Abstract
Background: The United States lags far behind other developed nations in our overall infant mortality rate. Public health researcher Arline Geronimus has described a "weathering" effect of chronic racial stress among Black women that contributes to high rates of preterm birth, the leading cause of infant death. Trusting relationships between clinicians and patients may play a role in reducing infant mortality for Black mothers. Based on a social-ecological model of health care communication around infant mortality, we focus here on doctor-patient communication and correlations between clinicians' understandings of systemic racism and their communication with Black pregnant patients.Methods: This paper reports the findings from interviews with 5 maternal health clinicians (prior to recruitment being temporarily paused due to COVID-19) practicing at Cuyahoga County hospitals that serve large populations of Black women. Qualitative coding methods based in grounded theory were used to draw out themes from interview transcripts.Results: Doctor-patient communication was an emergent theme in these interviews. Results suggest an association between clinicians' understanding of the impact of systemic racism and their ability to communicate successfully and form positive bonds with pregnant mothers who are at higher risk of infant mortality.Conclusion: Acknowledging systemic racism as the cause of poor social determinants of health, which in turn contribute to higher rates of infant mortality, may provide clinicians a pathway to more positive communication and higher levels of trust with their patients, which in turn may play a role in reducing infant mortality in the Black community. Further research should investigate these associations.
Highlights
The United States began tracking infant death by race in 1850, when 217 of every 1 000 White babies and 340 of every 1 000 Black babies did not reach their first birthday.[1]
Acknowledging systemic racism as the cause of poor social determinants of health, which in turn contribute to higher rates of infant mortality, may provide clinicians a pathway to more positive communication and higher levels of trust with their patients, which in turn may play a role in reducing infant mortality in the Black community
We interviewed 5 prenatal health care physicians at Cuyahoga County hospitals (Table 1)
Summary
The United States began tracking infant death by race in 1850, when 217 of every 1 000 White babies and 340 of every 1 000 Black babies did not reach their first birthday.[1]. Scholar Dorothy Roberts has argued that the state has historically neglected Black infants via the socioeconomic status (SES) of their mothers through poverty, inadequate housing, poor nutrition, and lack of access to health care.[6] Dr Roberts points, for example, to the harsh punishment of pregnant Black women who selfmedicate with illicit drugs versus the “temperate regulation” of pregnant middle-class women who use pharmaceuticals to treat their mental health, despite evidence that use of antidepressants and other prescribed medications during pregnancy may cause subtle neurological problems in newborns.[7] Such disparities in social treatment contribute to what public health researcher Arline Geronimus has termed “weathering,” which she defines as the deterioration of Black women’s health due to chronic stress This stress is caused by the cumulative exposure of socioeconomic disadvantage in a society burdened by structural and systemic racism and has consistently been linked to preterm birth.[8] Multiple studies have reported associations between hormonal markers of chronic stress and preterm birth, showing disproportionate effects among Black women and women with low SES.[9] Preterm birth, the leading cause of infant death, has increased 31% in the United States since 1980, among Black women, and risk identification, early detection, and pharmaceutical interventions have made no impact in reducing its occurrence.[9]. Based on a social-ecological model of health care communication around infant mortality, we focus here on doctor-patient communication and correlations between clinicians’ understandings of systemic racism and their communication with Black pregnant patients
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