RACIAL DISPARITIES

IN BIRTH OUTCOMES
FOR AFRICAN
AMERICAN WOMEN
By: Kaitlyn Kelly
 Racial Disparity in Birth Outcomes for
African American Women
■ Widely recognized in Public Health + still big problem (10)
– Even after significant national public health efforts and multidisciplinary
interventions
■ Black women systematically at a disadvantage with access to and quality of prenatal
care and birth outcomes for mother and baby (10, 3)
– “avoidable, unnecessary, and unjust” – M. Whitehead
■ Black women 2.6x more likely to have low birth weight baby than white women (4)
■ Black women have significantly higher rates of 22-25 different specific and severe
morbidity indicators (6)
■ Infant mortality rate for Blacks: 13.5 per 1000 live births (white is 5.7 per 1000) (6)
■ In 2002, only 68% of Black women had early and adequate prenatal care compared
to 79% for whites (6)
■ Black infants on average are born 2 weeks earlier and 600g lower than whites (4)
■ Black infants 2.5x more likely to die in first year of life (4)
 Consequences of the Birth
Outcomes Disparity
Health Issues:
• Baby:
• Low birth weight (1)
• Small for gestational age (1) Developmental/Psychological:
• Preterm birth (1)
• Infant mortality (1)
• Increased risk for acute lung
diseases, chronic diseases,
sepsis, metabolic problems,
diabetes, CVD (5)
• Mom:
• Maternal mortality (6)
• Increased risk post-birth
hemorrhage (6)
• Delayed detection of
preeclampsia/eclampsia +
gestational diabetes (6)
• Increased risk of infection if
long hospital stay (6)
• Emotional difficulties (6)
• Baby:
• Developmental
disadvantages (6)
• Increased risk for
psychiatric illnesses later
in life (5)
• Low birth weight impacts
growth + development (5)
• Mom:
• Increased mental stress (6)
• Increased risk of
depressive feelings (1)
• Increased risk of anxiety (1)
http://1.bp.blogspot.com/-
qkautYQzc7Q/VE_2tVFLsOI/AAAAAAAAVy4/AOch6GYkL_M/s1600/bl
ack_premature_baby_girls.PNG
Financial Problems:
• Preterm birth more likely to
need hospitalization in
NICU (11)
• Expensive!
• Reason to skip or start
prenatal care late (2)
• Financial impact of lengthy
hospital stay if birth
complications (2)
 An Additional Factor…
■ Experts agree that one huge factor is associated with this
health disparity is…Racism (6)
■ Exposure to stressful events during pregnancy can
significantly increase risk of preterm and very premature
birth (6)
■ Weathering Hypothesis  long-term exposure to stress can
lead to early deterioration of health for Black women (6)
■ Experiences of racism/discrimination play a role in mom’s
engagement with health care system: (6)
– Many report communication issues or perceived
discrimination during birth at hospital
– Association of past experiences with racism and a group
setting may result in delayed star to prenatal care
– Fosters distrust of health care system as a whole
https://ionemadamenoire.files.wordpress.com/2017/12/pregnan
– Clinicians may not be culturally competent enough to t-woman-hospital.jpg?w=1024&h=576

provide comprehensive care and a trusted environment

 Population Background: (8)
Subgroups More
■ African American Women Are: at Risk for
■ 13% of female population of US Negative Birth
■ More likely to have hypertension, die from breast cancer, and Outcomes:
more likely to contract chlamydia/gonorrhea
■ 1 in 4 are uninsured • Lower SES
• Live in unsafe or
■ Have accidental pregnancies at 3x the rate of white women poorer
■ 4x more likely to die from pregnancy-related causes neighborhoods
• Less education
■ Expectant mothers are more likely to be younger, less educated, • Less social support
and have lower SES
• Experience major
■ 21.4% have college degree of higher in 2010 stressors regularly
• Are uninsured
■ Starting and running their own businesses at 6x national average
• Younger age
■ Higher rates of unemployment and lower usual weekly earning
that whites
■ Poverty rate is 28.6% (compared to 10.8% for white women)
Social Determinants of Health (6)
Individual:
Community: -not getting early prenatal
-geography care
-neighborhood -inadequate knowledge
-social network about health/pregnancy
-social stigma -predisposition to
-perceived racism gestational diseases
-limited access to health -substance abuse
care -predisposition to CVD
-poor insurance -having mental illness
coverage -intimate partner violence
-inadequate education -income
opportunities -personal insurance
-inadequate work -housing/transportation
opportunities -social support
-self-efficacy
“Why America’s Black Mothers and Babies Are
in a Life-or-Death Crisis”- New York Times Magazine (12)

“The answer to
disparity in
death rates has
everything to do
with the lived
experience of
being a Black
woman in
America.” –L. Villarosa
 “Report: Pattern of Racial Disparity in Low
Birthweight in U.S.”
– U.S. News and World Report (9)
■ After a decade of declining numbers,
there were more babies born at a low birth
weight in 2016 than in 2014 – an
indicator of quality of life for mothers and
babies

■ “The increase in the number of babies
born at low birth weight in 2016
underscored that differences in health
and opportunity to access it were affected
by both place and race”.
 “Segregated communities of color are more likely to be
cut off from investments that promote good schools,
affordable housing and other opportunities for health,’
leading to poor health and worse rates of child poverty,
infant mortality and high school graduation”.
 Intervention Suggestion Based on
News Articles:
■ Create specific education and training program for
prenatal clinics
– to address the lack of competent care to all races
– To decrease perceived racism by patients
– and help decrease the distrust in the health care
system that many minorities feel
■ Training program could educate all providers
about social determinants of health that affect
that person
■ Program could come up with community outreach
programs
– with input from the community
https://static01.nyt.com/images/2018/04/26/well/doctors-
chen/doctors-chen-
■ can teach providers how to interact with patients
articleLarge.jpg?quality=75&auto=webp&disable=upscale
from different races or ethnicities.
References:
1. Bediako, P. T., Belue, R., & Hillemeier, M. M. (2015). A Comparison of Birth Outcomes Among Black, Hispanic, and Black Hispanic Women. Journal of Racial and Ethnic
Health Disparities,2(4), 573-582. doi:10.1007/s40615-015-0110-2

2. Bengiamin, M. I., Capitman, J. A., & Ruwe, M. B. (2009). Disparities in Initiation and Adherence to Prenatal Care: Impact of Insurance, Race-Ethnicity and
Nativity. Maternal and Child Health Journal,14(4), 618-624. doi:10.1007/s10995-009-0485-y

3. Braveman, P. (2014). What are Health Disparities and Health Equity? We Need to Be Clear. Public Health Reports,129(Suppl 2), 5-8.
doi:10.1177/00333549141291s203

4. Clay, S. L., & Andrade, F. C. (2015). Racial Disparities in Low Birthweight Risk: An Examination of Stress Predictors. Journal of Racial and Ethnic Health Disparities,3(2),
200-209. doi:10.1007/s40615-015-0128-5

5. Derosiers, A. (2017, July 31). Race and the Inequity in Maternal and Infant Health. Retrieved November 26, 2018, from https://www.nichq.org/insight/race-and-inequity-
maternal-and-infant-health

6. Gadson, A., Akpovi, E., & Mehta, P. K. (2017). Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. Seminars in
Perinatology,41(5), 308-317. doi:10.1053/j.semperi.2017.04.008

7. Gavin, N. I., Adams, E. K., Hartmann, K. E., Benedict, M. B., & Chireau, M. (2004). Racial and Ethnic Disparities in the Use of Pregnancy-Related Health Care Among
Medicaid Pregnant Women. Maternal and Child Health Journal,8(3), 113-126. doi:10.1023/b:maci.0000037645.63379.62

8. Guerra, M. (2013, November 7). Fact Sheet: The State of African American Women in the United States. Retrieved November 27, 2018, from
https://www.americanprogress.org/issues/race/reports/2013/11/07/79165/fact-sheet-the-state-of-african-american-women-in-the-united-states/

9. Newman, K. (2018, March 14). Report: Pattern of Racial Disparity in Low Birthweight in U.S. Retrieved from https://www.usnews.com/news/healthiest-
communities/articles/2018-03-14/report-pattern-of-racial-disparity-in-low-birthweight-in-us

10.Thomas, M., Spielvogel, A., Cohen, F., Fisher-Owens, S., Stotland, N., Wolfe, B., & Shumway, M. (2014). Maternal Differences and Birth Outcome Disparities: Diversity
Within a High-Risk Prenatal Clinic. Journal of Racial and Ethnic Health Disparities,1(1), 12-20. doi:10.1007/s40615-013-0002-2

11.Townsel, C., Keller, R., Kuo, C., Campbell, W. A., & Hussain, N. (2017). Racial/Ethnic Disparities in Morbidity and Mortality for Preterm Neonates Admitted to a Tertiary
Neonatal Intensive Care Unit. Journal of Racial and Ethnic Health Disparities,5(4), 867-874. doi:10.1007/s40615-017-0433-2

12.Villarosa, L. (2018, April 11). Why America's Black Mothers and Babies Are in a Life-or-Death Crisis. Retrieved from
https://www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-maternal-mortality.html