African-American infants are more than twice as likely as white infants to die before their first birthday, and the racial gap has gotten wider over time.
That startling statistic has prompted efforts to address race-based disparities in infant mortality, including in Florida, where the rates for black infants’ deaths rose between 2000 and 2004, defying a national decline. The Black Infant Health Practice Initiative, funded by the state, has formed a “community action team” in Miami-Dade County, which held a town hall meeting July 16th in Fort Lauderdale to educate the community on the issue.
The forum brought together experts from the Miami-Dade County Health Department, the Healthy Start Coalition of Miami-Dade, Full Circle Health Care, the Jessie Trice Community Health Center and prominent local physicians including Dr. James Bridges, a retired Miami physician and Dr. Nelson L. Adams, president of the National Medical Association.
Infant mortality is defined as the death of an infant in its first year of life. In Florida, over the twenty year period ending in 2006, while the overall mortality rate for black infants decreased from 18.7 per 1,000 live births to 12.9 per 1,000, the ratio of black infant deaths to white, non-Hispanic infant deaths grew, from 2.1 in 1986 to 2.3 twenty years later.
The disparity came as the mortality rate for babies born to white mothers fell faster, from 8.7 per 1,000 in 1986 to 5.6 per 1,000 in 2006. In Miami, black infants had a mortality rate of 11.5 per 1,000 live births, while white and Hispanic infants had a mortality rate of 4.7, lower than the national average of 6.9 per 1,000 live births.
HIGH RATES OF PREMATURE BLACK BIRTHS
In fact, according to statistics published by the Florida Department of Health, the black-white disparity in infant mortality rates has grown over time, from 1.9 in 1970 to 2.3 in 2006. And according to experts, the racial disparity is driven mostly by the significantly higher rates of premature births among black women, which accounts for 80 percent of the disparity. The other 20 percent is driven by a higher death rate for babies born at a normal weight.
“This isn’t new,” Dr. Diane Rowley, MD MPH, a professor of maternal and child health at the University of North Carolina School of Public Health, and the keynote speaker at the Fort Lauderdale event, said of the infant mortality gap.
“It’s been that way for 100 years and we haven’t been able to change it. It’s really an enigma. People have been working on it actively since the early 80s and what we know is that black babies are much more likely to be born at lighter weights and they’re much more likely to be born early – very preterm – and because they’re premature and they don’t have a normal birth weight – that leads to an elevated infant mortality rate.”
Rowley’s presentation cited a number of factors that could contribute to the problem, including inequities in access to a quality education, good jobs, decent and affordable housing, safe neighborhoods and environments, nutritious foods, and adequate healthcare.
Erin O’Connell, an epidemiologist with the Miami-Dade County Health Department, said a special federal Pregnancy Risk Assessment Monitoring System (or PRAMS) was recently conducted for Miami-Dade County. “They ask women 144 questions about their maternal health behavior,” said McConnell.
The study found that disproportionate numbers of black women respondents reported moving or losing their jobs during pregnancy, were separated from their partner, were incarcerated, or even suffered homelessness. Higher numbers also did not receive proper prenatal care.
According to the National Center for Health Statistics’ 2006 preliminary national report, 12.8 percent of all live births in that year were pre-term. For black women, the figure was 18.4 percent, and for white women it was 11.7 percent. For very preterm births (where the infant is born prior to its mother reaching 8 months gestation) – black infants had a 4.1 percent rate, while for white infants it was 1.6 percent. “This is where most of the deaths among infants occurred,” said Rowley. “This is what accounts for the disparity.”
Adams, an obstetrician-gynecologist who practices in Miami, said the racial disparities in preterm births and infant mortality rates defy class and income. “If you’re a black woman with a PhD, you’re more likely to have a preterm birth than a white woman with a GED,” he said. “Clearly there are other factors at work.” Adams said the same goes for low birth weight infants, also more prevalent among black mothers.
RACISM-RELATED STRESS CITED AS CULPRIT
Studies compiled by the Joint Center for Political and Economic Studies’ Health Policy Institute suggest that racism is one of those factors. Gina Wood, deputy director of the Joint Center’s Health
Policy Institute, said the key issue is stress. She cited a study by Dr. Fleda Mask Jackson at Emory University, which found that significant numbers of black women of all education and income levels reported feeling stress due to perceptions of racial or gender inequality, including anxieties about the role racism could play in the lives of their children.
“Some of the things that Dr. Jackson’s study talked about were the link between gender and racism and anger and anxiety, which are causal factors for diabetes, hypertension and obesity, all of which increase the risk of low birth weight or premature births,” said Wood.
Racism-related stress “might change a woman’s hormonal balance during pregnancy, because some of the same hormones that are active during pregnancy are part of the body’s response to stress,” said Rowley, adding that such stress can also elevate blood pressure, and even increase the chances of infection.
COMMUNITY CAN HELP
Rowley stressed that the community can do much to assist mothers before their children are born, by finding ways to reduce their stress and improve their environment.
“Suppose you are a working mother,” said Rowley. “You’re pregnant, you work all day and come home. You have to do the cooking, you’re already tired, may have had a bad day at work, and so the whole thing kind of snowballs. You may not feel like cooking what would be a good meal. Just to have somebody come over and cook for you would be something.”
Rowley said that neighbors and churches should take an active role with women who are pregnant, particularly in the black community, where nearly 7 in 10 children are born to a single mother. She also stressed the importance of the environment that many black pregnant women face.
“[There are] too many women who don’t have health insurance, who can’t get into care early. There’s still too much environmental exposure in terms of pollutants, not having good grocery stores in the neighborhood, anything that you would define as the environment, there are still too many negatives in our communities.”
Rowley said Florida has already taken positive steps. “Florida has a statewide Healthy Start Coalition, which a lot of states don’t have,” she said. “So overall, you’re ahead of the game. And you have political leaders involved at the local level. We need the community to get involved.”