The racial disparities in infant mortality rates in the United States have long been appalling. Nationwide, Black infants are 2.4 times more likely to die than white babies, but in Alabama the situation is particularly shocking. While the infant mortality rate has dropped for white babies per 1,000 live births — from a high of 8.2 in 1996 to 5.2 in 2015 — an Alabama Media Group analysis of Alabama Department of Health data has found that Black infant mortality is actually on the rise.
A staggering 15.3 Black babies die per 1,000 live births, making African-American babies three times more likely to die in the state than white babies. So what’s responsible for the trend? Unfortunately, no clear-cut answer exists. A toxic mix of poverty, racism, lifestyle choices, irregular prenatal care and even environmental factors contribute to this tragic trend. Most telling is that 45 percent of Black Alabama children are growing up poor, but just 18 percent of white children in the state live in poverty, according to the group VOICES for Alabama’s Children.
The racial gap in the infant mortality rate is hardly limited to Alabama, though. Bigger disparities can be found in racially diverse and politically liberal enclaves. In San Francisco, Black women are six times more likely to have an infant die than white women are, and in Washington, D.C., Black women are 10 times more likely to lose their babies, The Nation reported in February.
The Centers for Disease Control and Prevention has identified pre-term birth as the top contributor to the infant mortality rate, and Black women are 1.5 times more likely than white women to give birth to premature babies. Children born before the 37th week of pregnancy are considered premature. However, health care officials lack reliable methods to determine which women are at greater risk of having pre-term babies. Induced labor, C-sections and pregnancies involving multiples all pose an increased risk, but women without any of these factors give birth to premature infants all the time. The CDC also points to lifestyle factors to explain racial disparities in infant mortality rates. It encourages mothers of color to eat nutritiously, see health care officials regularly and take prenatal vitamins daily, among other tasks.
But even Black women who do all of the right things remain at high risk of giving birth to babies they will ultimately lose. In February, The Nation magazine profiled Tonda Thompson, who was working as a model in Los Angeles when she became pregnant in 2012 at age 25. Thompson said she never missed a doctor’s appointment while expecting, made sure to take her prenatal vitamins and not to gain too much weight. In a long-term relationship with a man she eventually married, Thompson welcomed motherhood. Sadly, her baby boy, Terrell, died at less than 24 hours old as a result of delivery complications.
Since even upper-income, highly educated Black women are more likely to suffer the loss of a baby than white women are, researchers have begun to seriously consider the role of racism in this urgent health problem. They know, for example, that the stress of racism can lead to health problems such as hypertension, which is dangerous during pregnancy. The likelihood that racism plays a role in infant deaths also is borne out by the fact that Black immigrant women in the U.S. don’t experience infant mortality rates as high as native-born Black women. That may be because these women come from mostly Black countries, where racism isn’t a regular occurrence in their lives.
“There’s something about growing up as a Black female in the United States that’s not good for your child-bearing health,” Dr. Richard David told PBS about a landmark 2007 study Chicago medical researchers conducted about race and the infant mortality rate. The study found that the effects of racism appear to cause Black women in the U.S. to deliver babies with low birth weights, making the infants more likely to die or suffer from health problems, should they live. Environmental factors, such as rising lead levels in the bloodstreams of Black women living in lower-income neighborhoods, also may contribute to the problem.
But the link between racism and the Black infant mortality rate doesn’t absolve the health care world of its responsibility in this crisis. Black doctors are woefully underrepresented in the industry, making up just 5 percent of all practicing physicians. And medical biases continually lead to African-Americans receiving substandard health care, such as fewer treatment options and less-potent pain medication. Despite all their training, white doctors also hold on to absurd beliefs that dehumanize African-Americans, such as the notion that Blacks literally have thicker skin than Caucasians do. (They don’t.)
Across the board, Black women have poorer outcomes in reproductive health than white women do. They are more likely to suffer from infertility and its potential contributors, such as uterine fibroids, than white women, but they’re less likely to achieve pregnancy through in vitro fertilization. And it’s not just their babies who die. Black women are four times more likely to die from pregnancy complications than white women. These statistics, combined with a long and shameful history of doctors sterilizing Black women without their consent, make it crystal clear that if more Black babies and their mothers are to survive pregnancy, labor and delivery, health care personnel can’t just point the finger elsewhere. They have to look within their medical establishments and question whether they are doing all they can to help African-American women get pregnant, stay pregnant and give birth to full-term babies who go on to thrive. The trove of data available about Black women’s health outcomes overwhelmingly suggests that they have not. How many Black babies have to die before officials behave as if they think Black women and Black infants matter?
