Black Motherhood: Why are the Black Babies Dying? Elizabeth O’Hare

Black Motherhood: Why are the Black Babies Dying?

Elizabeth O’Hare

For many women, pregnancy is an exciting time forawaiting and preparing for their

child. But, for black mothers, this time of excitementmay be filled with great fear because of the

risk and uncertainty of pregnancy. Blackwomen may be four timesmore likely than white

womento diefrom complications in pregnancyand their infants are two-and-a-halftimes as

likelyaswhite infantsto die before one year of life(Strait 39-53). Complex socioeconomic

factors most certainly play a role in the significant health inequalitiesbetweenwhite and black

mothersand their children, but these factors alone provide an incomplete picture of this disparity.

Authors have proposed the theory of “weathering” to describe the premature aging of black

women that contributes to disparities in maternal and infant health amongraces.

BlackAmericans are more likely than white Americans to suffer and even die from

multiple health complications, such as heart attack and diabetes and are increasingly suffering

from chronic illness(Division of Reproductive Health). Simons, et al describe that past studies

attribute the black-white health disparity to socioeconomic factors, proposing to resolve this

inequality by addressing the causes of poverty through humanitarian efforts and education. But

Simons, et al propose that although these efforts work in white communities, theyhave been

unsuccessful for improving black health. It is not only impoverished black Americans who are

affected, but even those in the middle and upper classes, indicating that the issue is not rooted in

economic standing alone and cannot be eradicated only through increased resources, although

these are necessary. Theanswer to thisinequality can be isolated by looking specifically at

prenatal care and infant healthfor black Americans. As John Strait describes, infant mortalityis

often used to compare health between demographics because it is indicative of social progress,

there are still large racial disparities in infant health and mortality, and the racial gap of infant

health has grown along with the concentration of extremely poor blacks into specific

communities(39-53). Therefore, studying maternal and infant health is beneficial to understand

racial inequalities as a whole.

The New York Times releaseda story in April 2018 about Simone, ablackmother of 2

boys, as well as a girl with whom she was pregnant. When Simone began experiencing severe

headaches, fatigue, and swelling, all symptoms of pre-eclampsia, she informed her doctor, who

repeatedly prescribed her to take copious amounts of Tylenol to make these symptoms go away.

But they persistedregardless of the Tylenol, and herdoctor did not seem concerned. Although

doctors are not expected to recognize and properly treat every disease state in a patient, pre

eclampsia has recognizable symptoms and is considered highly preventable (Nat’l Partnership

for Maternal Safety). Pre-eclampsia is a medical condition in which a pregnant woman has new

onset high blood pressure beginning after 20 weeks of pregnancy (Delivery Hospitalizations). If

not properly treated, itcan develop into eclampsia and the woman suffers from seizures, which

may lead to comatose and serious health complications, or even death, for both the mother and

baby (Delivery Hospitalizations). Simone’sdoctor should have recognized her symptoms as

something more than “par for the course” of pregnancy, but he did not seem to care enough to

show her compassion and provide her needed care. Although Simone sought out medical help,

she did not receiveadequate attention and care, as so manyother black mothers similarly

experience.

A 2017 study of Baltimore County hospitals found thatthere wasa significantly higher

risk for black mothers (p<0.022), and those with eclampsia (p<0.017) or high blood pressure

during pregnancy (0.001) to give birth to low birth weight (LBW)infants (Low Birth Weight). A

recent statistical brief in the healthcare cost and utilization project reported that black women are

almost 60% more likely than white women to develop pre-eclampsia and eclampsia during

pregnancy, at a rate of about 70 per 1000 deliveries (Delivery Hospitalizations). Not only are

black women more likely to suffer from these conditions, but their diagnosis is often likely to be

more severe, leading to harsher symptoms and a greater chance of morbidity and mortality

(Delivery Hospitalizations). Therefore, black mothers are not only more likely to give birth to

LBW infantsbecause they are at greater risk for pre-eclampsia/eclampsia, but also simply

because of their race. Similarly, the former study also found a significant correlation between

LBW infants and poor maternal education. In 2000, it was recorded that blacks are three times

more likely to live in “extremely poor neighborhoods” and experience long-term negative effects

from their impoverished conditions (Strait 39-53). It is not only unemployed and uneducated

blacks who live in these impoverished communities, but also those who are employed and well

educated(Strait 39-53). And Witt, et al found that, independent of other factors, the

neighborhood environment in which a black mother lives has an effect on birth weight and pre

term birth, as well as maternal health (1044-1051). Many black mothers, regardless of education,

are concentrated in the black impoverished communities and so are more likely to give birth to

LBW infants.

Returning to Simone’s story, the effects of black motherhood and racial healthcare

inequality are evident. Simone’s doctor repeatedly brushed aside Simone’s complaints of her

severe symptoms and ultimately gave herthe option of delivering her baby sixweeks early by C

section, seemingly only to conveniently fit his own schedule. In response, Simone felt that“it

was like he threw me away” (New York Times). It is not uncommon for black women to have C

sections, since they have an escalated risk of pre-eclampsia/eclampsia and about 60% of

pregnancies with these complications are delivered by C-section, almost double the rate of C

sections for pregnancies without pre-eclampsia/eclampsia(Delivery Hospitalizations). But

delivering a baby sixweeks early for conveniencewithout clear justification for early deliveryis

absurd. After turning down this offer, Simone returned home to her sons and abusive boyfriend,

the father of the child. Only 5 dayslater, her high blood pressure due to her (still undiagnosed)

pre-eclampsia caused the placenta of her daughter to detach from heruterus and sent Simone

rushing to the hospital with blood pouring from her cervix.

After giving birth to her still-born daughter, Simone said, “I felt like someone had taken

something from me, but also from them,” referring to her two sons who had lost their sister(New

York Times). The healthcare system continues to failto provide proper prenatal careto black

mothers. Simone’s words ring true forso many who have been failed by the healthcare system,

especially black mothers, who not only receive inadequate prenatal healthcare, but are

encouraged to seek abortions to end the life of their childrenbecause they feel that they have no

other choice. A recentstudy conducted by the Guttmacher Institute, Planned Parenthood’s

research wing, found that black women arealmostthree times more likely than white women to

obtain an abortion(Guttmacher Institute). Although this may be in part because of inadequate

healthcare and resources, Jason Riley, a writer forWall Street Journal, suggested that the main

reason abortion rates are so much higher among black women is because of unwed pregnancy. In

fact, in 2016, the CDC reported that 69.8% black births wereto unmarried women, compared

with 28.5% to white women. Like almost three-fourths of black mothers, Simone had to raise her

children and go through pregnancy without a husband, although she had an abusive boyfriend in

and out of her life during her pregnancy. Many black mothers feel that they have no choice other

than abortion because they lack the support and necessary resources to raise their children due to

unwed pregnancy, among other factors.

Furthermore, unwed pregnancy is not only increasing the fatalities of preborn black

babies, but also of black infants. A 2002 study conducted by the CDC indicated that the two

biggest contributing factors to black infant mortality were unwed motherhood and teenage

pregnancy [4]. In 1850, the black infant mortality rate was 340 per 1000, more than 50%higher

than that of white infants, which was 217 per 1000 [2]. The2002study reported that a black

infant is two-and-a-half times more likely to die before the first year of life than a white infant,

irrespective of maternal education, income, or other variables(Strait 39-53). As for age, the

percentage of births to black teenagers (29.3%), 15-19 years of age, was more than double that

for white teenagers (14.3%) [5]. Amongst these women, 59.6% of black mothers received WIC

food during pregnancy, compared to 26.2% of whitemothers and 63.3% paid for their delivery

with Medicaid, compared with 30.3% of white women, indicating differencesin socioeconomic

standing between races(Nat’l Vital Statistics). Yet, even in light of differences in healthcare

paymentand economic standing, a 1997 study found that higher maternal income did not have a

direct impact onblackinfant mortality, whereas white infant mortality decreased with higher

family income(Strait 39-53). Although this study did not account for all variables and is

somewhat incomplete, according to Strait, it is, nevertheless, significant that increased income

had no clear positive effect on black infant survival as it did for white infants. This indicates that

there is more to account for in assessing black infant death than family income alone.

It is well-known that infant morbidity and mortality increase significantly with pre-term

birth and low birth weight (LBW; <2500 g) or very low birth weight (VLBW; <1500 g) [6,8]. In

fact, LBW in the U.S. is one of the leading causes of infant death, with mortality 24 times higher

in LBW infants than those of normal weight (>2500 grams)(LBW Deliveries). Studies have also

shown that black women and impoverished women are at greater risk for pre-term delivery and

for giving birthto LBW/VLBW infants(Maternal Weathering, Neighborhood Disadvantage).

The risk for pre-term delivery is highest in adolescents and older women, significantly increasing

with age. In her theory of “weathering” or “accelerated aging,” Geronimus hypothesizedthat not

only does reproductive ability decline as a woman’s health declines with age, but also that black

women are more susceptible to early aging and health decline because of intense socioeconomic

pressure and discrimination. Simons, et al describe that, “The weathering hypothesis views the

elevated rates of illness and disability seen among Black Americans as a physiological response

to the structural barriers and daily slights, stereotypes, and other threats to one’s identity that

comprise the Black experience.” They propose that the unremitting racial discrimination

experienced by black Americans leads to chronic inflammation, which is highlycorrelated with

chronic illness. Therefore, black women face pregnancy complications such as mortality and

LBW earlier and more often than white women because they age sooneras a result of the intense

stress, pressure, and discrimination to which they are constantly subjected. Various other factors

attribute to this early aging, among which are inadequacies and inequalitiesin healthcare for

black women and infants, obstacles to healthy living, exposure to environmental pollutants, and

stress imposed by the woman’s environment (i.e. abuse, discrimination, and lack of support)

(Maternal Weathering).

Holzman, et alconducted a study to test the weathering hypothesisby comparing pre

term delivery rates among mothers of different races and high-risk behaviors(smoking during

pregnancy): non-smoking black mothers, smoking black mothers, non-smoking whitemothers,

and smoking whitemothers (Maternal Weathering). They used smoking as an indicator of high-

risk behavior not only because it is dangerous for fetal health, but also because they assumed it

may be used as a coping mechanism for mothers in difficult situations, and therefore potentially

suggestive of other high-risk behaviors and unhealthy lifestyle. They found that black smoking

mothershad significantlyhigher rates of pre-term deliveries and aged at accelerated rates,

therefore supporting the weathering hypothesis and indicating that black women are more likely

to have pre-term deliveries because of premature aging. This premature aging puts both the

mother and her children at much higher risk for pregnancy complications associated with age.

The premature agingof black women due to chronic stress and discrimination is a clear

example of the pervasive racism that still exists within the United States, and in many other parts

of the world. Black mothers and their babies are dying because of a racial inequality that is so

intense it causes their bodies to break down soonerand age more rapidlythan white women. This

weathering cannot be explained only bysocioeconomic factors, although these do play a

significant role in maternal and infant health, but speaks to a greater problem ofracism and

discrimination. Black mothers who endure the increased risk of death in pregnancy then face a

greater risk of losing their infants, and so often turn to abortion to escape these risksand the

burdens of unwed motherhood. Addressing the disparities between black and white mother and

infant mortality will require dramatic changes to provide the necessary resources for childrearing

and to lower the many contributors and stressors thatcause weathering in black women.

Works Cited

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