A new series of studies from the Joint Center for Political and Economic Studies' Health Policy Institute, along with a small but growing number of neonatalogists nationwide, suggests that the stressful effects of racism play a role.
"That's the elephant in the room," said Michael Lu, an obstetrician-gynecologist and professor at the University of California at Los Angeles who studies disparities in infant health. "When we're studying racial disparities, for decades people have looked at stress and infant mortality without looking at the reasons for the stress."
Black infant mortality is a complicated puzzle that includes poverty, poor nutrition, inadequate prenatal care, teen pregnancy, heredity, high blood pressure, stress, obesity, low birth weights and prematurity. However, some neonatologists and child health advocates have pushed for more research to get behind the social reasons why these factors seem to take a higher toll on African-American infants than they do on other babies.
For the 600 black women in Atlanta who participated in a related study on the effects of racial discrimination on health, the reasons for their higher stress levels ranged from hearing white teachers comment on "those kids" to working extra long hours to win acceptance from white colleagues.
"The pregnancy scares the life out of me because I am pregnant with a baby boy, and I know how black boys are treated in this society," one study participant told researchers from Spelman College and Emory University in Atlanta.
In his research, Lu and his colleagues found that the disproportionately higher number of fast-food restaurants and liquor stores, lower number of grocery stores and the higher cost of fresh produce in many urban, predominately black communities caused poorer pregnant black women to make stressful choices about what to eat and where to live. So did the higher crime rates in these communities and worries about sending children to poorly equipped, understaffed schools.
Lu and other researchers see these factors as part of a trend of racial inequality that's stressful to some poorer black expectant mothers.
"We know that one of the leading causes of infant mortality among African-Americans is preterm birth," Lu said. "We know that stress is an important risk factor, and it initiates the release of stress hormones leading to preterm birth and increase susceptibility for infection. The question is, do we think racial discrimination and racism is stressful?"
Over the past few years, several researchers have published studies in the American Journal of Public Health and the New England Journal of Medicine that examine this issue. The researchers found that whether rich or poor, well-educated or barely literate, African-American women were still more likely than white women, first-generation, poor Hispanic immigrant women and foreign-born black women to have premature and low birth-weight babies. In his research, Lu also found that when foreign-born black women had been in the United States for a generation they showed the same infant mortality rates as American-born black women.
"For many years, the operating theory in the health community 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, genetic causes," said Ronald David, a physician, professor and co-author of the Joint Centers' recent research on infant mortality. "However, we found that infant mortality for blacks remained high even when all these factors were controlled."
Though the infant mortality rate for all races has decreased over the past two decades, the United States still has one of the highest rates among developed nations. In this country, the infant mortality rate for black babies is 13.5 per 1,000 live births, compared with roughly 5.7 for whites and Hispanics, according to statistics from the Centers for Disease Control and Prevention.
The problem is especially acute in rural areas such as Mississippi's Delta region along U.S. 61, and urban centers such as Washington, D.C., and Memphis, Tenn. - which has a zip code where the infant mortality rate is higher than those of many Third World nations.
Organizations such as the Joint Center and the Black Women's Agenda, which focuses on issues of importance to African-American women, hope that additional research on the connection between racism and infant mortality might spark change. A PBS documentary, "Unnatural Causes: Is Inequality Making Us Sick," slated to air next year, explores the disparity in infant mortality and other ways in which racial and social inequality may affect health care.
McClatchy Newspapers 2007