Built Around Pontiac’s Babies: Rx Kids, the County’s Infant Death Reviews, and the Numbers No One Publishes

A cash program for new mothers and the county’s infant death review teams have both made Pontiac a focus. Black babies there still die at roughly four times the county’s white rate, and the numbers that would show whether anything is closing that gap are not public.

Where This Started

This week I received a set of records on infant and maternal deaths in Oakland County: state tables broken down by race, a year-by-year count of infant deaths in Pontiac running through October of this year, and charts tracking the city’s Black infant death rate for a decade. I checked every figure in them against the Michigan Department of Health and Human Services’ own published tables. They hold.

Here is what I noticed immediately. Pontiac is not a place nobody is watching. It has a well-funded cash program for new mothers. It has the county’s infant death review machinery pointed directly at it. And the gap between Black babies and white babies in this county is still sitting at four to one.

So the question for this series is not whether anyone cares about Pontiac’s babies. It is whether the public can see enough of the record to know if any of it is working, and for whom.

What the State’s Own Numbers Show

MDHHS publishes three-year average Black infant death rates for Michigan cities. For Pontiac, the rate was 19.4 per 1,000 live births in 2013 through 2015. It fell to 11.3 by 2018 through 2020, climbed back to 14.2 in 2020 through 2022, and stood at 11.4 for 2022 through 2024. The state attaches a confidence interval of plus or minus 6.4 to that most recent figure, which is the honest price of measuring deaths in a city of about 800 births a year.

For comparison, the statewide Black rate for 2022 through 2024 was 13.2, and Southfield, the other city the county’s teams focus on, was 8.8. Pontiac’s overall infant death rate across all races averaged 9.7 per 1,000 from 2020 through 2024, with an average of eight infant deaths a year. In 2024 alone the state counted seven infant deaths among 811 live births.

The county-wide picture is sharper. State tables covering Oakland County residents, last generated in March 2026, put the Black infant death rate for 2022 through 2024 at 8.9 per 1,000 and the white rate at 2.7. Year by year, the Black rate ran 13.8 in 2021, 7.9 in 2022, 8.8 in 2023, and 10.2 in 2024. The white rate never rose above 3.7 in any of those years. The county’s own 2025 maternal and child health report, using a three-year average through 2023, lists Black infants at 10.1 and white infants at 2.6.

The reviewed records also include Pontiac infant death counts by race for each year since 2020. Black infant deaths numbered 7, 6, 5, 2, 5, and 6 from 2020 through 2025, with one more recorded so far in 2026. White infant deaths over the same six years numbered 3, 1, 1, 1, 2, and 2. The 2024 total in those records matches the state’s published count of seven exactly. Across those six years, Black infants account for 31 of the 48 deaths recorded, in a city where about 43 percent of residents are Black, according to the Census Bureau.

Two details in the state’s tables push the real gap in one direction. Since 2020, Michigan has counted babies of multiracial mothers in an “other” category rather than splitting them across races, and the state’s own footnote says that change lowered the reported Black and white rates. And Pontiac’s white rate cannot be computed at all, because the state does not calculate a rate from fewer than six deaths. The only white comparison available for Pontiac families is the county-wide rate.

What Pontiac Families Are Up Against

An infant death rate is the last number in a long chain. The links before it are the conditions a mother lives in while she is pregnant and the conditions a baby comes home to. In Pontiac, those conditions are stacked.

Pontiac is a food desert. That is the setting for a pregnancy in a city where the Census Bureau puts the poverty rate at 24.4 percent and the median household income at $44,329, and where BridgeDetroit reported that roughly 45 percent of children under 5 live in poverty.

Food is not a side issue in a pregnancy. A 2025 study in JAMA Network Open followed more than 19,000 pregnancies at Kaiser Permanente Northern California and found that people who reported food insecurity while pregnant had a higher risk of preeclampsia, gestational diabetes, preterm birth, and NICU admission than those who did not. Preeclampsia risk was 28 percent higher. Preterm birth risk was 19 percent higher. Among those who received food assistance during pregnancy, most of those added risks largely disappeared.

Oakland County has put money behind food access in Pontiac before. In 2022 it directed $350,000 in federal pandemic relief money each to the Pontiac Community Foundation and to Lighthouse, the Pontiac-based nonprofit that was providing emergency food to roughly 5,000 households a week. County Executive Dave Coulter said at the time that more than 11 percent of the county’s children were food insecure.

Here is the pattern I keep coming back to. Food access, poverty, transportation, and prenatal care are each tracked by someone. Preterm birth and low birthweight are tracked by the county. Infant deaths are tracked by the state. Nobody publishes them side by side for Pontiac, so nobody can see how much of the four-to-one gap is built from conditions a city and county could change. The harm is systemic. The record of it is scattered, and the families carrying it cannot read it.

The Program Paying Pontiac’s Mothers

Rx Kids began in Flint in 2024 under Dr. Mona Hanna, the pediatrician who helped expose the Flint water crisis. It is run by Michigan State University’s Pediatric Public Health Initiative with the University of Michigan’s Poverty Solutions, and GiveDirectly administers the payments. The premise is simple: give every expectant mother in a community cash, with no income test and no conditions on how it is spent, because poverty is one of the strongest predictors of how a pregnancy and a baby’s first year turn out.

Pontiac became the program’s first southeast Michigan city when enrollment opened in May 2025. Families living in the city who are at least 16 weeks pregnant, or whose baby was born on or after May 1, 2025, are eligible. The local champion is the Oakland Livingston Human Service Agency, which handles outreach and registration. BridgeDetroit reported that roughly 45 percent of Pontiac children under 5 live in poverty. Funding of $8.5 million over two years came from the State of Michigan, the Alix Foundation, the Pontiac Funders Collaborative at the Community Foundation for Southeast Michigan, the Total Health Foundation of Priority Health, and $500,000 of the City of Pontiac’s opioid settlement money. Announcing the expansion, the collaborative’s director, Erin Casey, put it plainly: “Pontiac moms and babies matter.”

One structural difference stands out. In Flint, families receive $500 a month for a baby’s entire first year. In Pontiac, the money covered $1,500 during pregnancy and $500 a month for six months, with organizers asking other donors to fund the rest. Pontiac’s babies get half the monthly support Flint’s babies get, during the same first year in which infant deaths happen.

By October 15, 2025, the program reported more than $1 million paid out in Pontiac to more than 400 families and 250 babies.

Rx Kids is exactly the kind of program Pontiac needs. It puts money directly in mothers’ hands without making them prove they deserve it, and in Flint it measurably cut preterm births, low birthweight, and NICU stays. Pontiac’s version deserves the full twelve months Flint gets, and a state share that does not have to be fought for every budget cycle.

The Fight Over the State’s Share

Rx Kids’ expansion has been tied up in Lansing for most of a year. On December 10, 2025, the House Appropriations Committee voted to cut $645 million in work project funding, including $18.5 million the Legislature had already approved to expand Rx Kids to 19 communities. Rx Kids listed Pontiac, Hazel Park, and Royal Oak Township as the Oakland County sites directly affected and warned of “a significant risk of a pause or even a halt.” Two weeks later the program said payments and enrollment were continuing everywhere.

The fight resumed with the 2027 budget. As the Michigan Advance reported, the version the Legislature approved on July 3, 2026, kept $20 million in the MDHHS TANF budget that had previously gone to Rx Kids but spread it across five line items, one of which carries stricter conditions on use. At a July 7 press conference, House Speaker Matt Hall said of Rx Kids, “My view is that they will not be eligible for those pots.” Hanna told Bridge Michigan the money was still in the budget. MDHHS, which decides how the funds are spent, did not answer the Advance’s requests for comment.

The two years of funding announced for Pontiac began in spring 2025. The argument in Lansing is about whether a program aimed at the county’s widest racial gap in infant survival keeps its state share past that window.

The County Teams Watching Pontiac

Oakland County runs one of 13 Fetal and Infant Mortality Review teams in Michigan. The review team is a group of community members and professionals who read de-identified case summaries of infant and fetal deaths and identify what could have prevented them. A second body, the Best Start for Babies Oakland County community action team, is supposed to turn those recommendations into action through education and partnerships with hospitals, health plans, and community groups.

The county’s own performance page for this work says both teams have a “special focus on the communities of Pontiac and Southfield.” That page also reports that from 2015 through 2021, the county’s overall infant death rate fell while the Black rate stayed substantially higher and did not move. In other words, the improvement the county could point to did not reach the babies the gap was about.

The work these teams produce is hard to find. The county’s 2025 maternal and child health report cites a FIMR six-year report covering 2017 through 2024 as its source on leading causes of infant death and sleep-related deaths. That six-year report does not appear among the county’s published data reports. The Best Start for Babies page posts meeting minutes for 2024 and 2025, but the posted minutes stop at July 17, 2025. The team’s 2026 calendar lists six meetings, the next on November 19. In the November 21, 2024, minutes, the FIMR update consisted of holiday safety reminders and no findings.

The same November 2024 meeting heard a presentation from a hospital representative on Michigan’s maternal mortality surveillance data, who said pregnancy-related deaths in the state are trending upward, led by hypertension and mental health. No figures were recorded, and nothing in the minutes addresses Pontiac.

The Mothers No One Counts in Pontiac

If the infant data is thin at the city level, the maternal data does not exist there at all. MDHHS reports maternal mortality for Oakland County only in three-year windows, and nothing for Pontiac.

The county table in the reviewed records counts both pregnancy-related deaths and deaths from any cause during pregnancy or within a year after it, so it includes overdoses, homicides, and accidents along with medical complications. It reports rates per 1,000 live births. For 2022 through 2024, the rate for Black mothers was 1.5 and for white mothers 0.3, five times higher. Converted to the per-100,000 scale most maternal health reporting uses, that is 150 against 30. In the windows where both rates are published, the Black rate ran from three to six times the white rate.

For five straight windows, 2015 through 2017 to 2019 through 2021, the Black rate is suppressed as statistically unreliable. The white rate for most of those same years was published, including a rate of 0.2. The Black rate for the window immediately before the suppression began, 2014 through 2016, was published at 0.9. Suppression rules exist to keep tiny numbers from being misread, and the state applies them for a reason. The result, for those five windows, is a public record in which Black mothers in Oakland County disappear from the table while white mothers remain on it.

Pontiac’s own mothers never appear on it in the first place.

Why FOIA Hits a Wall

The first instinct with a records gap like this is a Freedom of Information Act request. In Michigan, that instinct runs into MCL 333.2888. The statute bars disclosure of vital records except as the Public Health Code allows, and it states outright that vital records are exempt from FOIA.

The same section gives MDHHS authority to establish procedures for disclosing vital records information for research purposes. That is the door. Aggregate, de-identified counts and rates come through MDHHS’s Division for Vital Records and Health Statistics by data request, not through a FOIA coordinator. The county knows this route: its own race-specific infant figures came through a data request in October 2023.

What FOIA can still reach is everything around the vital records: the county’s correspondence about what FIMR publishes, the six-year review report itself, the action team’s unposted minutes, and the data requests the county has filed. Those records are the next stop for this series.

What Would Answer the Question

None of this requires identifying a single family. The review teams already work from de-identified summaries. MDHHS already calculates city rates with confidence intervals. Rx Kids already runs a research program with university partners. The pieces exist. The public view of them does not.

Michigan Wrote Eugenics Into Law. It Never Wrote It Out.

Michigan was the first state to propose eugenic legislation, in 1897. In January 1913, John Harvey Kellogg’s Battle Creek Sanitarium hosted the First National Conference on Race Betterment, drawing more than 400 of the movement’s leading figures. The state’s sterilization laws, passed in 1913, 1923, and 1929, produced at least 3,786 documented sterilizations between 1914 and 1963, most of them at the state institution in Lapeer. Three in four of the people sterilized were women. Research on those records suggests Black Michiganders may have been about four times as likely as white residents to be sterilized, and found that poor families and Native people, including the Ottawa, were heavily targeted.

The sterilizations stopped. The question underneath them never went away. Eugenics was a decision about whose children the state considered worth having, and whose would be allowed to fall away. Its tools were a court order and a surgery. The tools now are quieter: a food desert left in place, a cash program for new mothers that works, left at half strength in Pontiac and fought over in Lansing, an infant death review whose findings stay off the county’s data page, a maternal mortality table where Black mothers disappear under an asterisk for five straight reporting periods.

I want to be direct about this, because it gets softened in almost every conversation about racial gaps in birth outcomes. No one in Oakland County has to intend this result for it to keep happening. That is how it works now. When a system produces the same racial pattern in who survives the first year of life, decade after decade, and the institutions responsible hold the most complete version of that record to themselves, the outcome lands where eugenics always aimed it: fewer Black babies surviving to their first birthday, Black mothers dying at five times the rate of white mothers, and a public that is never shown the full count.

The programs in this story are not that system. They are the people pushing against it. Rx Kids, the review teams, the nurses and outreach workers and hospital partners at the table, Lighthouse and the Pontiac Community Foundation: they are the counterweight. The system they work inside is what has to change.

Why This Matters Beyond Pontiac

Pontiac is a test case for something Michigan keeps doing: building programs aimed at a racial gap in infant survival while leaving the public with no way to watch the gap move. Rx Kids is a serious intervention with serious early results. The county’s review teams exist precisely to learn from every death. Both are vital, both are pointed at the right place, and both should be protected and expanded.

Neither program can fix a food desert, a bus route, or a poverty rate on its own, and neither was built to. That is exactly why the public needs the full picture: the gap is made of conditions, and conditions have owners.

But a gap that is measured in private gets managed in private. When the families most affected cannot see the numbers, they cannot ask whether the six-month payment window is enough, whether the review team’s recommendations are reaching Pontiac’s hospitals, or whether the mothers in their own neighborhoods are dying at the rate the county figures suggest.

None of that requires cutting a single program. It requires the system around them to stop absorbing their gains.

I will be following the records behind this, starting with what the county’s review team has found and who decided not to publish it. Pontiac’s babies are getting attention. Pontiac’s families deserve to see the scoreboard.