Racism Kills Us in Many Ways: High Maternal and Infant Death Rates among African Americans

Written by Sureshi Jayawardene and Serie McDougal

“African American mothers are dying at three to four times the rate of non-Hispanic white mothers, and infants born to African American mothers are dying at twice the rate as infants born to non-Hispanic white mothers.” This is a statement made in the Center for American Progress’s (CAP) recent report exploring the high rates of infant and maternal deaths among African Americans. Although some have suggested that the problem could be explained by Black mothers’ greater likelihood of being poor and less educated compared to White women, they found that this trend remained true across socioeconomic and education levels. Whatever their backgrounds, all African American mothers share experiences of racial and gender discrimination, which recent research shows, induces stress that can affect infant and maternal mortality. Even with notable Black women like Erica Garner and Serena Williams, pregnancy-related complications played a role in their own health. In Garner’s case, the two heart attacks she suffered after the birth of her son in August 2017 ultimately took her life at the end of that year. For the relatively powerful, healthy, and wealthy Serena Williams, while her pregnancy itself was easy, her daughter was born by emergency C-section because Williams’s heart-rate fell dramatically low.

Currently, maternal and infant mortality rates in the US represent a significant racial disparity. This racial gap has been consistent since the government and hospitals began collecting this data more than 100 years ago. According to CAP, in more than 50 years, not much has changed. It is the higher rates of preterm births and low birth weights among African American women that drives this gap.
 
CAP discusses how the typical risk factors such as physical health, socioeconomic status, prenatal care, and maternal health on their own are insufficient to explain the high incidence of the high rates of infant and maternal death among African Americans. Turning their attention to the role that racism plays in these outcomes, CAP concludes that chronic exposure especially during sensitive periods in early development can better explain these rates for African Americans. There are distinct developmental trajectories that set African American women apart from other racial groups, especially non-Hispanic Whites. According to CAP, “the social and economic forces of institutional racism set African American and non-Hispanic white women on distinct life tracks, with long-term consequences for their health and the health of their future children.” Some of these developmental setbacks experienced by African American families compared to non-Hispanic White families include:

• Housing/Families:
  • Fewer adequate housing options, despite being equally qualified when comparing income levels and credit scores
  • Greater likelihood of experiencing housing instability and eviction
  • African American girls are more likely to live in substandard housing with environmental toxins such as lead during childhood
• School:
  • African American girls experience a greater likelihood of suspension or expulsion, despite similar behaviors to non-Hispanic White girls
• Workforce:
  • African American women earn only 63 cents for every dollar earned by White men
  • More likely than White men and women to work in jobs that lack structural support such as flexible scheduling, paid sick days, and paid family leave
  • 72% of African American women are single heads of household, increasing the likelihood of stress

 
The “life course perspective” is a necessary and important intervention in this area of research because the experience of systematic racism produces profound and lifelong effects for African American families. The relationship between racism and the life span can also be explained using data for Black immigrant women—from the Caribbean and the African continent—who arrive in the US as adults and experience better birth outcomes than native-born African American women. For native-born African Americans, the continuous experience of racism can lead them to experience symptoms of post-traumatic stress disorder (emotional stress, physical harm, and fear) (Evans, Hemmings, Burkhalter, & Lacy, 2016).  Racism can cause African Americans to evaluate themselves negatively based on externally imposed standards which can lead to depression.  African American women must face gendered racism targeted at them because they are Black women.  Experiencing this stress can lead to frustration, anger, hopelessness, and hypertension.  Physiologically, it can increase cortisone levels in a pregnant mother, which can: trigger labor and/or cause inflammation restricting blood flow to the placenta and stunting infant growth (Carpenter, 2017).  According to Carpenter (2017) it is not just racial stress experienced during pregnancy, “stress throughout the span of a woman’s life can prompt biological changes that affect the health of her future children. Stress can disrupt immune, vascular, metabolic, and endocrine systems, and cause cells to age more quickly” (p.14).
 
Addressing this problem requires moving beyond a deficit approach that focusses almost exclusively on Black women’s health choices and behaviors and genetic factors.  Advocacy movements such as Black Mamas Matter Alliance and the National Birth Equity Collaborative are making strides in raising public awareness through racial and reproductive justice campaigns. Despite these efforts, there needs to be more research that uncovers better data on Black women’s health disparities alongside more continuous, systematic reviews of maternal and infant death. CAP suggests comprehensive, nationwide data collection on maternal deaths and complications, research that substantiates the mother’s health before, during, and between pregnancies, data sets that include information about environmental and social risk factors, assessment and analyses on the impact of overt and covert racism on toxic stress, research that identifies best practices and effective interventions for improving the quality and safety of maternity care, and research to identify effective interventions for addressing social determinants of health disparities. We at Afrometrics support these recommendations and add that what is needed is a culturally relevant research program that not only examines more critically the role that racism plays throughout the life span, but also accounts for the specific cultural values and needs of African American mothers.
 
 Works Cited
Carpenter, Z. (2017). “Black births matter.” The Nation, 304(7), 12-16.

Evans, A. M., Hemmings, C., Burkhalter, C., & Lacy, V. (2016). “Responding to race related trauma: counseling and research recommendations to promote post- Traumatic growth when counseling African American males.” Journal of Counselor Preparation & Supervision, 8(1), 78- 103.

Lambert, S., Robinson, W., & Ialongo, N. (2014). “The role of socially prescribed perfectionism in the link between perceived racial discrimination and African American adolescents’ depressive symptoms.” Journal of Abnormal Child Psychology, 42(4), 577-587.