Failing African American Mothers and Babies

Rachel at Our Bodies, Our Blog called my attention to a fascinating article on a woefully underreported topic, in Womens eNews this month – Black infant and maternal mortality in the United States. It’s a topic that, frankly, deserves much more attention from movements and communities across the spectrum – women’s health, feminism, reproductive rights, the medical establishment, mainstream media news, and alternative news sources all.

September is Infant Mortality Awareness Month. The truth is, however, as Kimberly Seals Allers writes in her article, Black Infant Mortality Points to Moms’ Crying Needs,

"…this country is miserably failing women of color, and black women in particular, in the process of birthing healthy babies."

When an obstetrician-gynecologist doesn’t know that African American women in the United States are nearly three times as likely to die during childbirth as white women are, or that the infant mortality rate in the black community is significantly higher than in other communities, there is a lot of work to be done. As Seals Allers (Womens eNews Editorial Director) writes:

In the course of interviewing obstetrics-gynecologists I have found
many who aren’t aware that their black patients are at a greater risk
during pregnancy, regardless of their socioeconomic status.

African Americans have an infant mortality rate 2.3 times higher than that for non-Hispanic whites. But this isn’t new information. Why do these racial health disparities then still exist in the United States? And as we consider our current health care reform measures, how do we address these kinds of inequities?

Seals Allers quotes Dr. Camara Jones, research director on social determinants of health and equity at the National Center for Chronic Disease Prevention and Health Promotion:

"In this country, we have for a long time thought of our individual
behaviors as the main determinants of health," said Jones in a recent
speech at the University of Georgia. But encouraging individuals to
adopt healthier habits is not the key to ending health disparities.

"If we are interested in eliminating racial disparities in health,"
said Jones, "we need to examine the fundamental causes of those racial
disparities." That includes an awareness of the systems that make race
an important distinction and acknowledging the existence of racism in
practices and organizations."

And Rachel at OBOS notes that addressing these racial disparities is not only an issue of morality or social justice but it makes sense economically, 

"In addition to the moral or social justice argument for eliminating health disparities, a recent report
on the economic burden of these disparities makes a money-saving
argument for eliminating them, estimating that doing so “would have
reduced direct medical care expenditures by $229.4 billion,” money that
some suggest could be used to pay for health reform."

While we make our best efforts to shine a much needed light on the health of women in the developing world as worthy recipients of our attention, one must ask why the health of women in this country is not being given equally as deserving attention?

Carol Jenkins, writing on RH Reality Check in response to Nicholas Kristoff’s and Sheryl WuDunn’s new book, Half the Sky, about the imperative of focusing on gender equity globally, calls African American women in the United States "invisibles", and an "endangered group right here in our backyard" precisely because of these staggering health inequities:

It is a group we need to keep in mind, because you won’t
see us very much in the media—home bred women of color don’t have the exotic appeal
of grand international rescue missions. But there are many of us who believe
that black women in America are now in full blown crisis, and require a
concerted effort of activists, philanthropists, big thinkers. Black women’s
voices are largely missing from our debate about health care, even as the
disparities in their care are the starkest. 

But where are the studies? The research on the multi-layered reasons for these staggering statistics? And why aren’t health care providers informed enough about these kinds of racial disparities to provide appropriate care?

In fact, infant mortality rates for black babies is rising in many states around the country. Sixteen states, of the 39 with a large enough population of black people to make the analysis reliable, "experienced rising black rates between the 1998-2000 and 2002-2004 period." Clearly, this gap persists and it’s not enough to continue to question. 

Seals Allers also raises these questions but adds that in the face of a serious lack of research and not nearly enough provider awareness, Black women – all women – need to advocate for themselves:

As a black woman, who can’t afford to wait for the government or
medical community to figure out how to save our babies, I have to
search for answers and solutions and ask black women all over the world
to do the same.

And as mothers and women of all races, whose lives are all
interconnected, we have to figure out how. It’s the least we can do.
Newborn lives are at stake.

The Department of Health and Human Services (HHS) did develop the Healthy People 2010 initiative to "provide a vision for achieving improved health for all Americans." The initiative contains two goals  – one of which is to eliminate disparities in health based on a variety of factors including race. But a midway review in 2005 acknowledged that, thus far, "While there
have been widespread improvements in rates for most of the populations
associated with the social and demographic characteristics included in
Goal 2, there is little evidence of systematic reductions in disparity." [emphasis mine]

The report also notes that, "It may
be more difficult or more costly to implement effective disease
prevention and health promotion programs for some populations. However,
unless greater reductions occur for the populations with the highest
rates, disparities will not be eliminated."

The key then is for all of us to agree that the lives of African American women and their babies are worth saving. It’s a question of prioritization. Yes, it is critical that African American women are aware of institionalized racism and racial health disparities so that they may advocate for themselves. But that is not enough, of course. Not nearly enough. 

In order to make real progress, we must see attention paid to this problem by President Obama, Congress, advocacy and grassroots organizations, the medical community, activists and the mainstream and alternative media.

Dr. Jones says it best, quoted in Kimberly Seals Allers’ article,

Racism is not some vague thought or practice, it operates through identifiable and addressable mechanisms, says Jones.

So let’s identify and address.

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  • momtfh

    I just got into it on Alas, a Blog with commenters arguing about the quality of the research that confirms that African American women have worse perinatal outcomes.


    It was really upsetting at what lengths apologists will go to deny that racism is pervasive and has real negative consequences. They really triggered a pet peeve of mine by creating unfounded hypothetical criticisms of the "statistical analysis" of the research. Which, of course, they had not read. And did not exist.


    Mom’s Tinfoil Hat.

  • amie-newman

    on your blog to get an idea of what went down with this guy. You are absolutely correct that regardless of socioeconomic status, Black women are still at higher risk for having low birth weight babies. And, of course, we’re talking also about a range of afflictions for which Black women (and Latino women and Native American women) are at greater risk than Non-Hispanic White women. But, also, these racial disparities are being taken on by the federal government, as I note in my  post! This is not a question of nitpicking one study. This is a widespread, devastating problem.

    Thanks so much for your excellent research and willingness to engage in such a difficult discussion with the commenter. Looking forward to discussing this further! 

    Amie Newman

    Managing Editor, RH Reality Check

  • lineline

    I recently attended an excellent event here in Oregon on this very topic. There was a showing of the documentary Unnatural Causes; When the Bough Breaks, a discussion, and Shafia Monroe spoke.


    The documentary discusses numerous studies regarding the birth outcomes of white women, black women, african immigrants, and of education levels. Relating to how you state that even when a black and white woman both have a PhD, the black women has drastically worse outcomes. One interesting study was done to rule out genetics, and showed that African immigrant women actually had better birth outcomes than black women. In several studies it was found that graduate level college educated black women had worse birth outcomes than high school drop-out white women. (and is true for other non-white individuals, these examples just focused on black women).


    Here is what I don’t see addressed enough even within these conversations (that was addressed well in the above): is how the chronic stress of racism over a lifetime effects one’s reproductive health. There have now been studies done to show that perceived racism throughout a lifetime relates to uterus inflammation, high blood pressure (duh), poor nutrient flow to the placenta (equaling low birth weight babies), and even when stress is low during pregnancy, when there is that lifetime of stress, the stress hormones add up and can still cause premature labor/babies. And it does. Racism over a lifetime effects birth outcomes.


    i.e. this is a social justice issue and not solely social service issue of racism in the medical system (which yes, is an issue). (and agreeing that therefore, minds need to be changed in so many ways)This is an excellent point it that it shoes that no matter how much nutrition counseling, or racist anti-smoking PSA’s happen, racism still matters!


    However, one promising point goes back to the midwifery model of care, and those amazing hour long prenatal appointments. Shafia Monroe is the founder and director of the International Center for Traditional Childbearing, and an amazing midwife. She does incredibly work against these issues, worldwide maternal health issues, puts on amazing culturally-relevant doula trainings, and is just a great personality. She has great outcomes, and feels that in the meantime the midwifery model can help compensate for that lifetime of racism induced chronic stress.


    If people are interested in showing this dvd, I know at least in Oregon the multnomah county health department women’s health initiate has copies they are happy to loan out, and the Portland libraries now have copies.

  • lineline

    to add to my own post – Many feminists would cringe at the idea that preconception health matters, as when this is discussed the vernacular easily becomes women as vessel, and the assumption that all women will bear children (all valid). HOWEVER, preconception health here, in terms of health effected by racism, is incredibly important. 

  • amie-newman

    Shafia Munroe’s talk and the documentary! I agree 100% that one mechanism for addressing racial health disparities, in the traditional health care system, is to look at other models of care – like the midwifery model. Unfortunately, midwifery care remains inaccessible to so many women in this country though that is certainly on the road towards changing. And this is an excellent reason to support federal licensure for CPMs and to include midwifery care in health care reform!

    The issue of racism causing the stress that then can result in poor birth and maternal health outcomes needs to be recognized as a crisis, as far as I’m concerned. 

    Thanks so much for the comment. I’m not sure where to go from here but I’ll take a deeper look into Shafia’s organization and the documentary for more information. As you note in your second comment, it’s critical that the feminist movement and the reproductive rights movement focus on these issues as equally important to women’s autonomy and equality as any other reproductive justice issue. 


    Amie Newman

    Managing Editor, RH Reality Check