In the Gap: Voices from the health divide is WHYY's continuing series in partnership with 900 AM WURD. This month, series producer Taunya English looks into African American women and their babies' health.

In Philadelphia and across the country, black babies are more likely than white babies to die before their first birthday. Black moms also are much more likely to have a baby who arrives too early or weighs too little.

"When my son was first born, he was in the palm of my hand, he was one pound, one ounce. He was basically flesh and bone," said Philadelphia resident Dana King.

King's son, Christian, arrived just seven months into her pregnancy. These days, he's growing and gaining at The Children's Hospital of Philadelphia. Christian is five-months-old and weighs more than 7 pounds now, but he's still linked to monitoring wires and feeding tubes.

"Every morning at about 5 a.m. I get up, get dressed, I drive out to CHOP, and I sit with Christian, I hold him, cuddle him, spend time with him," King said.

King has a mother's optimism about Christian's future, but sometimes she worries about what went wrong. The pregnancy was high risk because King has diabetes.

"I consulted with the doctors and I started taking prenatal vitamins and I got my diabetes under control. I wanted a baby. I planned for Christian. I had a good job, I had good insurance, I had a good positive attitude, strong support, family, friends, and my faith. It was just the roll of the dice," she said.

But experts say, for African American moms, the dice are weighted the wrong way.

University of Pennsylvania researcher Jennifer Culhane studies infant death rates.

"If you look at all black women in Philadelphia, compared to all white women in Philadelphia, the black women have right around three times the risk," Culhane said.

"My gut instinct tells me that this is because of maternal health," said Penn Medicine physician and researcher Charmaine Smith Wright.

"Black women specifically come to pregnancy less healthy, and I think oftentimes they end up intersecting with medical care later in the pregnancy, than white women, even after adjusting for education and income," Wright said.

Public health programs work to get pregnant women into care--early--and often. But Wright says some moms also need help to make pregnancy education fit into hectic, busy lives. Family advocates with the Maternity Care Coalition do that job.

"When you are sitting on someone's couch, and you say: You should try this. Oftentimes that information is that much more approachable and more attainable," Wright said.

Advocate Tekoa Judge works with South Philadelphia moms.

"It's just the relatability with my clients," she said. "Me having been in this community for awhile, and having the experience as an African American woman, knowing some of the issues that our community faces, it makes it easier for them to open up to me."

Judge visits with client Tiffany Lewis about once a month.

"I'm the mother of soon-to-be-five children, and I'm 8-months pregnant with another girl," Lewis said. 

She developed diabetes after her second child was born. "It's difficult. It's difficult. I lost a baby due to the diabetes with my sugars being out of control, way out of control. They said the baby's kidneys didn't grow. It was just a lot of stuff with it," Lewis said.

That's the kind of life stuff that Judge and Lewis chat about during their home visits. Everything from housing options and stress to swollen ankles. Lewis says she doesn't even mind the prodding about her diet.

"There are those moments when I sneak and get stuff, but I try not to," Lewis said.

For decades, efforts to narrow the health divide between black and white newborns have largely focused on what women do--and don't do--during pregnancy.

"So it looks like: 'Let's find women that use alcohol, and then let's strongly encourage them not to,'" said Penn researcher Jennifer Culhane. "Let's find women who have quote-unquote poor diets and teach them about healthy eating. So everything is about the individual."

Charmaine Wright says those fixes have done little to close the gap in early and underweight births.

"Puzzling this through, it's not just genetics, it's not just socioeconomics. It's a problem that has so many causes. What about growing up in this country leads to the gap?" 

That, Wright says, is the next big question for researchers to explore.

Taunya English is appearing on WURD's HealthQuest Live show on Monday, May 23 at noon.