Studies Plumb Depths of Black Maternal Health Woes

A black woman is 3.7 times more likely to die during pregnancy than a white woman and six times more likely to do so in some urban areas such as New York City.

Researchers at the Atlanta-based Centers for Disease Control and Prevention found college-educated black women twice as likely as other women to deliver premature or underweight babies. Scientists found subjects' birth outcomes resembled those of unemployed, uninsured white women with low education levels.

These are among the findings of five landmark reports released today by the Washington-based Joint Center for Political and Economic Studies that draw together existing data in a comprehensive review that calls for an end to the inequities.

The center concludes that African American babies--who are twice as likely as white infants to die before their first birthday--will have a better shot at life if the health inequities plaguing black mothers, such as less prenatal care and adequate nutrition, are corrected.

"The health disparities affecting African American women are nothing less than shocking, and we need to address the social causes behind them," says Alexine Jackson, board president of the Black Women's Agenda.

Stress, Racism, Poverty Implicated

The center's 19-member Courage to Love: Infant Mortality Commission--funded by the W.K. Kellogg Foundation and partnering with the UCLA School of Public Affairs and the University of Michigan's NIH Roadmap Disparities Center--says the health problems of black women and black infants stem not just from inadequate medical care but from stress, racism, poverty and other social pressures.

Released during the Congressional Black Caucus Foundation Annual Legislative Conference from Sept. 26 to 29, the reports also coincide with a meeting organized by the Joint Center and the Washington-based Black Women's Agenda for 250 representatives of black women's organizations in Washington, D.C. Attendees will discuss the reports and preview "Unnatural Causes: Is Inequality Making Us Sick?" an upcoming PBS television series that explores race and health.

In the five reports--one on breastfeeding, one on nutrition, two on infant mortality and one summarizing the others--commission members address the possible reasons for black women's negative birth outcomes.

Only 75 percent of African American women have prenatal care compared to 89 percent of white women.

Black women are more likely than their peers to have hypertension and diabetes, which can leave the fetus undernourished.

Although the American Academy of Pediatrics, in Elk Grove Village, Ill., says breastfeeding protects against ear infections, diarrhea and other health problems among infants--and though it recommends exclusive breastfeeding for the first six months of life--black women are 50 percent less likely to breastfeed than white or Hispanic women.

"Black women's eating habits also play a role," notes commission member Dr. Michael C. Lu, an associate professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA. "Only 1 in 4 African American women meets the recommended daily allowance for calcium, magnesium, zinc and vitamin E and 1 in 3 does not meet the RDA for iron and folate. Among low-income women, approximately 1 in 3 is anemic in the third trimester of pregnancy. And among low-income African American women, only 40 percent enter pregnancy with normal weight, and less than 30 percent achieve ideal weight gain during pregnancy."

Economic, Social Factors

Joint Center authors stress not only health factors, but economic and social conditions.

Black women are more likely to work part time and to go without health benefits. They are 20 percent more likely to be uninsured, and three times more likely to live below the federal poverty line.

Research shows black women are under more stress than their peers, and that stress can compromise the immune system, disrupt the hormonal balance and threaten vascular function.

The reports also implicate racism.

For instance, authors note recent studies at Chicago's Feinberg School of Medicine at Northwestern University find African American women who deliver pre-term, very low weight infants have a twofold greater lifelong exposure to racial discrimination than African American women who deliver full-term, normal weight babies. They cite a 2007 study from Atlanta's Spelman College in which black women agree racism is a source of the stress they cite as their "major" health risk.

"For black women, the effects of racism, sexism and class are multiplicative rather than additive," says Vijaya Hogan, director of the Health Disparities Curriculum at the University of North Carolina at Chapel Hill, who was not involved in the Joint Center reports. "Each increases the individual effect of the other and together they add up to more than the sum of their parts."

Contributions to Overall Crisis

Experts say the same problems causing poor birth outcomes for black women are likely contributing to an overall crisis in their health.

Black women are twice as likely as white women to be overweight, have heart attacks, develop diabetes or fail to get the recommended 30 minutes of exercise daily, reports the CDC.

They account for 72 percent of new AIDS cases even though they represent just 6 percent of the population, reports the Los Angeles-based Black AIDS Institute.

Their life expectancy is 69 years, eight years less than for white women, reports the Census.

Black-white health disparities explain why 40,000 African American women die of treatable causes each year, notes the office of the U.S. Surgeon General.

Authors of the center's reports call for better health care access and education to improve birth outcomes. They also call for sweeping social change such as legislation that will work to end economic and educational disparities.

On Sept. 29, the Chicago-based advocacy group African American Women Evolving is holding its own 100-member symposium on black women's health at Malcolm X College in Chicago.

"We need to pay attention to--and address--high infant mortality and other health problems affecting black women," says Gina E. Wood, deputy director of the Joint Center's Health Policy Institute. "This is broader than a medical issue. It's about the total environment--and the total life--of African American women."

Molly M. Ginty is a freelance writer based in New York City.