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BLACK INFANT MORTALITYAn American baby born today has a greater chance of living until her first birthday than she would have had in 1950. In spite of this encouraging news, the death rate for infants in the United States is higher than that of any other Western industrialized country. Further, the gap between the survival rates of black and white babies has increased. African American babies in the U.S. today are two-and-a-half times more likely to die before their first birthday than white babies.
While research into this disparity continues, many risk factors for black infant mortality have been identified. Ensuring healthy outcomes for African American mothers and their babies requires a good understanding of these complex and interrelated causes. Smoking. Smoking is the single most important factor in infant mortality. Even if the pregnant woman herself doesn't smoke, living with a smoker puts her baby at risk. Low maternal weight gain. When a pregnant woman doesn't gain enough weight, she places her baby at a risk second only to that of smoking. Personal beliefs as well as outdated medical advice may lead a woman to limit her weight gain. Adolescents may eat less in an attempt to conceal pregnancy. Compared with white mothers, more African American mothers gain too little weight during pregnancy. Poor nutrition. Many infants die as a direct result of their mothers' inadequate diets. While WIC could help, many women do not take advantage of this service, assuming a doctor's order is required, or that pregnant women are not eligible. Other women may not realize the importance of a nutritious diet on their baby's development. Late prenatal care. Early and regular prenatal care significantly lowers the risk of infant mortality. Fewer African American women get into care during their first trimester. Reasons for late care are complex and include mothers' reluctance to approach the medical establishment as well as a lack of doctors willing to accept Medicaid patients. Pre-term labor. Almost half of the babies who die in St. Joseph and Elkhart counties are born too early. Not recognizing the symptoms of pre-term labor, many women do not seek help in time to avoid delivering premature babies. Poverty. According to the Centers for Disease Control and Prevention, the infant mortality rate for babies born to women living in households with incomes below the poverty line is 60% higher than for babies of nonpoor women. CDC concluded that poverty raises infant morality rates as much as smoking during pregnancy or inadequate prenatal care. Social risks. Other life circumstances are also linked with higher rates of infant mortality. For example, infants born to women who are unmarried, very young, or over age 35 are more at risk. Substance abuse. When a pregnant woman takes a drink or a drug, her unborn baby does too. Babies exposed to drugs or alcohol are at high risk for low birth weight, premature birth and death. Domestic violence. Women's reluctance to report battering makes it difficult to get a clear picture of the extent of domestic violence. It is estimated that as many as 20% of pregnant teens and 17% of adult pregnant women are victims of domestic violence. The risk of fetal death after significant maternal trauma is quite high and fetal death can occur when no outward signs of injury are visible.
As researchers work to understand the causes of high black infant mortality, communities have the task of designing effective remedies based on their findings. As with most social challenges facing us today, there are no easy answers and no quick fixes. There are, however, many ways to begin. Information. Without information, the African American woman cannot take even the first steps to ensure her baby's life. She needs to know the risks, understand the importance of good nutrition and prenatal care, and recognize the symptoms of pre-term labor. She needs concrete information on how and where to get services such as WIC and smoke cessation programs. All knowledgeable professionals who work with pregnant women can be important information sources. Life-style changes. Awareness of the need for a behavior change is not necessarily enough. Women also need the on-going support and attention of the health care system, social service agencies, community groups, and the significant people in their lives to make those changes. Community support. The responsibility for closing the gap between black and white infant mortality belongs to all of us, at all levels. The African American community especially can play a key role in helping to share information and seek solutions. Members of churches and other community organizations must work together to ensure a healthy outcome for black infants. Comprehensive care coordination. Every pregnant woman at high risk for infant death requires intense attention. This goes for women with psychosocial risks as well as women with identified medical risks. A care coordinator provides such attention by guiding each woman to services needed for optimal health and well-being, providing follow-up to make sure she is able to access those services, and reinforcing healthy behaviors. Lower institutional barriers. The availability of medical services does not guarantee quality care for all pregnant women. Long waiting periods, poor staff attitudes, inconvenient hours and location are examples of institutional barriers. Full utilization of medical services requires the identification and dismantling of these and other barriers. Family support programs. Failure to seek prenatal care is also associated with personal and family problems. Comprehensive family support programs promote the healthy development of families through a range of social, educational and recreational activities. By teaching adolescents how to resist early sexual activity, encouraging fathers to be positively involved with their children and giving teens hope for the future, family support programs address life circumstances that can affect infant mortality. Research. The more clearly we understand the forces driving up the rate of black infant mortality, the more directly we can take aim at the causes. Furthermore, research into the successful strategies of women who do avoid risky behaviors and make positive life-style changes can help in the design of effective intervention programs. Legislation and public policy. Any discussion of strategies is incomplete without acknowledging that the causes of infant morality are rooted not only in individual behaviors, but also in poverty. Legislation and public policies should be scrutinized for their impact on the poorest members of our society. Without a concerted effort to decrease poverty in this country, infant mortality rates may remain among the highest in the industrialized world. Another public policy issue, though basic, impacts not only the definition of the problem, but the scope of the solutions. Do we seek just to narrow the gap or do we seek true health parity for black and white infants? If the latter, additional initiatives may be necessary to accelerate our progress in reaching this goal.
Nearly 35,000 babies died before their first birthday in the US in 1992, a rate of 8.5 for every 1,000 babies born that year.(1) During the same year, 27 out of every 1,000 African American babies died, compared to 8 out of every 1,000 white babies.(2) From 1989 through 1992 the leading causes of infant death in St. Joseph County were premature birth, SIDS and congenital abnormalities.(3) Substance use: Women who take three to five drinks of alcohol per day have twice as great a risk of having a low birth weight baby as nondrinking mothers.(4) Elevated rates of infant death have been observed among drug-abusing women and their infants.(4) Significantly more African American mothers acknowledge using alcohol and other drugs.(5) Cigarette smoking is the largest and most important known modifiable risk factor for low birth weight and infant death.(4) In St. Joseph County in 1992, 21% of black babies and 21% of white babies were born to women who smoked during pregnancy.(3 ) Out-of-wedlock births: Of Indiana Medicaid clients who had similar prenatal care in 1992, the babies of single women were 14 times as likely to die as the babies of married women.(6) In St. Joseph County 79% of black women who delivered a live birth in 1992 were on Medicaid, compared to 31% of white women.(3) Of all white women giving birth in Indiana in 1993, 25% were unmarried, while 70% of black births were to unmarried women.(7) Low birth weight: More than three fourths of infant deaths are caused by babies being born too small or too early.(4) In Indiana in 1992, twice as many black babies (12%) as white (6%) were born at a low birth weight.(8) Black women between 30-34 delivered low birth weight babies at a rate three times greater than white women.(7) Prenatal care: Among Indiana Medicaid clients in 1992, 17% of women with no prenatal care had babies who died as compared to 0.2% of women with 6 to 12 prenatal care visits.(6) Black women delayed getting early prenatal care twice as often as whites.(7) In 1992 in Indiana, 38% of black babies and 20% of white babies were born to mothers who received late or no prenatal care.(8) Nutrition and weight gain: In St. Joseph County in 1992, more than a third of black mothers (36%) compared to fewer than a fourth of white mothers (23%) gained too little weight during pregnancy.(3) In St. Joseph and Elkhart Counties, nutrition was a contributing factor in 25-30% of infant death cases. In many of these cases, mothers were eligible for, but did not seek, WIC services during pregnancy.(5) Age: In Indiana in 1992, 13% of all white births and 28% of all black births were to teens.(8) Babies born to teens are more likely to be born prematurely and 50 percent more likely to be low birth weight.(9) Poverty: The infant mortality rate for babies born to women in poverty is 60% higher than for other babies, making poverty as great a risk as smoking during pregnancy or inadequate prenatal care.(1) For all families with children under 18 in St. Joseph County in 1990, 11.5% lived below poverty; for black families, 59% lived below poverty.(10) Medicaid infants in St. Joseph County are more likely to die of infection, SIDS, prematurity, or congenital abnormalities. Of black women in St. Joseph County who delivered a live birth in 1992, 79% were on Medicaid, compared to 31% of white women.(3) References:
©1996 by Sue Christensen and Ann Rosen, The Family Connection of St. Joseph County, Inc. This briefing paper was developed for Memorial Health System, South Bend IN, for use in conjunction with a forumon teenage pregnancy, fatherhood, and black infant mortality. It may be copied in part or in whole to further advance the understanding of teenage pregnancy and to promote the implementation of successful strategies, providing credit is given to the authors, The Family Connection of St. Joseph County, Inc. and to Memorial Health System, South Bend, as sponsosr. |
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