Thursday, January 6, 2011

Race and Birth Weight Redux


A few months ago I posted an interesting excerpt on Racism and Birth Weight and I here I am going to bring up the topic again.

Jill of the Unnecesarean created a wonderful slide show full of graphs and charts on Racial and Ethnic Disparities in Infant Mortality and all the possible causes. I will be referring you to her slides throughout this post, where you can see a visual representation of the disparity in numbers.


African American infants are more than two times more likely to die during the first year of life than white infants (See Slide 1).

Preterm deliveries and low birth weight are the second leading cause of infant mortality in the United States. Low birth weight is defined as less than 2500 grams, and very low birth weight is defined as less tan 1500 grams. Among African Americans, it is the first leading cause. In fact, African American women are two to three times more likely than white women to deliver preterm, and their babies are three times as likely as white babies to die from prematurity/low birth weight. (See Slide 2)

For the past twenty years, workers and experts in the birth world have been fighting to bring these numbers down. There has been some success, with the overall number of preterm births reduced. However, this gain has been coupled with a widening black-white gap in infant mortality, with whites exhibiting a decline in preterm births at a much greater rate than blacks (CDC).

Why?

Is is genetics?

No. Birth weight distribution of African-born blacks is more closely related to US-born whites than to US-born blacks (See Slide 4)


Is it lack of prenatal care?

No. African American women are just as likely or more likely to receive prenatal care and yet still have higher rates of infant deaths than White Americans, including whites who receive little to no prenatal care (See Slide 6)


Is it a class issue? What about education level or socio-economic status?

No. See Slide 8


Many epidemiological studies have attempted to explain the difference in terms of factors such as maternal age, education, lifestyle, and socio-economic position. However, the results of these studies show that, at best, these factors can account for only a tiny portion of the difference. Studies show that college-educated black mothers are more likely to deliver low birth weight infants than white college-educated mothers.

Also, women who recently migrated to the United States are more likely to have infants of a higher birth weight than women in the same race/ethnic category born and raised in the United States, despite the majority of the migrant women falling into a lower socioeconomic class. These studies suggest “that growing up as a woman of color in the U.S. is somehow toxic to pregnancy, and imply a social etiology for racial/ethnic disparities in prematurity that is not solely explained by economics or education" (Rich-Edwards).

Its not even about maternal smoking during pregnancy.

African American non-smokers still had higher rates of infant deaths than White American smokers (See Slide 10).


Studies have shown that the common factor among African American women having preterm births and low birth weight babies may be a common, negative experience. Among all socioeconomic levels, African American women who reported experiences of racial discrimination at least three or more times proved to be at more than three times the risk for preterm delivery than women who have never experience racial discrimination (Lock).

Factors that might contribute to the disparity include racial differences in maternal medical conditions, stress, lack of social support, previous preterm delivery, and maternal health experiences that might be unique to black women (Hogan).

It would be beneficial to use a life course perspective to understand the effects of race and racism on birth outcomes. This would mean taking into account a person's biology, economics, psychology, sociology, history, etc (the sum total of a person's experience) in addition to that of their parents and grandparents.


Please enjoy these fascinating videos to help further understand what is going on between race and birth outcomes:

When the Bough Breaks: Kim Anderson's Story


When Atlanta lawyer Kim Anderson was pregnant with her first child, she did everything right: she ate a healthy diet, exercised, and got the best prenatal care. But her baby was born almost three months premature. How could this have happened? Some researchers believe that racism may play a role in unusually high rates of premature birth in the African-American community.

Excerpt from Episode 2 of "UNNATURAL CAUSES: Is Inequality Making Us Sick?", a ground-breaking documentary series that looks at how the social, economic and physical environments in which we are born, live, and work profoundly affect our longevity and health. The series broadcast nationally on PBS in spring 2008


How Racism Impacts Pregnancy Outcomes


UCLA obstetrician and gynecologist Dr. Michael Lu believes that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions that impact women's health not just when they become pregnant but from childhood, adolescence and into adulthood.

This video is a Web-exclusive supplement to "When the Bough Breaks," Episode 2 of "UNNATURAL CAUSES: Is Inequality Making Us Sick?"




References: 
The Unnecesarean - "Racism and Low Birth Weight 101" http://www.theunnecesarean.com/blog/2010/9/28/racism-and-low-birth-weight-101.html
 
Center for Disease Control 2002. "Infant Mortality and Low Birth Weight Among Black and White Infants - United States, 1980—2000” in Morbidity and Mortality Weekly Report 51(27):589-592

Rich-Edwards, J; Nancy Krieger, J Majzoub, Sally Zierler, E Lieberman, M Gillman 2001. "Maternal experiences of racism and violence as predictors of preterm birth: rationale and study design” In: Paediatric and Perinatal Epidemiology. Vol 15:124-135

Lock, M and V. Nguyen 2010. Biomedical technologies in practice. In: An Anthropology of Biomedicine. Pp. 17-31

Hogan VK, Richardson JL, Ferre CD, Durant T, Boisseau M. 2000. A public health framework for addressing black and white disparities in preterm delivery. Journal of American Medicine Women’s Association, Vol. 56:177-80

3 comments:

  1. This is a great post on a very important topic. I completely agree that a life course perspective is essential. Another consideration might be Chris Kuzawa's 'phenotypic inertia' idea, where birth outcomes from past generations carry over into future ones through the maternal line, perhaps through some epigenetic mechanism. Maybe multiple life courses are relevant.

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  2. Thank you! I agree that past generations can carry over into future ones, which is why I think its important to study parents and grandparents life experiences/genetics as well.

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  3. The documentary When the Bough Breaks, in which Dr. Lu is quoted/interviewed, is interesting. While it examines the issue of racism with regard to LBW births, it does not examine alternative stressors that may also cause LBW birth. In one segment the documentary also admitted that it is very difficult to measure racism.
    In addition the documentary does not examine possible medical-related causes of LBW births possibly including the tendencies of African American women to have high levels of hypertension and diabetes. Nor does it address the effect of poor lifestyle habits like smoking on LBW birth risk.
    The following dissertation concludes that lack of seeking prenatal care is strongly related to LBW births: "It was found that inadequate prenatal care was the predictor of low birthweight." Environmental stressors, prenatal care, and low birth weight effects on Black infants.
    Dissertation Author: Pamela J Hardy, 2011, 145 pages. Retrieved June 13.2013 http://udini.proquest.com/view/environmental-stressors-prenatal-pqid:2506516501/

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