Every expecting parent deserves the best health care experience for a healthy pregnancy and baby. Yet our health care system does not treat Black women and their babies equally. Many of the higher rates of poor birth outcomes experienced by African-American moms and babies, such as low birth-weight, premature births and even infant and maternal death, are due to implicit bias and structural racism in the health care system. We have to change the system today to protect tomorrow’s Black Legacy.
Black women are more likely to have premature births, regardless of economic factors, like income and education. College-educated Black women are more likely to give birth prematurely than White women with only a high school degree 1.
There isn’t a specific biologic reason for why Black women and babies are more likely to experience negative pregnancy and birth outcomes. New research has found that Black women experience “weathering 2,” or the long-term deterioration of their health not because of genetics or biology, but due to toxic stress in their environments.
Racial bias 3 within the health care system is contributing to the disproportionate number of pregnancy-related deaths among Black women. What does this look like? Research shows that health care professionals spend less time 4 with Black patients, ignore their symptoms, dismiss their complaints, and undertreat their pain. 5 This is often the result of implicit bias, which suggests that people, or health care providers, may act on the basis of prejudice and stereotypes without intending to do so6.
1. David RJ and Collins JW. (1997)
Differing Birth Weight among Infants of U.S.-Born Blacks,
African-Born Blacks, and U.S.-Born Whites. N Engl J Med 1997;
337:1209-1214 Retrieved from: https://www.nejm.org/doi/full/10.1056/NEJM199710233371706#t=article
2. Geronimus AT, Hicken M, Keene D, Bound J. (2006). “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health 96:826–33. Retrieved from: https://doi.org/10.2105/AJPH.2004.060749
3. Racial and ethnic disparities in obstetrics and gynecology. Committee Opinion No. 649. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e130–4.
4. Penner, L. A., Phelan, S. M., Earnshaw, V., Albrecht, T. L., & Dovidio, J. F. (2017). Patient stigma, medical interactions, and health care disparities: A selective review. In The Oxford Handbook of Stigma, Discrimination, and Health (pp. 183-201). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780190243470.001.0001
5. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America , 113 (16), 4296–4301. https://doi.org/10.1073/pnas.1516047113
6. Michael, B. (2015). Implicit Bias . Stanford Encyclopedia of Philosophy. Retrieved 1 July 2020, from https://plato.stanford.edu/entries/implicit-bias/.
Black infants in San Diego are nearly 3 times more likely to die than White infants. Based on comparison of African-American/Black and White 2013-2017 average infant mortality rates (8.3 vs. 2.9 deaths per 1,000 live births, respectively). Data from State of California, Department of Public Health, Center for Health Statistics and Informatics, Birth Cohort Statistical Master Files. Statistics prepared by County of San Diego, Health and Human Services Agency, Public Health Services.
Black infants in San Diego are nearly 60% more likely to be born premature and nearly 2 times more likely to be born with low birth-weight than White infants. Based on comparison of African-American/Black and White 2016-2018 average preterm birth rates (11.2% vs. 7.2%, respectively) and low birth weight rates. Data from State of California, Department of Public Health, Center for Health Statistics and Informatics, California Comprehensive Birth Files. Statistics prepared by County of San Diego, Health and Human Services Agency, Public Health Services.
California’s Black mothers are over 3 times more likely to die due to pregnancy or delivery complications than White mothers. Based on comparison of African-American/Black and White 2014-2018 average maternal and late maternal mortality rates (55.2 vs. 16.5 deaths per 100,000 live births, respectively). Data from Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, Division of Vital Statistics, Underlying Cause of Death 1999-2018 and Natality public-use data 2007-2018, on CDC WONDER Online Database. Accessed at http://wonder.cdc.gov on Jun 9, 2020
These disparities persist irrespective of factors such as the mother’s income or education. Based on comparison of African-American/Black and White 2013-2017 average infant mortality rates (8.3 vs. 2.9 deaths per 1,000 live births, respectively). Data from State of California, Department of Public Health, Center for Health Statistics and Informatics, Birth Cohort Statistical Master Files. Statistics prepared by County of San Diego, Health and Human Services Agency, Public Health Services.
San Diego’s Perinatal Equity Initiative (PEI) and its Black Legacy
Now campaign are working to raise awareness and compel action to
ensure we work together to reduce the inequities experienced by Black
women, babies and families, and ensure optimal pregnancies and birth
outcomes for all people while tackling issues such as structural
racism and inequality.
If you are expecting, or currently have a baby, you deserve the best care possible. Yet despite the same levels of education, insurance coverage, and preventive care, Black women are 3x more likely than White women to die during pregnancy and their babies are 60% more likely to be born premature. This is due to racial bias.
Until we eliminate systemic discrimination in health care, there are steps women and their partners can take to know their rights and ensure a healthy birth experience.
Resources and information are critical to building education about the role systemic racism and bias, particularly in health care settings, plays in contributing to poor outcomes such as low birthweight, premature birth, infant and maternal deaths in African Americans. Share them to further raise awareness and inspire action to end these inequities once and for all.
Share information about services, such as the Black Infant Health Program to expecting and current moms and get them connected to resources and care.
Are you a health care professional? Visit our Information for Health Care Professionals page for special calls to action.
For more reading and information, see below:
"Racism, not race, causes health disparities… "
Joia Crear-Perry, MD, Institute for Healing & Justice in Medicine.