“Look at the Whole Me”: A Mixed-Methods Examination of Black Infant Mortality in the US through Women’s Lived Experiences and Community Context

Maeve Wallace,Carmen Green,Katherine Theall,Joia Crear-Perry,Lisa Richardson

doi:10.3390/ijerph14070727

Abstract

In the US, the non-Hispanic Black infant mortality rate exceeds the rate among non-Hispanic Whites by more than two-fold. To explore factors underlying this persistent disparity, we employed a mixed methods approach with concurrent quantitative and qualitative data collection and analysis. Eighteen women participated in interviews about their experience of infant loss. Several common themes emerged across interviews, grouped by domain: individual experiences (trauma, grieving and counseling; criminalization); negative interactions with healthcare providers and the healthcare system; and broader contextual factors. Concurrently, we estimated the Black infant mortality rate (deaths per 1000 live births) using linked live birth-infant death records from 2010 to 2013 in every metropolitan statistical area in the US. Poisson regression examined how contextual indicators of population health, socioeconomic conditions of the Black population, and features of the communities in which they live were associated with Black infant mortality and inequity in Black–White infant mortality rates across 100 metropolitan statistical areas with the highest Black infant mortality rates. We used principal components analysis to create a Birth Equity Index in order to examine the collective impact of contextual indicators on Black infant mortality and racial inequity in mortality rates. The association between the Index and Black infant mortality was stronger than any single indicator alone: in metropolitan areas with the worst social, economic, and environmental conditions, Black infant mortality rates were on average 1.24 times higher than rates in areas where conditions were better (95% CI = 1.16, 1.32). The experiences of Black women in their homes, neighborhoods, and health care centers and the contexts in which they live may individually and collectively contribute to persistent racial inequity in infant mortality.

Highlights

Decades of medical and public health research have failed to explain or reduce race-associated differences in infant mortality in the US
Relative differences between Black and White rates were greatest in Trenton, NJ; Bridgeport-Stamford-Norwalk, CT; and San Francisco-Oakland-Hayward, CA where Black infant mortality rates were more than six times higher than the rate among Whites
Black/White infant mortality gaps averaged nearly seven excess Black infant deaths per 1000 live births, and Black infants were more than 2.5 times more likely to die before celebrating a first birthday

Summary

Introduction

Decades of medical and public health research have failed to explain or reduce race-associated differences in infant mortality in the US. Non-Hispanic (NH) Black women are more than twice as likely to experience the loss of a child before age one compared to NH White women [1]. This mortality gap between NH Black and NH White infants is largely driven by higher rates of preterm birth among NH Back women and infant death due to preterm-related causes [2]. Res. Public Health 2017, 14, 727; doi:10.3390/ijerph14070727 www.mdpi.com/journal/ijerph

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