Black Infant Mortality Research Articles

Persistent disparities in black infant mortality across gestational ages in the United States.

Persistent disparities in black infant mortality across gestational ages in the United States.

“Things your history teacher won't teach you: Science edition”: Black women science teachers as anti‐racist teachers

AbstractMarginalized communities cannot and do not have decontextualized experiences with how socioscientific issues, such as exposure to COVID‐19 as frontline essential workers, high Black infant mortality rates, air pollution leading to respiratory problems, and other issues, affect their communities. As PreK‐12 science teachers and teacher educators strive to dismantle oppressive practices in their classrooms and curriculum, it would be helpful to learn from Black women science teachers who have been engaging in anti‐racist practices before the racial awakenings of Summer 2020. In this study, three different virtual focus groups, or Sista Circles, were conducted with 18 Black women secondary science teachers. Ranging from 1 to 22 years of experience, Black women teachers across the country and international participants in Canada and Qatar participated in the Sista Circles. From intersectional qualitative analysis and narrative inquiry, the findings of the study reveal that Black women science teachers enact anti‐racist science teaching by bringing something new to the community; using NGSS standards within the context of the community; teaching at the intersection of history, culture, and science learning and teaching; and building critical consciousness in the science classroom. Furthermore, the findings of the study have implications for the use of anti‐racist frameworks within the context of science education that were authentically the practices of the Black women in the study. This study offers insights into how the critical consciousness of Black women teachers can be represented in the science classroom even in times of nonsupport from peers and administration. The power and necessity of Black women teachers are paramount in science classrooms specifically because of the neutral, apolitical ways science teaching has been approached in the past. The narratives and stories shared here exemplify how Black women science teachers transform science teaching and learning by displaying various acts of Criticality.

Abortion Restrictiveness and Infant Mortality: An Ecologic Study, 2014-2018

The U.S. has the highest infant mortality rate among peer countries. Restrictive abortion laws may contribute to poor infant health outcomes. This ecological study investigated the association between county-level infant mortality and state-level abortion access legislation in the U.S. from 2014 to 2018. A multivariable regression analysis with the outcome of county-level infant mortality rates, controlling for the primary exposure of state-level abortion laws, and county-level factors, county-level distance to an abortion facility, and state Medicaid expansion status was performed. Incidence rate ratios and 95% CIs were reported. Analyses were conducted in 2022-2023. There were 113,397 infant deaths among 19,559,660 live births (infant mortality rate=5.79 deaths/1,000 live births; 95% CI=5.75, 5.82). Black infant mortality rate (10.69/1,000) was more than twice the White infant mortality rate (4.87/1,000). In the multivariable model, increased infant mortality rates were seen in states with ≥8 restrictive laws, with the most restrictive (11-12 laws) having a 16% increased infant mortality level (adjusted incidence rate ratios=1.162; 95% CI=1.103, 1.224). Increased infant mortality rates were associated with increased county-level Black race individuals (adjusted incidence rate ratios=1.031; 95% CI=1.026, 1.037), high school education (adjusted incidence rate ratios=1.018; 95% CI=1.008, 1.029), maternal smoking (adjusted incidence rate ratios=1.025; 95% CI=1.018, 1.033), and inadequate prenatal care (adjusted incidence rate ratios=1.045; 95% CI=1.036, 1.055). State-level abortion law restrictiveness is associated with higher county-level infant mortality rates. The Supreme Court decision on Dobbs versus Jackson and changes in state laws limiting abortion may affect future infant mortality.

Road to Equity in Maternal and Child Health: Honoring the Past and Blazing New Paths.

This paper is a historical account of an initiative, as recalled by the authors who were directly involved, that brought to the forefront the long-standing and unjust reproductive health inequities in the United States. It is composed of three distinct but interrelated parts that together map the past, present, and future of addressing racial inequities in Maternal and Child Health. This paper is composed of three distinct but interrelated parts that together map the past, present, and future of addressing racial inequities in Maternal and Child Health.Part I recounts the history and achievements of a Centers for Disease for Control and Prevention initiative in the 1980-90's, led by the Prematurity Research Group in the Division of Reproductive Health, Pregnancy and Infant Health Branch. This initiative stimulated a paradigm shift in how we understand and address black infant mortality and the inequities in this outcome. Part II illustrates examples of some exemplary programmatic and policy legacies that stemmed either directly or indirectly from the Centers for Disease for Control and Prevention paradigm shift. Part III provides a discussion of how effectively the current practice in Maternal and Child Health applies this paradigm to address inequities and proposes a path for accelerating Title V agencies' progress toward birth equity. This CDC initiative was transformative in that it raised the visibility of African American researchers,moved the field from a focus on traditional epidemiologic risks such as personal health promotion and medical interventions, to include racism as a risk factor for inequitable birth outcomes. The paradigm examinedthe specific roles of historical and structural racism, and the racialized, contextualized, and temporal exposures that are unique to Black women's experiences in the United States. The initiative radically changed the narratives about the underlying factors contributing to inequities in birth outcomes of Black women, altered the way we currently approach addressing inequities, and holds the keys for transforming practice to a more holistic and systematic approach to building sustained organizational structures in maternal and child health that accelerate the achievement of birth equity.

Association of State-Level Tax Policy and Infant Mortality in the United States, 1996-2019

Infant mortality in the United States is highest among peer nations; it is also inequitable, with the highest rates among Black infants. The association between tax policy and infant mortality is not well understood. To examine the association between state-level tax policy and state-level infant mortality in the US. This state-level, population-based cross-sectional study investigated the association between tax policy and infant mortality in the US from 1996 through 2019. All US infant births and deaths were included, with data obtained from the National Center for Health Statistics. Data were analyzed from November 28, 2021, to July 9, 2022. State-level tax policy was operationalized as tax revenue per capita and tax progressivity. The Suits index was used to measure tax progressivity, with higher progressivity indicating increased tax rates for wealthier individuals. The association between tax policy and infant mortality rates was analyzed using a multivariable, negative binomial, generalized estimating equations model. Since 6 years of tax progressivity data were available (1995, 2002, 2009, 2012, 2014, and 2018), 300 state-years were included. Adjusted incidence rate ratios (aIRRs) were calculated controlling for year, state-level demographic variables, federal transfer revenue, and other revenue. Secondary analyses were conducted for racial and ethnic subgroups. There were 148 336 infant deaths in the US from 1996 through 2019, including 27 861 Hispanic infants, 1882 non-Hispanic American Indian or Alaska Native infants, 5792 non-Hispanic Asian or Pacific Islander infants, 41 560 non-Hispanic Black infants, and 68 666 non-Hispanic White infants. The overall infant mortality rate was 6.29 deaths per 1000 live births. Each $1000 increase in tax revenue per capita was associated with a 2.6% decrease in the infant mortality rate (aIRR, 0.97; 95% CI, 0.95-0.99). An increase of 0.10 in the Suits index (ie, increased tax progressivity) was associated with a 4.6% decrease in the infant mortality rate (aIRR, 0.95; 95% CI, 0.91-0.99). Increased tax progressivity was associated with decreased non-Hispanic White infant mortality (aIRR, 0.95; 95% CI, 0.91-0.99), and increased tax revenue was associated with increased non-Hispanic Black infant mortality (aIRR, 1.04; 95% CI, 1.01-1.08). In this cross-sectional study, an increase in tax revenue and the Suits index of tax progressivity were both associated with decreased infant mortality. These associations varied by race and ethnicity. Tax policy is an important, modifiable social determinant of health that may influence state-level infant mortality.

Dismantling racist ideologies in nursing academia to enhance the success of students identifying as Black, Indigenous and students of colour.

Dismantling racist ideologies in nursing academia to enhance the success of students identifying as Black, Indigenous and students of colour.

Geographic heterogeneity in Black-white infant mortality disparities.

Despite recent decreases in Black infant mortality, racial disparities persist, motivating continued research into factors related to these inequalities. While the inverse association between education and infant mortality has been documented across races, less is known about its geographic heterogeneity. Using vital statistics from the National Center for Health Statistics, this study considers Black-white disparities in infant mortality for births occurring between 2011 and 2015 across regions and metropolitan status of maternal residence. With logistic regressions, we investigate heterogeneity in maternal educational gradients of infant mortality by geographic residence both within and between races. Beyond confirming the well-known relationship between education and infant mortality, our findings document a slight metropolitan advantage for infants born to white mothers as well as lower returns to education for infants born to Black mothers residing in nonmetropolitan counties. We observe a metropolitan advantage for infants born to Black mothers with at least a bachelor's degree, but a metropolitan disadvantage for infants born to Black mothers with less than a high school degree. The South is driving this divergence, pointing to particular mechanisms limiting returns to education for Southern Black mothers in nonmetropolitan areas. This paper's geographic perspective emphasizes that racial infant health disparities are not uniform across the country and cannot be fully understood through individual and household characteristics.

Parental Health Literacy and NICU Provider Bias

The purpose was to explore the perceptions of bias and transition readiness for parents of Black preterm newborns before NICU discharge within the construct of parental health literacy (PHL). Preterm birth is the leading cause of mortality for Black infants in the United States. The readiness of parents to transition to providing care at home after NICU discharge must be prioritized. PHL is the degree to which parents can access, understand, and apply information related to the care of their newborn. Implicit bias is an unconscious negative association or judgment about an individual or group based on personal characteristics. Parental perceptions of bias toward them by NICU providers negatively affect the establishment of trusting relationships. Optimal transfer of information pertinent to the care of the newborn after NICU discharge requires trust, potentially facilitating continuation of disparate Black infant morbidity and mortality outcomes.

Black women’s experiences with professional accompaniment at prenatal appointments

ABSTRACT U.S. public health statistics report dismal Black infant and maternal mortality rates. Prenatal care alone, while essential, does not reduce such disparities. Objectives: The purpose of the study was to explore Black women’s experiences when a perinatal support professional (PSP) accompanies them to prenatal medical appointments. Design: This research used a phenomenological approach, using data from in-depth individual interviews to explore the essence of 25 Black women’s experiences. Results: We identified three major themes from the data that together, show that PSPs served as communication bridges for their clients. Clients said their PSPs helped them to understand and feel seen and heard by their medical providers during their prenatal appointments. The third theme was the deep level of trust the clients developed for their PSPs which made the first two themes possible. PSPs’ intervention resulted in reduced stress and uncertainty in medical interactions and increased women’s trust in their providers’ recommendations. Conclusions: Including a trusted, knowledgeable advocate like a PSP may be an important intervention in improving Black women’s prenatal care experiences, reducing stress associated with medical interactions, and ultimately reducing pregnancy-related health disparities.

Engaging Diverse Stakeholders of Color to Reduce Black Infant Mortality: Lessons Learned.

Engaging Diverse Stakeholders of Color to Reduce Black Infant Mortality: Lessons Learned.

Framing Black Infant and Maternal Mortality.

This article looks to the past to consider how government officials, health professionals, and legal authorities have historically framed racial disparities in birth and the lasting impact these explanations have had on Black birthing experiences and outcomes.

Addressing Black Infant Mortality Through Harnessing the Power of Community.

In Hamilton County, Ohio, the infant mortality rate is above the national average and the Black infant mortality rate is more than 3 times the white infant mortality rate. These racial disparities in infant mortality cannot be explained through other socio-economic characteristics like education, income, housing, or medical insurance. Research has shown that racism, not race itself, is the driving force behind the high disparity in infant mortality rates in Hamilton County and the nation as well. The World Health Organization (WHO) and the Institute of Medicine have long cited institutional/structural racism and cultural racism as a key factor in health disparity. A paradigm shift needed to occur to address the consequences of racism within the lives of Black women, namely disempowerment and agency. The Commission on Social Determinants of Health (CSDH) model was which engaged Black women and positioned them as an asset, to share in the process of strategizing, creating, and implementing a plan. Queens Village was founded to implement the CSDH model and address the upstream determinants of infant mortality through cultivating a sense of community.

Using Collective Impact to Develop a Community-Led Initiative for Improving Black Infant Mortality.

The United States has one of the highest infant mortality rates among developed countries. When stratified by race, disparities are more evident: Black infant mortality rates are 2.5 times higher than non-Hispanic white infants. Structural, systemic racism is a contributing cause for these racial disparities. Multisector collaborations focused on a common agenda, often referred to as collective impact, have been used for infant mortality reduction interventions. In addition, community-based participatory approaches have been applied to incorporate those with lived experience related to adverse pregnancy outcomes. This article critically describes the transition of an infant mortality collective impact initiative from being led by a multisector organizational group to being community led over a 5-year period, 2015-2020. A 34-member community leaders group was developed and determined four priorities and corresponding strategies for the initiative. Findings show that community participatory approaches are a way to address racial equity for public health initiatives.

Unfolding Birth Justice in Settler States

AbstractThere is growing scholarly and public attention toward the stark racial disparities in birth outcomes in the US. To lower disparate rates of Indigenous and Black infant mortality rates and maternal mortality rates, public and elected officials have proposed extending comprehensive prenatal care and medical resources and addressing racial biases in healthcare delivery. These efforts aim to bring minoritized and marginalized peoples and communities “into the fold.” In this essay, I consider the potential dangers of such contemporary efforts by critically analyzing historical initiatives to address birth outcomes and reproductive health in Indigenous communities. By foregrounding settler colonial social orders and their links to settler capitalism, I show how historical efforts to bring Indigenous peoples “into the fold” jeopardized Indigenous birth and reproductive capacities, while also upholding heteropatriarchal notions of sexuality, family, and racial difference.

Changing Systems That Influence Birth Outcomes in Marginalized Zip Codes.

* Abbreviations: ECEP — : early childhood education provider FIMR-CAT — : Fetal and Infant Mortality Review Community Action Team GMCHL — : grassroots maternal and child health leader HP — : Healthy People IMR — : infant mortality rate MCH — : maternal and child health SDOH — : social determinants of health SSWG — : Safe Sleep Work Group Indiana’s government is prioritizing the reduction of the state’s persistently high infant mortality levels. Despite improvements in overall state and Black infant mortality rates, high rates persist within Indianapolis zip codes, characterized by multigenerational poverty and underrepresented minorities (Table 1). These rates occur in the presence of high-quality health care and home-visiting programs working to address the leading causes of infant death (birth defects, preterm birth and low birth weight, maternal pregnancy complications, and sudden unexpected infant death).1 Numerous studies, however, link infant mortality to underlying root causes associated with the social determinants of health (SDOH).2–4 Addressing the SDOH requires sustainable improvements in social systems that influence women’s health and birth outcomes. Our work complements the work of health care by building the capacity of individuals and organizations within targeted zip codes to remove social inequities that impact birth outcomes. View this table: TABLE 1 Indiana Urban Zip Codes With Persistently High Infant Mortality Rates, 2014–2018 Our work with families motivated and informed our approach. First, many families have experienced infant mortality across multiple generations. Second, even with public communication campaigns focused on prenatal care, safe sleep practice, and women’s health, many residents are unaware of the leading and root causes of poor birth outcomes. Third, residents are not aware of the linkages between social demographics and poor birth outcomes. Fourth, neighborhood networks within communities are often insular; likewise, policy-making networks are insular. There is a need to merge community and policy networks to facilitate dialogue and share realities and solution strategies. Finally, … Address correspondence to Nancy L. Swigonski, MD, MPH, MBA, FAAP, Department of Pediatrics, School of Medicine, Indiana University, 410 W 10th St, Suite 2000, Indianapolis, IN 46202. E-mail: nswigons{at}iu.edu

Structural racism and risk of SARS-CoV-2 in pregnancy.

BackgroundStructural racism leads to adverse health outcomes, as highlighted by inequities in COVID-19 infections. We characterized Black/White disparities among pregnant women with SARS-CoV-2 in Cuyahoga County which has some of the most extreme health disparities in the U.S., such as a rate of Black infant mortality that is three times that of White counterparts.MethodsThis was a retrospective cohort study using data collected as part of public health surveillance between March 16, 2020 until October 1, 2020. This study aimed to compare Black and Non-Black pregnant women infected with SARS-CoV-2 to understand how the distribution of risk factors may differ by race. Outcomes included age, gestational age at infection, medical co-morbidities, exposure history, socio-economic status, occupation, symptom severity and pregnancy complications.FindingsOne hundred and sixty-two women were included. 81 (50%) were Black, 67 (41%) White, 9 (0·05%) Hispanic, 2 (0·01%) Asian; and three did not self-identify with any particular race. More than half who supplied occupational information (n = 132) were essential workers as classified by the CDC definition (55%, n = 73). Black women were younger (p = 0·0062) and more likely to identify an occupational contact as exposing them to SARS-CoV-2 (p = 0·020). Non-Black women were more likely to work from home (p = 0·018) and indicate a personal or household contact as their exposure (p = 0·020). Occupation was a risk factor for severe symptoms (aOR 4·487, p = 0·037). Most Black women lived in areas with median income <$39,000 and Black women were more likely to have a preterm delivery (22·2% versus 0%, p = 0·026).InterpretationMany pregnant women infected by SARS-CoV-2 are essential workers. Black women are more likely than White counterparts to have occupational exposure as the presumed source for their infection. Limitations in occupational options and controlling risk in these positions could be related to lower socio-economic status, resulting from a long history of structural racism in Cuyahoga County as evidenced by redlining and other policies limiting opportunities for people of color.Fundingnone.

Water purification efforts and the black‐white infant mortality gap, 1906–1938

According to Troesken (2004), efforts to purify municipal water supplies at the turn of the 20th century dramatically improved the relative health of Blacks. There is, however, little empirical evidence to support the Troesken hypothesis. Using city-level data published by the U.S. Bureau of the Census for the period 1906–1938, we explore the relationship between water purification efforts and the Black-White infant mortality gap. Our results suggest that, while water filtration was effective across the board, adding chlorine to the water supply reduced mortality only among Black infants. Specifically, chlorination is associated with a 9 percent reduction in Black infant mortality and a 10 percent reduction in the Black-White infant mortality gap. We also find that chlorination led to a substantial reduction in the Black-White diarrhea mortality gap among children under the age of two, although this estimate is measured with less precision.

Structural racism, racial inequities and urban–rural differences in infant mortality in the US

BackgroundWhile evidence shows considerable geographic variations in county-level racial inequities in infant mortality, the role of structural racism across urban–rural lines remains unexplored. The objective of this study was to...

How $250,000 Could Improve Birth Outcomes for Black Mothers and Infants: A Proposed Interprofessional, Community-Centered Doula Program

The purpose of this article is to examine the well-established body of evidence demonstrating significant racial inequities in Black maternal and infant morbidity and mortality, and to conduct further literature reviews to propose feasible solutions to lessen these inequalities. The factors contributing to racial inequities in maternal and infant health are complex. They include structural factors (i.e., public policies, institutional practices, cultural representations in healthcare), interpersonal factors (i.e., lack of diversity in the medical profession, interpersonal racism including that which happens in healthcare settings) and social factors (i.e., economic instability, lack of access to quality care, lack of reliable transportation, food insecurities, etc.). Therefore, efforts to address inequities require the interplay of professionals across many healthcare and non-healthcare disciplines. Our team proposes an interdisciplinary, community-centered doula program, consisting of doulas, social workers, and a community health educator. This program assumes an initial budget of $250,000 with multiple suggested avenues of financial sustainability. The goal of this hypothetical program is to support Black women and pregnant people and to lessen inequities in a way that is innovative, feasible, and financially sensible, all with the understanding that not all factors contributing to inequities can realistically be addressed through a single program.

About the Contributors

About the Contributors