The Toll of Racism on African American Mothers and Their Infants

Dreyer, Benard P.

doi:10.1001/jamanetworkopen.2021.38828

Cited by 5 publications

(6 citation statements)

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“…For Black/AA infants, the reduction in infant mortality associated with greater maternal education (college degree) did not compensate for the increase in infant mortality because of other causes, including SDOH such as racism and other health inequities that Black/AA families experience (Matoba & Collins, 2017). Previous researchers have highlighted the effects of racism on increased Black/AA infant mortality (Carpenter, 2017; Dreyer, 2021; Pabayo et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Research reveals that measures of structural racism are associated with higher infant mortality rates among Black infants, but not among White infants (Pabayo et al, 2019; Wallace et al, 2017). Interpersonal experiences of racism are also chronic stressors for Black/AA and contribute to poor birth outcomes such as low infant birth weight, prematurity, and infant mortality among Black/AA infants (Carpenter, 2017; Dreyer, 2021; Giscombé & Lobel, 2005). In another study, two thirds of Black/AA, Hispanic, and Asian mothers reported discrimination, and those who reported the highest discrimination had poorer outcomes in infant birth weights at 6 months and body mass index at 3 years and higher levels of oral inflammation, which correlated with chronic physiological stress (Condon et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

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The Effects of Race, Ethnicity, and Maternal Education on Infant Mortality

Atkins,

Pontes,

Patterson

et al. 2023

Nursing Research

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Background The state of New Jersey has a large Black/African American (AA) versus White racial disparity in infant mortality and educational level at childbirth. This disparity, measured by rate ratio, increases with greater maternal education among varied racial–ethnic groups. The nature of this disparity measured by rate differences has not been explored. Objectives Infant birth and mortality data were used to examine whether racial or ethnic disparities in infant mortality increased with greater maternal education, comparing rate differences and rate ratios. Racial and ethnic variations in the association between maternal education and infant mortality were examined. Methods Data were from the New Jersey State Health Assessment Data for all New Jersey births between 2014–2018 stratified by race and ethnicity, maternal education, and infant mortality (n = 481,333). R software was used to create a data set and estimate additive and multiplicative interactions, rate differences, and rate ratios for infant mortality by maternal race/ethnicity and educational levels among four racial–ethnic groups. Results Infant mortality was significantly greater for Black/AA and Hispanic mothers than for White mothers. At all educational levels, Black/AA mothers had the highest prevalence of infant mortality compared to other racial or ethnic groups. Rate differences in infant mortality showed a decrease in Black/AA–White differences for mothers with a high school education or less compared to mothers with a college degree. However, rate ratios showed an increase in Black/AA–White ratio with increasing education levels for mothers with high school education or less than mothers with a college degree. Risk ratios comparing infant mortality for Black/AA versus Hispanic or Asian mothers showed more than a twofold greater risk at all education levels for Black/AA infants. Finally, college-educated Black/AA mothers had significantly higher rates of infant mortality than White or Hispanic mothers with a high school education or less. Discussion/Implications Black/AA mothers with a college degree had a higher infant mortality rate than White, Hispanic, or Asian mothers with a high school education or less. Future research should address contextual/systemic contributors to this disparity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effects of Race, Ethnicity, and Maternal Education on Infant Mortality

Atkins,

Pontes,

Patterson

et al. 2023

Nursing Research

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“…Experienced over the lifespan, racism may function as a chronic stressor 5 affecting stress-sensitive biological functioning within the sympathetic-adrenal-medullary (SMA) axis, 16 the hypothalamic-pituitary-adrenal (HPA) axis, 17 the cardiovascular system, 18 the immune system and inflammation, 19 placental functioning, 20 and other systems involved in pregnancy outcomes. 21 This study demonstrated higher rates of cesarean birth attributed to non-reassuring fetal status among Black participants, regardless of medical risk factors. Previous studies have shown that Black childbearing people have twice the rate of cesareans compared with White and other groups due to non-reassuring fetal status, despite adjustments for medical, pregnancy, neonatal, and sociodemographic risks.…”

Section: Discussionmentioning

confidence: 58%

Race, ethnicity, and indications for primary cesarean birth: Associations within a national birth center registry

Manns‐James,

Vines,

Alliman

et al. 2023

Birth

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BackgroundRacial and ethnic disparities in cesarean rates in the United States are well documented. This study investigated whether cesarean inequities persist in midwife‐led birth center care, including for individuals with the lowest medical risk.MethodsNational registry records of 174,230 childbearing people enrolled in care in 115 midwifery‐led birth center practices between 2007 and 2022 were analyzed for primary cesarean rates and indications by race and ethnicity. The lowest medical risk subsample (n = 70,521) was analyzed for independent drivers of cesarean birth.ResultsPrimary cesarean rates among nulliparas (15.5%) and multiparas (5.7%) were low for all enrollees. Among nulliparas in the lowest‐risk subsample, non‐Latinx Black (aOR = 1.37; 95% CI, 1.15–1.63), Latinx (aOR = 1.51; 95% CI, 1.32–1.73), and Asian participants (aOR = 1.48; 95% CI, 1.19–1.85) remained at higher risk for primary cesarean than White participants. Among multiparas, only Black participants experienced a higher primary cesarean risk (aOR = 1.49; 95% CI, 1.02–2.18). Intrapartum transfers from birth centers were equivalent or lower for Black (14.0%, p = 0.345) and Latinx (12.7%, p < 0.001) enrollees. Black participants experienced a higher proportion of primary cesareans attributed to non‐reassuring fetal status, regardless of risk factors. Place of admission was a stronger predictor of primary cesarean than race or ethnicity.ConclusionsPlace of first admission in labor was the strongest predictor of cesarean. Racism as a chronic stressor and a determinant of clinical decision‐making reduces choice in birth settings and may increase cesarean rates. Research on components of birth settings that drive inequitable outcomes is warranted.

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“…Another analogous and important example is that worse obstetrical outcomes among Black mothers who experience the highest rates of SMM, maternal mortality, and infant mortality 2 , 3 , 33 , 34 , 35 are hypothesized to, in part, be a consequence of the traumatic toll of racism in the United States. 36 Thus, it is possible that if the psychological needs of patients were screened for and adequately addressed antepartum, the negative impact of maternal stress could be mitigated.…”

Section: Resultsmentioning

confidence: 99%