What are perinatal outcome disparities?
Disparities are differences between the rates of health outcomes between one group and another. The disparity refers to the difference, or gap. For example in the United States, African American infants are more than twice as likely to die in their first year of life than non-Hispanic white infants. The difference between the infant mortality rate for African American infants (12.67/1000) and the infant mortality rate for white infant (5.52/1000) is a gap, or disparity (Based on the National Vital Statistics Report). We use the term disparity because it is widely used in the literature, and we also use the terms gap and difference interchangeably with disparity, as those terms are more understandable in some cases.
Why are there racial differences in infant and maternal mortality rates and prematurity rates?
Much research has been done over the years regarding differences in health outcomes between people of different racial groups. (See ‘Trainings’ for more information about the history of ‘race’ as a concept, and the history of race and science’.) For many years the medical and health establishments assumed that racial differences in outcomes could be explained directly by either differences in specific hereditary characteristics – ‘genetics’ and/or by differences in income level/rates of poverty, access to health care services, educational level of the mother, ‘risky’ behavior of the mother such as smoking, malnutrition or drug use, etc. However, NONE of these factors has been shown to explain the differences in infant mortality rates, prematurity rates, maternal mortality rates, and other morbidities. In other words, there is not something inherently ‘wrong’ with African American mother’s genetics or behaviors that directly causes worse perinatal outcomes.
What does explain the difference?
In analyzing the data, researchers are confirming the impact of a factor of which many communities are already acutely aware. Racism itself, experienced over a lifetime by African American women in the United States, is a variable that can explain the differences in perinatal outcomes. Experiencing and surviving racism over a lifetime has physical and emotional impacts- such as the impacts of the chronic release of stress hormones throughout a lifetime of experiencing racism. These physical and emotional impacts then affect a woman’s physical and emotional state when she conceives, is pregnant, and gives birth. There is a particularly strong connection between the physical impacts of racism on the mother’s body, and premature delivery.
Here are some resources discussing perinatal outcome disparities in the US, followed by some resources discussing basic concepts in the research and public health about health outcomes in general.
Some web resources about perinatal outcome disparities
Click here for a list of resources on the impact of racism and oppression on birth outcomes.
Some resources about concepts regarding health equity, and ways to understand the reasons for health disparities:
- Basic concepts of social determinants of health, World Health Organization
- Resources on social determinants of health from the CDC
- Resources on the life course approach from HRSA
- Resources from Think Cultural Health at the Office of Minority Health
- HHS Action Plan to Reduce Racial and Ethnic Health Disparities
What can midwives and supporters do?
Help fund and publicize models that work!!
The JJ Way is a midwifery based model of prenatal care created by Jennie Joseph, LM, CPM, that has significantly reduced prematurity and low birth weight, and closed the racial disparity gap among participants. Included on this webpage is a downloadable evaluation report on the outcomes of the JJ Way Community Based Maternity Center for 2017. Additional research studies and reports found here.
The Centering Pregnancy model of prenatal care has been show in several studies to reduce prematurity rates, particularly among African American women. Here are two studies:
- Group Prenatal Care and Perinatal Outcomes: A Randomized Controlled Trial
- The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population
The Birthing Project USA is a national maternal child health program that uses community based peer support to improve outcomes for African American and other racially marginalized women.
The National Association to Advance Black Birth, formerly known as International Center for Traditional Childbearing, is an infant mortality prevention, breastfeeding promotion and midwife training non-profit organization.