An alarming statistic is that black infants born in the U.S. have more than double the chance of dying during their first year of life compared with white infants. (1) The death rate for black infants born here is as high as it would be if they were born in a developing country. The following facts surely have something to do with the poor survival rates of black infants in the U.S.: Twice as many blacks as whites live in poverty (20% vs. 10%), and nearly twice as many blacks as whites are among the 45 million people in this country who lack health insurance (43% vs. 24%). (2, 3)
Infant mortality (death within the first year of life) is most often a consequence of preterm birth (before 37 weeks gestation) and low birthweight. It’s no surprise, then, to learn that the rate of preterm birth is much higher in black women than in white women. In fact, the rate of preterm birth in black women in America is higher than it is in black women in Africa (18.5% vs. 11.9%). (4) Besides poverty and lack of access to healthcare, other factors such as psychosocial stress, bottle-feeding, exposure to lead, intrauterine growth and diet also play into the health of a mother and her infant. (5)
Racial disparities in infant mortality between blacks and whites are nothing new, but they’re not improving. However, a recent three year study in Ohio shows one way they might be changed: Prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) dramatically reduced the racial disparity in infant mortality rates among participants. While infant mortality rates among non-participants was 21% for blacks vs. 7.8% for whites, black women who did participate had infant mortality rates in line with white participants’ (9.6% vs. 6.7%). (6)
Other specific factors have been linked to increased infant mortality, including inadequate prenatal care, younger maternal age and lower educational levels. It only makes sense, then, that earlier initiation of prenatal care, and access to risk-appropriate OB and neonatal care would help improve outcomes in populations at risk. Programs to support parenting of premature and low birthweight infants should also help improve infant mortality statistics. (7)
We can also learn from the European and Scandanavian countries which have laudable, low rates—far lower than ours—of both preterm birth and neonatal/infant mortality. Their numerous social programs supporting pregnant women have been instrumental in achieving these results. In many of these countries, paid maternity leave begins 6-12 weeks before birth, with a specific eye towards minimizing preterm births. Mothers also have access to sick leave from their jobs after birth, which may or may not be paid. Prenatal care is comprehensive and free. Other supports include housing and social supports for more vulnerable populations of women. (8)
Our infant mortality rate is a national embarrassment—we rank 28th out of 32 countries in the world, falling behind such countries as the Czech Republic, Slovenia, Estonia, Greece, Hungary, Poland, Slovakia and even Cuba. (9) The major solution to improving our infant mortality rate is to first improve our preterm birth rate, and especially to work towards minimizing the differences in outcomes between blacks and whites. This will require reordering our priorities and putting some political muscle into the mix. Money spent upfront to prevent preterm birth will go a long way towards reducing the current economic burden related to preterm birth, estimated by the Institute of Medicine in 2006 to be 26 billion dollars. (10) Hopefully, the emotional burden of losing a child too early can be lessened as well.
Please help the March of Dimes in their mission to help moms have full-term pregnancies and research the problems that threaten the health of babies.
(1) “U.S. Infant Mortality Rate Decline Stalls, Racial Disparities Remain, CDC Data Indicate.” Online at http://www.medicalnewstoday.com/articles/116767.php.
(2) Income Inequality: Millions Left Behind. February 2004. Third Edition. Americans for Democratic Action, Inc. Washington, DC. Online at http://www.inequality.org/incineqada.pdf. Accessed June 29, 2004.
(3) Snyder, U. “Preterm Birth as a Social Disease.” Medscape Pediatrics, May/June, 2004. Online at http://www.medscape.com/viewarticle/481732.
(4) March of Dimes. “Preterm Births Rise by 36 Percent Since Early 1980s; Late Preterm Infants Drive the Increase,” Press Release January 7, 2009.
(5) Fiscella, K. “Racial Disparity in Infant and Maternal Mortality: Confluence of Infection, and Microvascular Dysfunction.” Maternal and Child Health Journal 2004;8:45-54.
(6) Khanani et al. “The Impact of Prenatal WIC Participation on Infant Mortality and Racial Disparities.” American Journal of Public Health 2010 Apr 1;100 Suppl 1:S204-9. Epub 2010 Feb 10.
(7) Kitsantas & Gaffney. “Racial/Ethnic Disparities in Infant Mortality.” Journal of Perinatal Medicine 2010;38(1):87-94.
(8) Williams BC. “Social Approaches to Lowering Infant Mortality: Lessons from the European Experience.” Journal of Public Health Policy 1994;15: pp. 18-25.
(9) Dezen & Lynch. “Babies Born Just a Few Weeks Too Soon are Three Times More Likely to Lose the Battle to Survive.” Press Release from March of Dimes, May 3, 2010. Online at http://www.marchofdimes.com/news/may3_2010.html.
(10) Institute of Medicine. “Preterm Birth: Causes, Consequences, and Prevention.” National Academies Press, Washington, DC. July 13, 2006.