Did you know that September is Infant Mortality Awareness Month?
Globally, The United States spends more on healthcare than any other country. Yet, it has worse birth outcomes than many other countries globally. Despite recent declines in infant mortality, the United States ranked 26th among the 29 Organization for Economic Co-operation and Development (OECD) countries in 2010, behind most European countries as well as Japan, Korea, Israel, Australia, and New Zealand (1). The U.S. infant mortality rate of 6.1 infant deaths per 1,000 live births was more than twice that for Japan and Finland (both 2.3), the countries with the lowest rates. Twenty-one of the 26 OECD countries studied had infant mortality rates below 5.0.
Overall in the United States, white infants die at a rate of 5-6/1000 births and Hispanic infants have a similar infant mortality rate. African American Infants die at a rate of approximately 11.4/1000 births. I’m here in Texas and our infant mortality rate for white and hispanic infants is 5.5/1000 births while it is 11.4/1000 for African American Infants. In Travis County (the Greater Austin Area where I live), African American Infants have an infant mortality rate of 11.5/1000 births, whereas white infants have an infant mortality rate of 3.7/1000 births and Hispanic infants 6/1000 births.(2) What is the cause of this disparity?
Researchers and public health officials have numerous speculations as to why the IMR for African American infants is so poor,
- Delayed initiation of prenatal care among African American women
- Lack of access to quality prenatal care
- Lack of insurance
- Preterm labor/Prematurity
- Low birth weight
- Birth Defect
- Maternal health complications
However Dr. Michael Lu, an obstetrician and gynecologist at the David Geffen School of Medicine at UCLA and a professor in the Department of Community Health Sciences and the Center for Healthier Children, Families and Communities at UCLA School of Public Health has proposed other reasons for the birth outcome disparities. In his groundbreaking research paper “Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach“ (3) Dr Lu and his colleagues point to systemic racism in American culture as the underlying cause of the birth outcome disparities. Lu and his colleagues point out that racism passed down through generations, as well as repeated racial slights in the daily lives of African American women has created an allostatic load of stress on African American women that is affecting their overall health, but in particular, their reproductive health and causing the negative birth outcomes we see in African American women and infants. To address these social determinants of health, Lu and his colleagues propose a 12 point Life-Course approach to closing the racial gap in birth outcomes.
- Provide Inter-conception care for women with prior adverse pregnancy outcomes
- Increase access to preconception care for African American women
- Improve the quality of prenatal care for African American women
- Expand healthcare access over the life course for African American women
- Strengthen father involvement in African American families
- Enhance systems coordination and integration for family support services
- Create reproductive social capital in African American communities
- Invest in community building and urban renewal
- Close the education gap
- Reduce poverty among African American families
- Support working mothers and families
- Undo Racism
Lu and his colleagues have presented an approach that not only address issues surrounding pregnancy and childbearing, but also addresses the social issues affecting African American families and communities. Lu makes some very bold statements, ones that some people may be loathe to accept and even less likely to act upon. But as Lu says in his publication,
“We will not close the Black-White gap in birth outcomes without political will to do so. Political will is the ability to command resources to make things happen (i.e. implement the 12 points).”
As the saying goes, “Where there is a will, there is a way!” The question now becomes do we the American people have the will, the actual desire to close this gap?
MacDorman MF, Mathews TJ, Mohangoo AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe, 2010. National vital statistics reports; vol 63 no 5. Hyattsville, MD: National Center for Health Statistics. 2014.
Austin Travis County Health and Human Services Department. Infant Mortality Rate Causes of Death for Travis County, 2000-2011. Data Source, Center for Health Statistics, Texas Department of State Health Services. Texas Behavioral Risk Factor Surveillance System (BRFSS) 2011-2012
Lu, M.C., MD, MPH, Kotelchuck, M., PhD, MPH, Hogan, V., DrPH, Jones, L., MA, Wright, K., PhD, MPH, Halfon, N., MD, MPH. “Closing The Black-White Gap in Birth Outcomes: A Life-Course Approach” Ethnicity and Disease, Volume 20, Winter 2010.
Seldom do I revert to childish gloating, but occasionally I just have to go there. Such is the case as I am gleefully reading the report put out by the US Centers for Disease Control and Prevention utilizing data from the National Center for Health Statistics which shows that Black fathers are just as engaged-if not more so-in the rearing and support of their children than fathers of other races.
Excuse me while I take a moment to gloat.
“Ha! Told yaaaaaaa!!”
“Na na na na na, you were wrong!!!!!”
Now you may be wondering why I am so over the moon about this research? Well, there are several reasons.
1. I am sick to death of hearing how black men are no good, they “hit it and quit it” and don’t take responsibility for the children that they help create.
2. I am sick and tired of hearing that all the ills of the world are because of black men.
3. I am thoroughly done with the portrayal of black men-black people actually-as uncivilized and bringing down the status of US culture globally.
4. And I am beyond through with this nation feeling that it is okay to kill a black male simply because he is present in time and space!
Now you all may be wondering, “What in God’s name does any of this have to do with high risk pregnancy and bed rest??” Well, it has everything to do with it. As I have often reported, African American women and infants have the worst birth outcomes of any other race or ethnicity in the US, with 2-4 times the morbidity and mortality of women and infants of other races and ethnicities. An African American infant is more than twice as likely to die before its first birthday than infants of other races and ethnicities and this is due primarily to preterm birth!!!
Are you following me yet?
Let me continue. Ever since I can remember and at least for my adult professional life “the party line” regarding the black family has been,
“It’s the breakdown of the black family, and the absence of black fathers in particular, that is the cause of the high maternal and infant morbidity and mortality that exists amongst African Americans.”
As an African American, and now as a divorced single mama, I knew that isn’t at all the case but had no way of substantiating what I knew to be true. Now there is concrete data obtained by one of the most reputable scientific bodies in the United States that has shown what many of us African Americans already knew. Yes, many more African American children are born to and/or raised by “single” mothers, but what this study has shown is that while the parents of a child may not be married, they may in fact be together (co-habitating) and even if they are not living together, African American fathers are intricately involved in the rearing of and support (and here I do mean financially) of their children, in many cases more than White or Latino fathers.
So again you may be asking, “What does this have to do with preterm labor and infant mortality?” Stay with me.
There is a lot going on in the United States as regards race and quite frankly none of it is good. We have all seen and heard the news reports of police shooting unarmed African American men, racial profiling of both African American men and women, disparities in discipline for African American School Children and so on and so on and so on. These are daily facts of life, daily stressors for African American women, and daily stressors for the infants they are carrying. Additionally, poverty for all families is reaching heights not seen since the great depression and other times in our history. The unemployment rate is still teetering on the high side and looms highest amongst African American men. More depressing is the fact that people of any race with higher educations are now just as likely as those with little to no education to endure a prolonged time of unemployment, and those numbers are again higher for African American men. This amounts to markedly elevated stress for African American men and African American women, their partners. Stress, as well as poverty, is not good for anyone, but particularly not good for pregnant African American women and the infants that they are carrying. We know that stress is an independent risk factor for preterm labor, prematurity and low birth weight all areas in which African Americans have the highest rates. So I think that it is safe to say that poverty, unemployment and racism are far strong predictors and stressors on maternal and infant morbidity and mortality in African Americans than “absentee dads”.
Now I know that many of you are going to come right back at me and say, “But what about black on black violence? What about the crime rates in predominantly black neighborhoods? And we know that many African American men abandon their family responsibilities.” Agreed. But the data from this study, which was broad and the study well constructed, shows that despite all these negative influences, African American men continue to be hands on fathers, and at greater rates than white or Latino fathers.
I wholeheartedly admit that there is much that needs to be done within my culture to heal it. But let’s not look astray too much to lay blame. Much of what we see in these urban, depressed areas is poverty; boarded up buildings, non-existent stores and services, poorer schools and no revenue coming into these areas. Add to that no jobs, no way for people in these areas to support themselves and their families, no money, leads to crime and yes, homicides. Is it okay? No. Is it an excuse? Of course not. But let’s consider the fact that if people in these areas had jobs, income and ways in which to support and sustain their families, then, according to data from the CDC again, crime rates would in fact go down and quality of life would go up.
But I myself have veered a bit off topic. The bottom line is this-even in depressed economic times, even in economically depressed communities, even when jobless, even with the threats to their lives black men are taking care of their children. Contrary to the sensationalized news reports and the stereotypic depictions on television and in movies, black men are taking care of their children-their families. The question now becomes, how can we as a culture, as a nation give them a hand so that this can continue? What are we as a nation, as a culture doing to reduce poverty, increase jobs, increase opportunities for education so that not just black men, but all men, can have the means to raise and support their children?
Finally, we have to ask the question, “Have we too narrowly defined “family”? We know from this work that there are men and women living together and raising their children but not married, or married and helping to raise their spouse’s children. Aren’t they still a family? What about blended families? Large extended families? This is all data that is yet to be analyzed-or even obtained. We know that African Americans being of the African diaspora are a “tribal” people. Migration and dispersion-both voluntary and involuntary-has also played a role in the depressed socioeconomic status of African Americans resulting in decreased community support for families. How are we as African Americans going to re-establish our communities and our families going forward?
There are many unanswered questions and I am sure that many more studies will come about, but what we do know is this: African American men are supporting their children and its time to toss out the stereotypes of them as “absentee fathers” and do what we can to support their efforts and the efforts of all men who want to be active parents to their children.
Jo Jones, Ph.D., and William D. Mosher, Ph.D., “Father’s Involvement With Their Children: United States, 2006–2010”. National Health Statistics Report, Number 71, December 20, 2013
The Causes of Infant Mortality-The US Centers for Disease Control and Prevention
African-American Women and Their Babies at a Higher Risk for Pregnancy and Birth Complications–The US Centers for Disease Control and Prevention
Black Unemployment Rate 2015: In Better Economy, African-Americans See Minimal Gains–International Business Times.
Murry, V. M., Brown, P. A., Brody, G. H., Cutrona, C. E. and Simons, R. L. (2001), “Racial Discrimination as a Moderator of the Links Among Stress, Maternal Psychological Functioning, and Family Relationships.” Journal of Marriage and Family, 63: 915–926. doi: 10.1111/j.1741-3737.2001.00915. x
The Absent Black Father Myth Debunked-by CDC–The Daily Kos
Mamas on Bedrest: Can routine cervical measuring and treatment with progesterone as indicated reduce and/or eventually eliminate bed rest?January 6th, 2015
Hello Mamas and Happy New Year!!!
Right before we all took a much anticipated holiday break, The Society for Maternal-Fetal Medicine (SMFM) added their voice to those of The American Congress of Obstetricians and Gynecologists (ACOG), The American College of Nurse Midwives (ACNM), The March of Dimes, Medicaid and The Perinatal Research Branch of the Eunice Kennedy Shriver Institute to recommend that preterm birth risk screening include cervical length measurements and for those women at increased risk, treatment with progesterone injections.
Why is this important? Well, if you visit our Facebook page, you will notice that a large number of the mamas in our community are on bed rest for cervical insufficiency or incompetent cervix. Cervical insufficiency is one of the leading causes of preterm labor in the US and one of the leading causes of infant mortality (infant death). The United States ranks 55th globally in infant mortality, with 26,000 infants dying annually before their first birthdays. This is a horrendous and utterly embarrassing statistic given that the US is one of the richest countries in the world with some of the most advanced health care, yet we can’t seem to save our babies. What is worse, infant mortality in the United States for African American babies is twice that of Caucasian babies, so deaths among little black infants is disproportionately high in the US.
But despite all this doom and gloom, the upside is that all of these medical societies have looked at the data as well as at available treatments and they have all come to the same conclusion: If there is more screening for preterm labor in pregnant women-measurement of the cervix and in those women at risk, the initiation of progesterone injections-the rates of preterm labor can be reduced 40-50% in mamas having just one baby and no prior history of preterm birth. And if every pregnant woman is screened for shortened cervix and those at risk identified and started on progesterone shots, medical costs associated with preterm labor, premature birth and subsequent medical and developmental support could be reduced by $750 million annually. Given that preterm labor and prematurity currently costs the US in excess of $26.2 billion annually, this is substantial savings. All of the medical societies are also in agreement that if a woman is noted to have a shortened cervix and is less than 24 weeks gestation, she should have a cerclage (a surgical stitich placed to hold the cervix closed) placed.
Preterm labor and prematurity are major issues in Maternal and Infant health and the leading cause of infant death before one year in the United States. If by simply screening and measuring cervical length early on with ultrasound and providing treatment with progesterone and cerclage can reduce preterm labor and prematurity and save the lives of babies, then we should be adopting these recommendations.
The elephant in the room for us here is will these practices negate the need for prescribed bed rest? That subject was not addressed in these recommendations, however, many of these same professional medical societies are recommending that bed rest not be routinely prescribed due to the negative effects that is has on Mamas’ bodies. So it will be very interesting to see how these recommendations are implemented and their effect on the overall preterm labor and prematurity rates. My guess is that if rates start dropping, we my in fact see a reduction in the bed rest prescription. Now wouldn’t that be exciting???
Mamas, share this information with your health care providers and see what they have to say. If you’ve been screened for a shortened cervix and started on progesterone, let us know in the comments section below. We would love to share the journey with you (join our Facebook Community!!)! And if you are prescribed the progesterone and/or cerclage without bedrest, do let us know how you fare and when you deliver your baby.
Society for Maternal-Fetal Medicine Joins with Other Organizations to Brief Congress on Need for Medical Protocols that will Save the Lives of Infants in the US by Reducing Preterm Birth. (Press Release December 17, 2014, Washington, D.C. Society for Maternal-Fetal Medicine. www.smfm.org