In America, black women are far more likely than women of any other race to have children that die before their first birthday. They have the highest infant mortality rate. It’s not known exactly why this is so but it’s true regardless of age, income or education of the mother.Bermudian Nia Williams is working to change this. A registered nurse in Maryland, she specialises in maternal health and for the last eight years has been working with the African American Health Program in Montgomery County, Maryland.Widely considered an affluent area, the county has about a million people with a good mix of ethnicities. Because African American women have an infant mortality rate two to four times higher than any other race, the African American Health Program was started.“This non-profit organisation began in 2001, to address health disparities among African Americans in Montgomery County focusing on infant mortality, diabetes, cardiovascular health, cancer, and HIV/AIDS,” said Ms Williams.She currently serves as team leader for the SMILE (Start More Infants Living Equally-Healthy) Program, in which there are three nurse case managers.Research has shown that working closely with mothers from their first trimester of pregnancy is effective in bettering the chances their children will be healthy.Ms Williams said she and her two colleagues help women manage a wide variety of matters.“We are concerned with anything that can go wrong in a black woman’s pregnancy, any issue that can threaten the healthy birth of the baby and its health up to its first birthday,” said Ms Williams.“As a nurse case manager, I ensure that my clients have access to healthcare. If needed, I help them obtain health insurance,” she said. “I also ensure my clients seek prenatal care early, maintain optimal nutrition and have interventions to reduce stress.“I ensure that infants are received into safe and nurturing home environments, provide cribs and car seats and where necessary, referrals to other agencies,” Ms Williams added.She also gives childbirth and breastfeeding classes to 50 participants, twice a year.Black women from all social strata are in the programme. It was not designed to cater to only those of lower income.“Ideally we want to see women in their first trimester,” said Ms Williams,” but most come in their second and third.”The nurses meet with each of their clients at least once a month and keep track of their physical health, their mental state and living conditions.“We are concerned with the social determinants of health of the women, because all of these can impact the health of the baby,” said Ms Williams.Ms Williams said she’s seen the programme expand in the eight years she’s been there a third nurse was brought on board a few years ago.“We don’t turn anyone away,” she said. “We are into the 50s in terms of clients. The Department of Health and Social Services has noticed and there’s a possibility we will get a fourth nurse.”Although each nurse must meet with each of her clients every month, Ms Williams said that’s really the bare minimum.“I have teenagers that I see every week,” she said.The challenges aren’t limited to teens or poor clients.“‘Even married, college-educated black women often have a lot of serious issues during pregnancy,” she said.“Clients range from 13 years old to 44. They have tons of social issues, hypertension, gestational diabetes, history of drug abuse we make sure each woman is getting everything she needs to have a healthy birth outcome and be a responsible parent.”