Infant Mortality and African Americans

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Researchers and health experts have sought unsuccessfully for years to determine why African American women suffer significantly higher infant mortality rates than their white counterparts. As this gap between black and white infant deaths continues to expand, it is time to adopt new approaches towards addressing this paradox.

The most recent data (2003) shows the infant mortality rate for blacks as 13.5 per 1,000 live births, compared to 5.7 for non–Hispanic whites and Hispanics.

While the root causes of these disparities in infant mortality rates is not thoroughly understood, the operating theory has been that the high incidence of infant deaths among African Americans is attributed to higher teen pregnancy rates, single motherhood, lower education levels, poverty, and–most recently suggested–genetic causes.

Clearly, however, the need for new approaches to understanding this phenomenon is underscored by research disclosing that high levels of infant mortality persist, even when most of these factors are controlled. Also consider that African Americans have higher infant mortality rates in every age category; maternal characteristics, such as marital or employment status, do not alter the disparities; and there is no differentiation when education or income levels are considered.

Furthermore, the genetic theory is weakened by research that shows better birth outcomes among foreign–born black women. It seems that regardless of their socioeconomic status, native–born African American women fare worse in birth outcomes compared to white women at every income and education level.

So what is causing the high rates of infant mortality for black women and their children?

Two years ago, the search for answers to these perplexing questions led the Health Policy Institute of the Joint Center for Political and Economic Studies to establish a national Commission to study infant mortality from a different perspective. Conventional wisdom wasn’t finding the cure for high infant mortality, so our Commission set out on a different course: evaluating the role that relationships play in the infant mortality mystery.

The experts on our Commission have concluded that focusing on relationships and their associated effects on the well–being of the mother and infant results in a better understanding of the infant mortality challenge. This new approach is grounded in the social determinants of health theory: women and their babies must be viewed not only as individuals, but as members of families, communities, and larger systems that have either positive or negative impacts upon their psychological and physical states. The economies, opportunities, environmental influences, as well as risk and protective factors within their places of work, life, and play must all be considered as factors in infant mortality.

The Courage to Love: Infant Mortality Commission co–chaired by Ronald David, MD, MDiv, and Barbara Nelson, PhD, in collaboration with the University of California, Los Angeles (UCLA) School of Public Affairs arrived at their conclusions after reviewing the history of infant mortality rates, examining basic assumptions, redefining the problem, and presenting new avenues for intervention. The Commission’s intentional focus on "relationality" has potential implications for improved pregnancy outcomes, economic prosperity, and meaningful civic participation for all women and for African American women in particular.

For instance, one of the Commission’s research papers examines the critical relationship between breastfeeding and infant mortality among African Americans.

When reviewing research, the Commission determined that breastfeeding could play a key role in infant mortality disparity. African American women were identified as the racial/ethnic group with the lowest rate of breastfeeding, yet the highest infant mortality rate. The authors explored the benefits of breastfeeding and the issues associated with racial/ethnic disparities in breastfeeding, concluding with an action plan for closing the gap through promotion of breastfeeding based on education, training, awareness, support, and research. Other Commission papers examine relationships between infant mortality and maternal nutrition, as well as infant mortality and resilience.

Moreover, the Commission has analyzed the historical framework of policies and practices to reduce infant mortality; the authentic voices of those affected by infant mortality; and infant mortality in a global context.

The Commission’s work is poised to become the foundation for new approaches to addressing the infant mortality problem, and saving lives.

Gina E. Wood is the Deputy Director of the Health Policy Institute. The Health Policy Institute (HPI) is a principle program of the Joint Center for Political and Economic Studies. The HPI was operationally launched in 2002 with a grant from the W. K. Kellogg Foundation. The Foundations’ purpose was to enable the Joint Center to build a health policy institute that would facilitate the participation of "neglected" or "unheard" voices in health policy debates and that would improve the health of underserved and diverse people by supporting national partners in efforts to help communities inform policy and sharing promising practices. For more information visit www.jointcenter.org.

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