Racism and Low Birth Weight 101
Tuesday, September 28, 2010 at 10:12AM
By Jill—Unnecesarean
September is National Infant Mortality Awareness Month. As the month comes to a close, we will feature a few interviews on the topic with a commitment to not isolating such an important issue to merely one calendar month.
In recent years, both traditional journalism and social media have illuminated the United States’ shockingly low infant mortality rank. The United States Department of Health and Human Services published these facts last month.
United States ranked 28th in the world in infant mortality, in 2006.
In the United States in 2006, 28,509 infants died before reaching their first birthday, an infant mortality rate of 6.7 per 1,000 live births.
African American infants are more than two times more likely to die during the first year of life than white infants.
Infant mortality rate by race per thousand live birth
o Asian – 4.3
o Blacks – 13.1
o Native American – 8.3
o White – 5.7
o Total – 6.7The United States infant mortality rate was more than 3 times as high as the infant mortality rate in Hong Kong (1.8 per 1,000 live births), the country with the lowest reported rate in 2006.
It is almost incomprehensible that African American babies are dying at this rate. How is that even possible in this day and age, we all ask.
For decades, OB-GYNs, midwives, epidemiologists and other health experts have focused on the prenatal period to improve the health of pregnant women and babies. While this remains a crucial window for education and personal responsibility, it has proven to be just one piece of the puzzle.
I’ve assembled a slide show of sorts for you to click through at your own pace that will, I hope, inspire you to start doing your own reading and research on the topic. Please consider this an oversimplified Racism and Low Birth Weight 101.
Reader Comments (59)
This data is sobering and infuriating no many how many times I look at it. But you've also made it accessible (while at the same time giving people a place to deepen their understanding), and that, my friend, is quite the feat.
Hot. Damn.
You rock, Jill.
I really think it is definitely reaching to claim that babies of one race die at a faster rate than babies of another rate, solely because the women were at some point exposed to racism. I am not buying it. It really comes off as flashing the race card. You have a lot great on your site. This is the first time I have seen something so far off and out there. I hope you consider removing it. You never even listed reasons for these babies to die. Did they die in that first year due to child abuse? Improper care? Murder? Domestic abuse? Malnutrition? In all my years of working with women whose children died, and from my own experience of my own dying, I have never ever seen race as an issue. People of certain races may have higher incidents of abuse or crime, which may contribute to the deaths, but simple racism does not explain away this. If you factor in things such as car seat use, formula vs breastfeeding, age of parent, baby sleeping on front or back, alcohol or drug use in the home, families (single parents vs married, dad or grandparents in the picture), education of the parents, etc etc etc, then you will find a better explanation behind the infant deaths. It is not just as simple as the race card.
Thank you so much for such a wonderful slide show. It addresses all of the popularly professed confounders that racism apologists wish were the real culprits. I got into it with some commenters on Alas, A Blog explained and linked to here a year ago when they tried to trot out the "it's class!" "it's SES!" excuses. It's too bad that people struggle so hard to deny the real, documentable effects of racism.
Lisa, it sounds like you need to do some reading! Check out the links and read those studies and articles so you can see what they controlled for.
"In all my years of working with women whose children died, and from my own experience of my own dying, I have never ever seen race as an issue."
I think that says it all. You just don't see it. Or you don't want to.
@Lisa, did you see the slide show and read the research it refers to? It actually answers what you say pretty clearly. Did you see the study where they adjusted for forty factors, including education level, etc, and there was still a huge disparity? We are not talking about your own opinion or your own anecdotal experience. There is a significant amount of good research on racial disparity in health outcomes, and it is really sad to see people denying it exists.
And, really? Race card? That is such an offensive term.
Lisa, you should really delve into the study itself, and the Alas A Blog discussion MomTFH linked.
Obviously, time will tell if the results can be reproduced, or if the stats will change.
But try to address the study on its merits, not on your own experience--if you read you will see they controlled for issues like malnutrition, class, and income.
This is not about how *you* treat people of other races, but the experiences of those people themselves, over a lifetime.
I think we're seeing comments like this because we tend to believe most people are like us. Therefore, if we aren't racist, most people probably aren't racist. That's the logic I see here. I don't know that these death rates are necessarily due to racism. I think we need to hear more before we come to that conclusion, though unfortunately it isn't one we can entirely throw out. It's fascinating that so many controls were done, and we still don't understand why this is happening. I truly hope that it turns out to be something a little more controllable than the nebulous "racism."
Most fascinating talk I ever attended at a conference was a research doctor presenting slide after slide after slide illustrating this issue. Like Lisa, I sat there thinking "Yeah, but what about....?" and the next slide would counter that. I found it particularly compelling that the effect only applies to babies of women who were themselves gestated in the USA. Women gestated and born in Africa who moved to the US at an early age did not have such a profound increase in risk of poor outcome. I also found it compelling that even affluent African American professors had a higher risk of poor outcome than their white colleagues.
At the time, the only remaining rational explanation was racism.
Since then, I have come up with one more "Yeah, but what about...?" that I don't recall being addressed at the conference, and I'm too lazy to go dig through the links to answer myself....what about Vitamin D? People with dark skins living a US lifestyle are more susceptible to vitamin D deficiency. There seems to be growing evidence that vitamin D levels can influence pregnancy outcomes. Could being gestated in a vitamin-D poor uterus produce lifelong impacts on that baby?
Well, Liz, as far as know, about 70% of the US population is vitamin D deficient, not just African Americans. So, why is it an issue in particular for African Americans? And why doesn't it apply to African born blacks in cities who live a modern lifestyle?
I would also ask why people, not Lisa in particular but in general, are so eager to find another explanation? Racism is very well documented in some of these studies and in studies on other negative health outcomes. It is a understandable stressor. It is prevalent in our society. I think that the concerted efforts to apologize for or deny the effects of racism by searching around for more palatable explanations are partially responsible for entrenching it further.
@Liz Chalmers and others - health disparities along these lines occur in more areas than just maternal and child health. I've read some articles that I believe addressed cardiovascular health and blood pressure where they were able to correlate experienced racism with worse health. I'm at work now, but will check my facts when I get home and report back in!
How is it nebulous? Look at slides 16 and 17. Read the Collins study, please. Here's an excerpt:
Our study adds to the small but growing evidence of a relation between African American women’s exposure to interpersonal racial discrimination and pregnancy outcomes. We found that African American mothers who delivered VLBW preterm infants were more likely to report experiencing interpersonal racial discrimination during their lifetime than African American mothers who delivered NLBW infants at term. Stratified analyses showed that this association persisted across the common risk categories for reproductive health. In multivariate logistic regression models, the adjusted odds ratio of VLBW for African American mothers who experienced interpersonal racial discrimination in 1 or more and 3 or more (compared with none) domains equaled 1.7 and 2.6, respectively. Interestingly, among African American women who worked outside the home, those who gave birth to VLBW infants were more likely to report racial discrimination in the workplace than were the working mothers of NLBW infants. These findings provide evidence that greater lifetime exposure to racial discrimination among African American women contributes to the racial disparity in VLBW infants.
The conventional investigative approach to the racial disparity in the rates of VLBW births has been based on the implicit assumption that there is a set of risk factors that differ in quantity between the races but exert similar effects on African American and White women. An extensive literature has shown that established risk factors have minimal impact on the rate of VLBW for African Americans.6,7 Moreover, this conceptualization does not take into account the nonrandom, pervasive, and multifaceted inequality that is bound up in the historical context of race, nor does it capture its effect on human beings over time.18,31,32 Because African American women are regularly exposed to unique societal risk factors closely related to race,18,31–33 restricting the search for such factors to a sample of African American women seems reasonable. We used an interviewer-administered closed-ended questionnaire to capture the variability of lifetime exposure to incidents perceived as racial discrimination and describe its association with infant birth-weight. The frequency of lifetime reported incidents of interpersonal racial discrimination in at least 1 domain was 40% among our control subjects. If we take this frequency as an accurate estimate for the general population of urban African American women, then exposure to perceived racial discrimination is a common risk factor. This estimate is consistent with published prevalence rates.34
I'm not able to open the slide show so I'm gathering this from the comments. I am a mom who was pregnant with a visible disability. If you want to talk about interpersonal stress, it would seem women with disabilities would have to deal with that at least as much as black women,
I am not sure why it's such a controversial thing to explore racism in this manner. I also don't understand why people feel the need to compare, i.e. people with disabilities have it hard too, yada, yada, yada. Science asks a question and seeks answers yet people feel attacked or defensive without even reading the studies and articles. As a black women I find this very tiring, especially since so many of the naysayers can never really understand what it is like to experience this.
It's not so much a comparison thing, as it is, if racism causes these problems, then wouldn't other isms? I'd be interested in how this plays out along socioeconomic lines too
I will speak for myself that I didn't feel attacked until you came on the thread and said yada yada yada in reference to my pain
I don't see it as controversial to explore racism in this manner. That's why I asked a scientific question...if I felt it was controversial, I wouldn't say anything at all. (OK, that's not true, but I'd certainly hesitate!)
I'm completely willing to accept that this is a racism issue, but not without exploring other possibilities in parallel. I do this with ALL topics, not just race-related ones. In this specific case, wouldn't it be a TRAGEDY if poor outcomes continued when simple vitamin D supplementation was the answer? I'm just wondering if there is an answer simpler than 'fix racism'...probably not, but why not explore it?
Vitamin D deficiency is (I've read) higher in those with dark skins because darker skin doesn't convert sunlight to vitamin D as efficiently. (Hence increasing rates of rickets.) Makes sense...those in African climates would generally be exposed to plenty of sun so the skin doesn't need to convert as efficiently. If you live in far north of Norway, it's important that the skin can convert as efficiently as possible.
Rates of vitamin D deficiency for blacks and whites:
"The unadjusted mean maternal serum 25(OH)D concentrations at 4–21 wk gestation and at term were significantly higher among white women than black women.... At 4–21 wk gestation, the vast majority of black women were either vitamin D deficient or insufficient. This is in sharp contrast to white women, almost none of whom were vitamin D deficient at 4–21 wk gestation. "
http://jn.nutrition.org/cgi/content/full/137/2/447
Here's an example of a study on vitamin D, heart disease, and the differences between races:
http://www.urmc.rochester.edu/news/story/index.cfm?id=2731
Not proof, of course...could definitely also be racism
I'm going to say some things out of genuine confusion, seeking a genuine honest answer, so please don't attack me if I say something "off" - I totally claim ignorance of this matter and want to be set straight. I've been reading about racism a lot in the birth advocacy world as well as the fat acceptance world and I'm left a little confused about something and my confusion might explain why some people don't accept racism as a reason. From what I have gathered, in an extremely simplified way, is that regardless of how one thinks or feels, as long as one is not black, then one is racist. Period. And this sort of thing being said by white folks, almost stating it proudly like a badge of honor for admitting "I'm white and that makes me racist". Mainly this all being directed towards those who benefit from "white privelege" and by having that it is therefore impossible to not be racist. Those who do not even have the factor of race register in their mind, those who really don't see a person's skin color when they look at another, are still racist simply because they are physically incapable of ever understanding life as a person of color. In one way I understand, but at the same time I don't because...well there's no point then, in even attacking racism. Why do anything about racism if it is a battle that will never, ever end? I think this might be why people call "race card" and don't believe something like racism can cause babies to die - it's something that can never be fixed if it will exist even if it technically doesn't. The only solution would be to live in a world of one color skin and since that's just not plausible, perhaps people grasp for other answers; it's not that they don't believe it exists, but rather they don't believe it is something that can ever be fixed.
Holy crap, Lisa!
No, this isn't about racism, those black babies probably just die at higher rates "due to child abuse? Improper care? Murder? Domestic abuse? Malnutrition?" It couldn't possibly because the experience of racism has a physiological impact on black women. No, it's because black women probably abuse, improperly care for, murder, abuse again, and malnourish their children. Racism isn't even a factor. Right. Glad we got that sorted out.
Yetch! I was a little sleepy this afternoon, but this woke me right up..
Thanks for posting about this, Jill. And there's a blog carnival about racism and midwifery coming right up:
Carnival!
I don't want this to turn into a vitamin D discussion. I am a vitamin D fan. I just think it is a distractor from the real issue.
Also, you need to find some more direct causality and make sure that the studies are done on black women.
Like this one:
Vitamin D levels linked to small for gestational age babies in white women, but not in black women
Conclusions:
" After confounder adjustment, there was a U-shaped relation between serum 25(OH)D and risk of SGA among white mothers, with the lowest risk from 60 to 80 nmol/L. Compared with serum 25(OH)D 37.5–75 nmol/L, SGA odds ratios (95% CI) for levels <37.5 and >75 nmol/L were 7.5 (1.8, 31.9) and 2.1 (1.2, 3.8), respectively. There was no relation between 25(OH)D and SGA risk among black mothers. One SNP in the VDR gene among white women and 3 SNP in black women were significantly associated with SGA. Our results suggest that vitamin D has a complex relation with fetal growth that may vary by race."
Nothing wrong, in theory, with researching nutrition. Something wrong with trying to explain away the effects of racism as a nutritional deficiency (or abuse, or drug use, for that matter). On a blog post focusing on racism, a very real problem, what is wrong with acknowledging it is a real problem rather than trying to deny it?
Home and with references!! Sorry that I'm just slightly too lazy to type out these references in an actual citation style.
Before everyone's eyes glaze over, my point here is that racial disparities in MANY areas of health are correlated with experiences of racism or discrimination. @Liz Chalmers, vitamin D shortages surely can't explain all of these things away; @Kimbriel: while I agree that many marginalized communities experience discriminatory treatment that is likely to have ill health effects (Jill and others have spent time here on obesity, for example), the most severe effects are usually felt by Black communities. If you have references or information about disabled women, their health outcomes related to childbearing, and the health of their infants, I'd love to read it. Maybe a good topic for a Monday Open Thread sometime?
In all of these studies, the researchers were able to find correlations between experiences of racism/discrimination and poorer health outcomes:
"Perceived Racism in Relation to Weight Change in the Black Women's Health Study" (Ann Epidemiol 2009; 19:379-387 Cozier YC, Wise LA, Palmer JR, Rosenberg L)
"Racial Discrimination and Blood Pressure: The CARDIA Study of Young Black and White Adults" AJPH Oct 1996, 86; 10.
"Perceived Racial/Ethnic Discrimination Among Fifth-Grade Students and Its Association with Mental Health" (AJPH May 2009, Vol 99, No. 5)
"The Association Between Perceived Discrimination and Obesity in a Population -Based Multiracial and Multiethnic Adult Sample" (AJPJ Vol 99, No 7, (July 2009) Hunte HER and Williams DR) "Consistent with other studies, our analyses showed that perceived unfair treatment was associated with increased abdominal obesity. Compared with Irish, Jewish, Polish, and Italian Whites who did not experience perceived chronic discrimination, Irish, Jewish, Polish, and Italian Whites who perceived chronic discrimination were 2 to 6 times more likely to have a high-risk waist circumference." In this study, the same was not shown to be the case among Blacks and Hispanics; the authors give several reasons that might explain why they didn't see this effect in their data despite that others have.
"Skin Color, Ethnicity, and Blood Pressure I: Detroit Blacks" AJPH December 1978, Vol 68, No. 12. Harburg E, Gleibermann L, Roeper P, Schork MA, Schull WJ.
...Yes, we have known about this since 1978. Sad.
I should add, this selection is from a course reader - it is FAR from an exhaustive list, just what I had at hand and have personally read!