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/.

3x

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.

60%

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.

3x

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.

Jabrasia, Dorian, and Ahliyah, El Cajon

Role of Structural Racism  

“Laws have kept Black people from freedom, from voting, from education, from insurance, from housing, from government assistance, from health care, from shopping, from walking, from driving, from breathing…”
– Professor Ibram X. Kendi, Founding Director of the Boston University Center for Antiracist Research and one of America’s leading antiracist voices 1.

Structural racism is a system of policies, rules, and laws that produce and reproduce relentless, race-based inequities. More specifically, structural racism is the normalization and legitimization of historical, cultural, institutional and interpersonal injustices that routinely privilege and advantage whites, while producing long-term adverse outcomes for African Americans and other people of color. Structural racism is not something that a few people or institutions choose to practice. Instead, it has been woven into the fabric of the U.S. and is a feature of the social, economic and political systems in which we all exist 2.

Structural racism in health care means that African-American women receive poorer quality of care than white women. It means the denial of care when African-American women seek help when experiencing pain, or when health care providers fail to listen to them, include them in decisions about their care, and treat them with dignity and respect 3. Structural racism has led to poor birth outcomes such as premature birth, low-birthweight babies, or worse – maternal or infant death – for African Americans at much higher rates than whites. In addition, African-American women experiencing the effects of structural racism over the course of their lives are subject to higher rates of toxic stress. Toxic stress is stress resulting from strong, frequent or prolonged adversity – such as racism and discrimination, extreme poverty, neglect, depression, exposure to violence, and emotional or physical abuse, among others. When this type of stress is constant, it becomes “toxic” to the body and leads to many physical, mental, and emotional health problems, and can put a mother and her infant at risk for poor birth outcomes.4

1. Kendi, I. X. (2017). Stamped from the beginning: The definitive history of racist ideas in America. Random House.
2. The Aspen Institute. Accessed online at: https://www.aspeninstitute.org/blog-posts/structural-racism-definition/
3. Taylor J, Novoa C, Hamm K and Phadke S. “Eliminating Racial Disparities in Maternal and INfant Mortality: A Comprehensive Policy Blueprint”. (Washington: Center for American Progress 2019). Available at: https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/.
4. Alio, A. (2017). “Toxic Stress and Maternal and Infant Health: A Brief Overview and Tips for Community Health Workers.University of Rochester Medical Center, NYS Maternal & Infant Health Center of Excellence. Accessed online at: https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/finger-lakes-regional-perinatal/documents/Toxic-Stress-_27June2017_Final.pdf

Jabrasia, Dorian, and Ahliyah, El Cajon

Now is the time to change these alarming trends and preserve San Diego’s Black Legacy Now.

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.

Know Your Rights

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.

Take Action

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.

Additional Reading and Resources

For more reading and information, see below:

"Racism, not race, causes health disparities… "

 

Joia Crear-Perry, MD, Institute for Healing & Justice in Medicine.