first place’
Zapata, Wisconsin’s state specialist in child and maternal health, said she wants more focus on preventing the problems that hurt people in the first place.
“There’s always so much focus on just when you get pregnant and right after. It’s kind of like a house is on fire and it’s burning, and then you’re always just focusing on how can the fire truck get there faster,” she said. “Let’s focus on preventing the fire in the first place.”
That means addressing stressors faced by Black Wisconsinites across their lifespan.
“It’s like once you’re pregnant, you can qualify for all these services. But sadly, from a physiological and biological standpoint, a lot of times it’s too late,” Zapata said. “Because that birthing person — what happened to them all the way into their childhood, and even what was going on with their parents, and when they were in utero, the environment, the stress that their parents were having — that impacts them, that impacts their birth outcomes.”
Zapata said reducing Wisconsin’s Black infant mortality rate will require more than improving medical care. It will require confronting the centuries of systemic racism and inequity that have shaped Black women’s experiences with health care, government and other institutions — and rebuilding trust that has been eroded over generations.
“We’re not going to be able to undo some of the things that got us here in just five years,” she said.
She pointed to a history of exclusion and abuse that is not as distant as it can seem. Less than a century ago, Black people were barred from medical schools, she said, while unethical government and medical practices against people of color have contributed to generations of distrust.
“All of that accumulated harm plays a role into what we’re seeing today,” Zapata said.
That history is reflected in the health care system Black women encounter today, she said. Even when women have access to a doctor or hospital, that doesn’t necessarily mean they feel heard, respected or safe enough to fully engage with the system.
“We’re working within a system that’s just not designed to provide equitable care to all people in all backgrounds,” Zapata said. “We want to look around and see that it reflects the diversity of our community, or just come in and see someone that looks like me.”
Building that trust, she said, requires something the current health care system often does not give providers or patients: time.
Providers can be expected to see dozens of patients a day, while appointments designed to take an hour are squeezed into 15-minute slots. Long waitlists can make it difficult for patients to establish relationships with providers in the first place.
For Black women who already approach the health care system with distrust, those constraints can be especially consequential, Zapata said. A rushed appointment can leave a patient feeling dismissed even when the provider is not intentionally doing so.
“Patients who feel brushed off will be less likely to engage with that system again,” she said.
If something goes wrong during a pregnancy, that can mean a mother is less likely to call her doctor or seek help.
“There’s a lot of Black women that are scared to have children in our state, just because of the statistics,” Zapata said. “When we come into a provider, because of that unique background, we need more time.”
That need extends beyond the exam room. Zapata recalled treating a mother who, just 24 hours after giving birth, was pleading to leave the hospital because she had no child care. Another mother was discharged with her newborn to a homeless shelter.
“They don’t even have a place for the baby to sleep,” she said. “It is just heartbreaking.”
Those circumstances can make it difficult for a mother to focus on her own health or her baby’s health, even when medical care is available.
“Do you think they’re listening to us with their whole heart, with their full attention?” Zapata said of patients in these circumstances. “No, because their brain is thinking about how they’re going to survive.”
Doulas are one option to help bridge some of that divide, she said. Because they can provide advocacy, emotional support and culturally informed guidance, doulas can help women feel safer navigating a health care system that might not feel built for them.
For Black women, she said, that kind of support is not an extra. It is part of what they are asking for as the state tries to change outcomes that have persisted for generations.
‘Too many funerals’
Zapata’s daughter, Aameira, was in the neonatal intensive care unit for three months after she was born. She is now almost 16 years old. Her mother describes her talent for photography, her sassy personality, her beautiful singing voice — each moment of praise an appreciation for the fact that her daughter survived what many babies born that early do not.
It was the moments, days, weeks and months that followed Aameira’s birth that Zapata says shaped the trajectory of her life’s work.
“When I walked out of the NICU with her in my arms, I made a commitment that I’m going to dedicate my career to finding ways to make sure every baby gets to walk out,” Zapata said.
That has remained a driving factor in her work as a doctor, as a state health official, as a mother and as a resident of a state where too many babies don’t make it to age 1.
“I’ve been to too many funerals of babies who didn’t make it to their first birthday. Words can’t express that. I’ve had to do CPR on a baby that came into the hospital already basically gone,” Zapata said. “When you have those types of memories, and screams of family members, and faces drilled in your mind, in your soul, it just really impacts the work that you do.”
Erin McGroarty is a health and policy reporter for the Cap Times in Madison. She can be reached at emcgroarty@captimes.com.
Republish our articles for free, online or in print, under a Creative Commons license.
