In the United States, data have shown that Black women experience higher rates of birth and pregnancy complications including infant mortality compared with other ethnicities. According to the U.S. Centers for Disease Control and Prevention, the risk of preterm birth for non-Hispanic Black women is approximately 1.5 times the rate seen in white women.
The CDC released “Trends in Infant Mortality in the United States, 2005-2014,” which shows that babies born to Black women still have infant mortality approximately twice that of non-Hispanic, white women.
“The rates have been double for some time now and it’s perplexing,” stated Dr. Judy Lubin, director of Allies for Reaching Community Health Equity. “The underlying cause of infant mortality is pointing to a number of different factors. Certainly poverty plays a part in it, but racism and psycho-social stress are all part of the reason we continue to see the high numbers among Black women.”
Lubin continued, “It’s not just social economic status because when you look at the data, it shows a stat that high income or middle-class Black women also have high rates of infant mortality. It shows us that there is something else happening in the social context that is contributing to these high rates among Black women. That makes us ask the question: What is it about the social context in which Black women live and exist daily that contribute to higher infant mortality rates? And so certainly one of the keys areas is psycho-social stress.”
Infant mortality is the number of deaths of infants under 1 year old per 1,000 live births. This rate is often used as an indicator of the level of health in a country.
According to the CDC, preterm, or premature, delivery is the most frequent cause of infant mortality, accounting for more than one-third of all infant deaths during the first year of life. Black women have the highest infant mortality at 11 per 1,000 births, compared with white and Hispanic women. Research has shown that high level of stress is a factor in the high infant mortality.
“When researchers have looked into this, you see stress among low income Black women as well as high income and highly educated Black women,” stated Lubin. “The sources of stress might be different, for example for a low-income woman, it may be poverty related stress and insecurities such as not being secure in your housing, the ability to provide for your family, your neighborhood, neighborhood conditions and resources available.”
Lubin added, “We know that there is a higher level of infant mortality when pregnant Black women live in neighborhoods that have higher levels of segregation or social isolation, and because of that you’re going to see higher levels of poor birth outcomes. If you compare white women that are living in predominantly white neighborhoods, then segregation doesn’t have an effect on their birth outcomes. So segregation and what that means for Black communities is something very specific and can easily lead to economic depressed neighborhoods, high crimes neighborhood and neighborhoods that don’t have jobs. These also contribute to the level of stress.”
According to the March of Dimes website, maternal stress has been associated with poor birth outcomes, including preterm birth, infant mortality and low birthweight. Increased maternal psychosocial stress is associated with vascular disorders, such as high blood pressure and preeclampsia, which are major medical reasons for preterm delivery. These conditions are most common for women who are African-American, older or in first-time pregnancies.
“When we are thinking about median or high-income Black women, some of the sources of stress might include having to work harder to survive,” said Lubin. “We know that higher income or higher educated African-Americans are more likely to experience racial discrimination in the workplace. So racism is playing a factor in this at different levels.
“We can’t say it’s because of poverty or lack of health care just simply because we know that. But when we look at the numbers for higher educated or higher income Black women we are still seeing alarming levels of infant mortality. High levels of stress begin to weigh on your body. Some researchers argue that it’s that wearing of the body that then triggers pre-term labor and other pregnancy problems.”
As stated on cdc.gov, the CDC provides support to state Perinatal Quality Collaborative initiatives in California, New York, Illinois, Massachusetts, North Carolina and Ohio. State PQCs are networks of perinatal care providers and public health professionals working together to implement best practices to improve pregnancy outcomes for women and newborns.
This support includes real-time reporting of perinatal clinical quality measures that help doctors and other health care providers prevent prematurity and improve outcomes for infants born too early and too small.
ARCHE is a program of the Center for Global Policy Solution in Washington D.C. ARCHE is focused on raising awareness about what is called the social determinants of health.
“We expand the way we think about health, particularly the underlying causes of health disparities within the communities of color, under-served and low-income communities,’ stated Lubin. “Those social determinants of health are education, income, poverty, racism and transportation. We know each of these are tied to or affect health outcomes in disadvantaged communities, so we work on building equity across those different determinants, so everyone has a fear chance to be healthy.
“We offer training to public health practitioners, to community organizers and leaders and policy makers to make them understand what are the underlying cause of differences in health by race, ethnicity, gender, geography and income.”
Even though there are no definite ways to prevent many of the leading causes of infant mortality, there are many ways to reduce the baby’s risk.
“One of the things Black women have to do is consider their preconception,” said Lubin. “If you’re planning or thinking about wanting to have a baby, make sure you are taking care of your health and maintaining a healthy weight. Make healthy choices in terms of nutrition, exercising regularly, getting 400 micrograms folic acid, watching alcohol intake and the levels of stress.
“As a nation we can make sure that everyone has access to quality affordable health care. That’s going to help to ensure that the pregnant women have the access and care they need to deliver healthy babies. We also need to look at neighborhood conditions and the resources in economically depressed communities. The availability of health care services, transportation, fresh food outlets, sidewalks, parks and recreation facilities are vital, so that residents living there can exercise and enjoy a good quality of life. Certainly the ongoing struggle to address is racism in our society and where is appears within institutions, systems, education, health care, policing and employment. We have to eliminate racism or racial discrimination in all of these sectors and systems so that everyone has a fair chance to be healthy and succeed.”