Racial disparities in HealthCare

Mamas on Bedrest: Why I Can’t Tolerate The US Infant Mortality Rate

September 14th, 2011

Mamas on Bedrest, I can’t tolerate the fact that more black babies die in infancy than babies of other racial backgrounds. It sickens me. It angers me! It makes me want to cry. As a mama of two beautiful black children, the thought that simply by being African American their lives were at risk in their infancy is horrifying. I am lucky, I know. I have a husband who has single handedly supported our family financially while I was pregnant and beyond. I had the best healthcare. We live in a wonderful residential area and I don’t smoke or do drugs. Yet I still lost 2 children and my daughter was a preterm infant of low birth weight. What’s up?

September is Infant Mortality Awareness Month. We define infant mortality rate (IMR) as the number of deaths of infants under one year old per 1,000 live births. This rate is often used as an indicator of the level of health in a country. According to Index Mundi, the current IMR for the United States is 6.06/1000 live births. The breakdown is male: 6.72 deaths/1,000 live births, female: 5.37 deaths/1,000 live births and these numbers, from the CIA World Factbook, are accurate as of July 12, 2011.

Infant Mortality is often used as an indicator of the overall health of a nation. Looking at these numbers, things look pretty good for the US. But once you start looking “behind the numbers” things get a little sketchier. The United Nations lists infant mortality rates of most of the world’s countries. On this list, the US ranks 34th among nations of the world, and amongst industrialized nations and many of our “western” allies, we rank dead last. Suddenly things aren’t looking quite so rosy.

But we’ve improved. According to the Department of Health and Human Services,

“Overall, the nation’s infant mortality rate has fallen from 20 deaths per 1,000 live births in 1970 to 6.9 deaths in 2003 (preliminary data). The 2002 rate of 7.0 deaths, based on complete data, was higher than the 2001 rate (6.8), but has fallen 8 percent since 1995 and 24 percent since 1990. In 2002, the leading causes of infant mortality were congenital anomalies, disorders related to immaturity (short gestation and unspecified low birthweight), SIDS, and maternal complications.”

The most discouraging fact about infant mortality in the US is that it varies tremendously across racial groups. African American infants have an infant mortality rate of more than twice that of  Caucasian and Hispanic infants. African American women, especially teenagers, are more likely to start prenatal care late in the first trimester or beyond and this is a known risk factor for increased infant mortality. The DHHS reports that for mothers 15 to 19 years of age, 29 percent received no early prenatal care in 2004.

According to the DHHS, there are 3 steps that we can implement now to lower infant mortality in the US and to narrow the gap amongst the racial groups.

  1. Promoting Access to Prenatal and Infant Care – Babies born to mothers who received no prenatal care are three times more likely to be born at low birth weight, and five times more likely to die, than those whose mothers received prenatal care. They also support a number of programs designed to improve access to care including Healthy Start, Medicaid/SCHIP programs, Prenatal care hotlines and immunization programs.
  2. Promoting Healthy Choices of Known treatments and behaviors that will lower infant risk – DHHS has promoted and implemented many programs proven to increase infant mortality. In particular, DHHS has be a staunch supporter of Maternal and Child Health Services (MCH) Block Grant (Title V). HRSA provides block grants to states to develop service systems to meet critical challenges in maternal and child health, including reducing infant mortality. These state efforts are developed with careful attention to Health Status Indicators and National Performance Measures, among them those that emphasize the importance of adequate prenatal care in improving the health of pregnant women and reducing infant mortality. In an average year, about 60 percent of U.S. women who give birth receive services through MCH programs.
  3. Increasing Research into the causes and potential cures of infant mortality – In addition to a myriad of research projects addressing specific causes of infant mortality, The Centers for Disease Control and Prevention is examining sociocultural, behavioral and environmental factors, including stress and social support, related to preterm births among African-American women in Harlem, N.Y., and Los Angeles, CA to try to get to the root issue causing the racial disparities in IMR.

Mamas on Bedrest are always in my mind when I read such reports because your pregnancy complications put you and your babies at risk. I think we all have to ask the questions, are we doing absolutely everything to ensure that pregnant women receive all the support and resources that they need to gestate and give birth to healthy babies? In my opinion, the answer is “No”. When a mama on bed rest has to worry about her job, feels forced to leave her bed and risk her child’s life in order to keep her job, is unable to meet her financial obligations and/or cannot access or afford much needed medical care for herself and her baby then we as a nation have failed her and her baby.

The US can redeem itself and lower its infant mortality rate. But it will require that we place the health and well being of mamas and babies before grandstanding, posturing and “political games of chicken” in our legislature. We have to impress upon our legislative leaders that our infant mortality rate is unacceptable and that disparities in IMR amongst infants of different racial backgrounds is also unacceptable. Speak up mamas! Your voices need to be heard! Your stories need to be told! Change will only happen when we demand it and refuse to settle for anything less than the absolute best for ourselves and our children. I won’t tolerate it. Will you?

References:

Preventing Infant Mortality: Fact Sheet The Department of Health and Human Services