Although medical advances in the past century have reduced infant mortality around the globe, the U.S. rate is still high compared to other developed countries. But the situation is even worse for black infants.
A new report from Duke’s Samuel DuBois Cook Center on Social Equity along with the Insight Center for Community Economic Development found that the white IMR in the U.S. in 2013 was five per 1,000 births, whereas the black IMR was 11.2 per 1,000. The report also examined the social factors that lead to racial disparities in infant mortality rates.
“One of the key goals of the report was to break some of the myths that are out there about black women and infant mortality, that this was an issue of drug use or obesity or age,” said Keisha Bentley-Edwards, director of the Health Equity Working Group for the Cook Center and co-author of the report. “The key issue is that what we look at as protective factors in the general population don't protect black women in the same way, and the risk factors are riskier.”
Although the white IMR in the U.S. resembles that of developed nations such as New Zealand, the black IMR is more similar to countries with fewer resources, such as Thailand, Romania and Grenada.
The report found that the black-white disparity exists regardless of the mother’s education level, but the gap is even greater for those with a master’s degree or higher. And it’s highest for black mothers with a doctorate or professional degree.
“Of course, white women would face gender-based discrimination, but black women face both gender-based discrimination and racism,” said Imari Smith, graduate research assistant at the Cook Center who worked on the report.
She added that people that are in more discriminatory environments have higher levels of stress and prolonged stress, which may contribute to the infant mortality gap.
Bentley-Edwards explained that stress is bad for the body in general, but particularly during pregnancy.
“Research has shown that you can see experience of discrimination having an impact on health,” she said.
In addition, the facilities and resources available in primarily black communities are often under-resourced, and studies have shown that the quality of care at predominantly black hospitals is not as good as it is at hospitals serving white communities.
To eliminate the disparity in mortality rates, the authors suggested implementing programs that focus on healthy maternal and child outcomes for black women, since they are more likely to experience racism and discrimination. These factors must be addressed to decrease the black IMR, which has been about twice that of the white IMR for more than 35 years, Smith noted.
“This needs to be a priority—it’s been going on for too long,” she said.
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Although some believe that the black-white gap occurs because of differences in risky behaviors, the authors noted that future research should examine systemic barriers to positive birth outcomes for black women.
Behaviors such as drinking alcohol, using drugs and smoking cigarettes can lead to increased infant mortality, but the authors asserted that the black-white gap in IMR cannot be explained by these factors alone.
Smith noted that she also hopes future studies delve into why certain protective factors aren’t actually that protective for black women.
“We need to find out how these factors actually interact with each other so that we can operationalize that into an equitable solution,” she said. “Marginalized groups have limited access to the same protective factors and resources that non-marginalized groups do.”
Bentley-Edwards added that there needs to be more research comparing different groups of black women, instead of focusing solely on the difference between white and black women.
She also issued a call to fight racism and discrimination in everyday life.
“When you see discrimination occurring, be an advocate or speak up and be supportive of the black women in your life,” she said. “Don't add to someone’s stress by denying racism exists.”