NRPLUS MEMBER ARTICLE A s Americans discuss black livelihood in the context of recent high-profile black deaths at the hands of police officers, a merciless villain is quietly snatching away thousands of black lives each year: infant mortality.
To be sure, medicine has gone a long way toward keeping black babies alive. In 1850, the black infant-mortality rate was 340 per 1,000 (compared with 217 per 1,000 for whites). Still, despite progress, last year over 7,000 black babies died in the United States before reaching one year of age — one baby for every 87 born. Troublingly, the infant-mortality rate is far higher for blacks than for other races: The CDC reports that non-Hispanic black babies die at a rate of 11.4 per 1,000, while for Hispanic and white babies the figure is 5 per 1,000. For Asian babies, it’s 3.6 per 1,000.
Why the discrepancy? In a comprehensive study, the CDC finds that there are five conditions in particular causing high mortality rates for black babies: low birthweight, congenital malformations, maternal complications, unintentional injuries (e.g., accidental suffocation or strangulation in bed), and sudden infant-death syndrome (SIDS). Of these, the two conditions that cause black infants to die at the highest rate relative to non-black infants are low birthweight (which causes four times more black infant deaths per capita than white infant deaths) and maternal complications (a 3.5 factor by the same measure). Both of those conditions happen to be among the top three leading causes of black-infant mortality, which helps to explain why the infant-mortality gap between blacks and other races is so dramatic.
Breaking down the data further, we see that there are two main issues at play: First, conditions deadly to infants are simply more prevalent among black babies and their mothers than among babies and mothers of other races. Of black infants, 13.3 percent are of low birthweight, but just 7.1 percent of white infants are. Moreover, black infants are at three times greater risk of accidental death than are white babies, and at more than four times the risk of developing SIDS. Black mothers, too, are more likely to have adverse conditions: They are three times more likely than white mothers to have uterine tumors that induce postpartum hemorrhaging and slightly more likely to have preeclampsia (the sudden rise of blood pressure). And on average, as the American Journal of Public Health reports, black mothers are 30 percent more susceptible to physical “weathering,” the premature aging of one’s body due to social stresses. Indeed, these discrepancies help explain why black mothers themselves are at more than twice the risk of dying during pregnancy than white mothers, though it should be noted that the maternal-mortality rate is roughly 30 times lower than the infant-mortality rate.
Second, even when the mortality rate is adjusted for the prevalence of given conditions among black and white people, black babies still fare worse than other babies. Here is how this adjustment is made: If one group has a condition twice as often as another group, and dies from the condition ten times as often, the prevalence-adjusted mortality rate is 5:1. The prevalence-adjusted black–white infant mortality ratio is 2:1 for low birthweight and 3:2 for congenital malformations. These discrepancies, of course, are partly attributable to the compounding effect of having several adverse conditions at once. (For example, having a low birthweight tends to be more dangerous for black babies than for white babies, given that black babies are more likely to be experiencing other harmful conditions on top of the low birthweight.)
Some might reflexively claim that the infant-mortality issue is easily amendable; after all, deaths by accidental strangulation and suffocation have been linked to uninformed parental practices, which can be corrected through education. Still, accidental deaths such as these account for just 4.5 percent of the black-infant deaths. It is also deeply misguided to write off most black-infant deaths as attributable to unlucky genetics: Study after study has demonstrated that most pregnancy-related deaths are preventable.
Rather, deep structural issues seem to be at play. The CDC observes that 10.2 percent of black mothers receive late prenatal care or none at all — 2.3 times higher than the rate for white mothers. In addition, 33.4 percent of black mothers receive no first-trimester care, as opposed to 17.6 percent of white mothers. Given that prenatal care is essential to diagnosing and treating dangerous conditions, as well as to establishing important doctor–patient relationships, this gap is alarming. And even when black mothers receive sufficient medical care, they tend to report being discriminated against or neglected by medical professionals in a way white mothers don’t.
Joedrecka Brown Speights has studied the black–white infant-mortality gap extensively over the decades. She and colleagues highlight many key determinants of the gap, including “socioeconomic status, maternal behaviors, access to health care, nutrition, social capital.” Certainly, lowering black-infant mortality must be tied into broadly improving the health and wealth of black communities, the achievements of which are themselves massive undertakings. But the reports of discrimination and bias tell us that there is an intangible element at play as well, a certain inability of the medical field to connect with black patients and understand their specific problems. This disharmony makes sense: Black people are 13 percent of the population but just 5 percent of doctors, though they are much better represented in nursing.
To solve the problem of poor prenatal care for black women, the Center for American Progress (CAP) suggests several measures — for example, “offer African American women tools to navigate the health care system.” Also, “train providers to address racism and build a more diverse health care workforce.” Finally, “dismantle care barriers with a comprehensive approach.” Striving toward a more diverse health-care system does not mean abandoning merit; it is precisely through facilitating connections with black mothers and saving black babies that diversity could here prove meritocratic. Moreover, expanding access to care for pregnant black women does not mean abandoning fiscal responsibility; even just managing preterm births presents a $26 billion annual burden on the economy, and investing in proper care could ease much of the problem. Neither do CAP’s strategies necessarily need to come out of a government budget: Bill and Melinda Gates have donated $100 million toward addressing adverse birth outcomes. Through increased media coverage and heightened societal awareness, other charitable givers as well could also be encouraged to focus their efforts on infant mortality.
The issue of infant mortality directly affects many thousands of people each year in the most devastating way possible. Lowering the infant-mortality rate for blacks even to the level of other racial groups would be a tremendous victory for equity, and it would save the lives of roughly 4,000 babies annually. It is toward this goal, among others, that the truest advocates for black lives in health, public policy, and philanthropy are sure to gravitate in the coming years.