Why Causation Matters

Abstract

Although it is tempting to construe the correlation between Black “race” and higher rates of preterm birth as causal, this logic is flawed. Worse, the continued use of Black “race” as a risk factor for preterm birth is actively harmful. Using Black “race” as a risk factor suggests a causal relationship that does not exist and, critically, obscures what actually causes Black patients to be more vulnerable to poorer maternal and infant outcomes: anti-Black racism. Failing to name anti-Black racism as the root cause of Black patients' vulnerability conceals key pathways and tempts us to construe Black “race” as immutably related to higher rates of preterm birth. The result is that we overlook two highly treatable pathways—chronic stress and implicit bias—through which anti-Black racism negatively contributes to birth. Thus, clinicians may underuse important tools to reduce stress from racism and discrimination while missing opportunities to address implicit bias within their practices and institutions. Fortunately, researchers, physicians, clinicians, and medical staff can positively affect Black maternal and infant health by shifting our causal paradigm. By eliminating the use of Black “race” as a risk factor and naming anti-Black racism as the root cause of Black patients' vulnerability, we can practice anti-racist maternity care and take a critical step toward achieving birth equity.

Birth and postnatal outcomes among infants of immigrant parents of different admission categories and parents born in Canada: a population-based retrospective study

“…37 In addition, immigrants may encounter systematic racism, which has long been dem onstrated as a determinant of adverse birth outcomes includ ing preterm birth. 46,47 Despite the increased risk of early pre term birth, immigrants, including refugees, did not have a higher risk of infant death in our study, probably owing to the low occurrence of early preterm birth (13% of all preterm births), and nonrefugee immigrants had lower risk of neonatal death after adjusting for covariates.…”

Racial and ethnic differences in the risk of recurrent preterm or small for gestational age births in the United States: a systematic review and stratified analysis

“…However, to our knowledge, no study has provided a direct genetic analysis of recurrent preterm birth, even in the absence of other risk factors. Furthermore, given the legacy of anti-Black racism in the U.S., and lower rates of preterm birth among foreign-born Black women, relying on genetic risk to explain the Black-White disparity in the recurrence of adverse birth outcomes is not recommended [ 27 ].…”