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Racism and infant mortality in more detail

August 27th, 2008 (08:26 pm)
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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.

After I wrote my summary, I found the article available online! it's here:
http://www.ajph.org/cgi/reprint/94/12/2125.pdf
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.
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."

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."
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.
Available here: http://www.ajph.org/cgi/reprint/94/8/1358.pdf
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.)

Comments

Posted by: ajponder ([info]ajponder)
Posted at: August 27th, 2008 11:17 am (UTC)

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!!!

Posted by: Kate Orman ([info]kateorman)
Posted at: August 27th, 2008 11:25 am (UTC)

"A great deal of intelligence can be invested in ignorance when the need for illusion is deep."
- Saul Bellow

Posted by: ajponder ([info]ajponder)
Posted at: August 27th, 2008 12:25 pm (UTC)

I know - and it's tearing me apart. Thankyou for the quote! it's awesome. :)

Posted by: Kate Orman ([info]kateorman)
Posted at: August 27th, 2008 12:28 pm (UTC)

It's from my little collection for posting during Usenet arguments - must post it here. :)

Posted by: Paul_B =:o} ([info]pbristow)
Posted at: August 27th, 2008 11:46 am (UTC)
_XI-sing

[NODS]

A small degree of hysteresis in one's belief system is a good thing, to prevent one being "blown around by every wind of belief", as someone in the New Testament once put it (or as the atheists put it, "extraordinary claims require extraordinary proof").

I said a *small* degree, guys... =:o\

Posted by: Kate Orman ([info]kateorman)
Posted at: August 27th, 2008 12:34 pm (UTC)

I think that's quite right. I don't think it's ever wrong, when confronted by a new idea, to say "I'm not convinced, give me more evidence". It's sad, though, that POC have been telling us White folk about their experiences forever, but we find them so hard to believe. Perhaps that's understandable - we almost never see the discrimination with our own eyes, and besides, who wants to live in a racist society? But we've got to de-ostrich, and I hope these figures help.

Posted by: Jim Vowles ([info]jvowles)
Posted at: August 27th, 2008 04:26 pm (UTC)

The thing is, it's NEVER wrong to question something that goes against your own direct experience.

Kate has been diligent in researching things -- and when someone says "the black characters on Doctor Who are treated differently", she digs in and finds out whether that's true. To someone who came in believing in their gut that it was true, Kate is the equivalent of the status quo folks. Whereas to someone who is looking at the new Who from a storytelling or writerly perspective, it's clearly not the case, and the numbers actually back that up.

The numbers back up the assertion that women who feel they're victims of racism are more likely to deliver a low-birth-weight baby, and that their children are more likely to die. That's sobering.

I am interested in how you might factor out all the obvious legacy of racism -- poverty, education, cultural priorities and traditions, etc. I've been told repeatedly that certain aspects of the inner city culture are "a black thing I wouldn't understand", but some of that seems pretty obvious to me, having read books like MAMA (which illustrate pretty well the lingering effects of racism and poor social policies and how they shaped many black families).

But there IS a difference between questioning the results and discrediting the studies. The whole POINT of science is to question, after all, to get at the truth.

For example, I find it likely that racism is a stressor, but wasn't sure it was quantifiable. My specific qualm remains: how do you separate the rather abstract concept of racism from the clear elements of the legacy of racism?

More than that, I'm not sure how useful a study like this is, because addressing a nebulous concept like "racism" -- and in this case, the fact that certain people feel like victims of racism -- isn't necessarily something you can build policy around. There is no indicator for how much of the perceived racism is backed up by actions or statements, and how much of it is in the victim's mind. That doesn't matter on one level because it's the perception of racism that creates the stress.

Whereas you CAN build policies around more understandable things like "the schools are broken", "there is no health clinic in this part of town", or even "the system rewards multiple births for unwed mothers seeking state support".

There is only so much that can be done on my end to not act like a racist -- I can address most of the actions and words that are likely to cause offense, for example -- but I cannot control how you choose to interpret my words or actions.

I'm not making the case here that it's the fault of the women who believe themselves to be victims -- far from it -- I'm just saying that it's probably more productive to deal with parts of racism's legacy that can be defined and addressed in more obvious ways, than it is to dwell on feelings of oppression.. In fact, addressing the more obvious problems may help reverse the harder-to-tackle stuff, if we're lucky. Education and health care are bigger factors than almost anything else, across the board, and making progress there will likely have a bigger impact.

Posted by: ajponder ([info]ajponder)
Posted at: August 27th, 2008 08:30 pm (UTC)

Please note I also have a science degree - And also please note - earlier post said quantifying this phenomenon is the difficult thing - so I agree with you there completely on that one and the difficulty of getting correct results given so many variables. But there is absolutely no doubt that triple the death rate of europeans is a problem and that's often been blamed on the people who are actually doing the suffering - how many people do you know who are sick and it's somehow their fault? Anyway most of all I love the way you've got straight down to the heart of the issue - what should be done about it. It's pretty obvious something needs to be done, and given that treating this information like a fact until we know better wont stop the earth from turning and again and none of this detracts from my point- which I will state slightly differently- there's none so blind as do not want to see. But you are right when you say we should always question research, and that's particularly apparent when it's funded or conducted by someone with a vested interest - because my *blind* statement holds just as true then.

Anyway keep on questioning - the truth is out there - just don't think that you'll like it when you see it for it doesn't come with sealed certificates from god. Nor will it be the truth, the whole truth and nothing but the truth because we poor creatures experience so little of the world, and have to interpret the rest. So for now I'm happy a little blob of yellow on my lawn is a flower, given that it's surrounded by other little blobs of yellow that definitely are flowers, but if it flies away, I'll be equally confident it's a butterfly. But that still doesn't stop the "fact" that my lawn "needs" mowing. :)

Posted by: Kate Orman ([info]kateorman)
Posted at: August 27th, 2008 11:11 pm (UTC)
science

I don't really understand statistics, but the researchers are using statistical tools to correct for the influence of other factors such as poverty and education, so that what's left is just the effect of personally experiencing discrimination.

If the experiences of racism seem nebulous, then the next step is to make them seem more concrete, so I want to get hold of the questionnaires about experiences of discrimination, and also some anecdotal evidence which will help clarify what goes on. The additional studies (which I'll snag next week) should help us out there.

Of course, it's not possible to completely separate the perception of being discriminated against from more concrete phenomena such as poverty - the study which found the most stress resulted from discrimination in getting a job or at work is a good example. Perhaps these are areas where policy can be built (or improved upon), both by the government and by employers too, who after all stand to lose a lot if they don't make the best use of their human resources.

Posted by: ajponder ([info]ajponder)
Posted at: August 29th, 2008 01:53 am (UTC)

Grasp of statistics does seem weak when you're saying that "what's left is *just* the effect of..." That is the researchers intention, and most studies are pretty diligent about such things, but there have been plenty of examples where some crucial variable that could not have been or was not foreseen has turned the results of a study on its heels. That's why there's lies, damned lies and statistics. Not that I think the studies are wrong in this case, partly because you've got studies coming from different directions confirming each other, and partly because hell, it just makes sense and I'm prepared to go with an unproven H1 when the H0 makes no sense at all. Statistics are wonderful but they are also dangerous - for a start alot of research on weight "corrects" alot of the results because they don't like the answers & Drug companies are chronic for tampering with, er, "correcting" their results. but (I think I remember) this study said very openly how it did its corrections and that's usually the sign of a good study - open to peer review. Sorry pig/pedantic headedness just.. has.. to.. can't... help... myself...

Posted by: Brown Eyed Girl ([info]browneyedgirl65)
Posted at: August 27th, 2008 01:55 pm (UTC)

As per white disbelief in the face of POC information - it's understandable to some degree -- it's easy to shake out the big stuff like actual slavery, laws written two different ways and so on. But what we are working on now has the many to one problem -- one POC will experience many examples of discrimination from many people, but each of *those* people, if they even recognize their own racism in the first place (big if) will only see their own single tree and not the forest out there.

It's a similar phenomenon online when one person feels flamed to death about something -- but *each* person responding was "only" doing so once. But the pile-on still exists.

I wish I knew what the answers were for getting everyone to understand these things. I know that my big "aha" was relating it back to my own experiences of discrimination as a deaf person & as a woman. And I had to understand and name those discriminations first, instead of somehow blaming them on myself, to learn to see the larger patterns.

Hm, and I bet self blame is operating here too, which would increase the resulting stresses from the discrimination even more. Gah.

Posted by: Kate Orman ([info]kateorman)
Posted at: August 27th, 2008 11:19 pm (UTC)

I love your example of the tree and the forest!

Because White peeps almost never experience racial discrimination ourselves, it does helps hugely to be able to relate it to something we have experienced: bullying, ableism, flamefests. :)

Self-blame... constantly being told you suck eventually makes you believe you do suck. So yeah.

Posted by: murasaki_1966 ([info]murasaki_1966)
Posted at: August 28th, 2008 04:50 am (UTC)

Kate, this might interest you.

http://www.slate.com/id/2198731/

Posted by: Kate Orman ([info]kateorman)
Posted at: August 28th, 2008 07:37 am (UTC)

Ooh ta!

Posted by: hereville ([info]hereville)
Posted at: September 1st, 2008 05:45 pm (UTC)

"The strongest effect was seen in women in their twenties, and women with college education discrimination in finding a job or in the workplace were most closely correleated with VLBW."

Is there a word missing from this sentence? It doesn't quite parse.

That aside, thanks for posting this. Very interesting (horrifying).

Posted by: Kate Orman ([info]kateorman)
Posted at: September 3rd, 2008 08:34 am (UTC)

Thanks - I've repaired that mangled sentence.

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