Racism and infant mortality in more detail
For those who came in late: even if you take into consideration other factors such as income, education, and genetics, the Black infant mortality rate in the US is still higher than for other groups. What's the missing factor? The review article I summarised earlier cited four journal articles which found a link between infant mortality and Black mothers' personal, direct experience of discrimination.
I was able to get hold of all four journal articles. Let me try my best to summarise them. Very briefly: multiple studies have found that premature birth, and low birthweight, are more likely for African American mothers who report having personally experienced high levels of discrimination.
Sarah Mustillo et al. Self-Reported Experiences of Racial Discrimination and Black-White Differences in Preterm and Low-Birthweight Deliveries: The CARDIA Study. American Journal of Public Health 94(12) December 2004 pp 2125-2131.
The Coronary Artery Risk Development in Young Adults followed thousands of Americans over a period of years. Participants "completed a discrimination questionnaire asking them whether they had 'ever experienced discrimination, been prevented from doing something or been hassled or made to feel inferior... because of their race or color' in any of 7 situations: 'at school, getting a job, at work, getting housing, getting medical care, on the street or in a public setting, and from the police or in the courts.' Even when other factors (depression, smoking, alcohol, education, income, marital status, etc) were taken into account, for mothers who reported experiencing discrimination in at least three of these situations, premature births were 3.1 times as likely, and low birthweight was 5 times as likely.Collins, James W. et al. Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination. American Journal of Public Health 94(12) December 2004 pp 2132-2138.
After I wrote my summary, I found the article available online! it's here:
http://www.ajph.org/cgi/reprint/94/12/2125.pdf
This three-year study involved hundreds of Black mothers in Illinois. "All participants were asked their lifetime and pregnancy exposure to interpersonal racial discrimination in 5 domains: at work, getting a job, at school, getting medical care, and getting service at a restaurant or store... Current or recently employed participants were asked an additional 20 questions about their lifetime and past year's experiences with interpersonal racial discrimination at their primary place of employment."Dole, Nancy et al. Psychosocial Factors and Preterm Birth Among African American and White Women in Central North Carolina. American Journal of Public Health 94(8) August 2004, pp 1358-1365.
Marital status, income, Medicare status, prenatal care, and alcohol made little difference; smoking and greater age made a slight difference; but high levels of racial discrimination over the mother's lifetime meant 3.2 times the chance of a very low birthweight. Adjusted for maternal age, education, and cigarette smoking, the chance of VLBW was 2.6 times as high. The strongest effect was seen in women experiencing discrimination in finding a job or in the workplace.
The researchers note: "The frequency of lifetime reported incidents of interpersonal racial discrimination in at least 1 domain was 40% among our control subjects. If we take this frequency as an accurate estimate for the general population of urban African American women, then exposure to perceived racial discrimination is a common risk factor. This estimate is consistent with published prevalence rates."
Available here: http://www.ajph.org/cgi/reprint/94/8/13
I'll leave this one for you to look at online, but in a nutshell: "African American women who reported high levels of perceived racial or gender discrimination were more likely than those who reported lower levels to deliver preterm."Stancil T R; Hertz-Picciotto I; Schramm M; Watt-Morse M. Stress and pregnancy among African-American women. Paediatric and perinatal epidemiology 2000;14(2):127-35.
Finally, the review cites this earlier study from 2000, in which "preliminary analysis" found a link between racism, stress, and infant mortality, and recommends further research. The abstract is available online here: http://www.ncbi.nlm.nih.gov/pubmed/10791655
In turn, these journal articles cite dozens of further studies which support the link between racial discrimination, stress, poor health, and infant mortality. (I'll try to get hold of some of those as well.) In the face of all this evidence, it becomes hard to deny that African American women are still directly experiencing racial discrimination, in all walks of life, and that it's causing real harm.
As I said earlier, the relentless atmosphere of threat, insult, frustration, and unfairness, I experienced during high school damaged my mental and physical health, as is typical of targets of bullying. So to me it makes perfect sense that the lifelong and far greater pressure on Black women would damage their health and their babies' health. The main cause of Black infant deaths is premature birth, associated with low birthweight; premature birth and low birthweight are linked to stress, which affects the immune and endocrine systems and blood pressure; stress is caused by racial discrimination. It's logical, but more importantly, the evidence supports it.
You may be thinking something like, "But these are self reports of perceived discrimination. What if some (or all!) of it is just paranoia, or imagination, or oversensitivity, or a mistake?" The thing is, the amount of discrimination reported is consistent across multiple studies. The CARDIA mothers reported the same amount as the CARDIA participants taken as a whole; the CARDIA participants and the Illinois study participants reported the same amount as in other studies. With so many studies producing the same figures, it becomes hard to believe that the discrimination can be explained away as incorrect perceptions.
(Visitors please note: I have a science degree, but I'm not a researcher, a doctor, or a statistician - I'm just fortunate enough to work in a university library. For that matter, nor am I American, Black, or a mother.)





It's amazing - when it's a result nobody wants to hear - there have to be multiple studies of hundreds/thousands of people before anybody will listen and even then every effort is made to discredit the results - but when it's to confirm the status quo a study can include less than a hundred people, and be quoted all over the world as fact!!!