While infant mortality has steadily decreased in recent decades, with the majority of babies in the U.S. being born healthy, disparities in birth outcomes between black and white women have long persisted. In fact, black women experience poorer birth outcomes than all other races in the United States, including higher rates of infant deaths, maternal deaths, preterm births, and very low birth weights, as seen below:

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Source: Center for Disease Control and Prevention

From 2005 until 2011, infant mortality even declined at a faster rate for black women (from 14.3 percent to 11.6 percent) than for white women (from 5.7 percent to 4.8 percent), slightly narrowing the gap and giving hope that the disparity would eventually close. However, in 2012, black infant mortality rate leveled off and even increased from 11.4 percent to 11.7 percent between 2014 and 2015. Currently, black women have an infant mortality rate that is over twice that of white women’s (11.3 percent compared to 4.9 percent).

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In addition to higher rates of maternal and infant mortality, black births have higher rates of short gestation, congenital malformations, sudden infant death syndrome (SIDS), and maternal complications. As shown below, black women’s rates are at least 1.5x those of white women’s in all regards:

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Source: JAMA Pediatrics

Though a wide gap in SES persists between black and white populations, socioeconomic factors alone cannot explain disparities in birth outcomes, as the disparity is consistent across all education levels, an indicator of SES:

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Source of Data: Colorado Department of Public Health and Environment and Michigan State University

Across all education levels, rates of black infant mortality are nearly 3 times greater than white rates. Though the gap slightly narrows amongst black and white women with lower education levels, it increases amongst women with higher education. This suggests that white women with low education levels have higher rate of infant mortality, thus closing the gap a little. However, infant morality rates for white women with higher education (Bachelor’s degree or Master’s degree) decreases by nearly half. Meanwhile, black women with higher education levels do not fare as well, and their rates of infant mortality either increase or see a modest decrease.

Furthermore, the disparity in infant mortality persists across maternal income levels:

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The persistence of black-white disparities in birth outcomes suggests that some difference between black and white women accounts for the disparity. Some have suggested that this difference is genetic, asserting black women are genetically incapable of carrying healthy, large babies to full term.

However, comparisons between infants of black women born in Sub-Saharan Africa, black women born in the United States, and white women born in the United States counters suggestions of a genetic factor tied to race. Mean birth weights of infants born to African-born black women approximated the mean birth weights of infants born to U.S.-born white women. Furthermore, the overall distribution of birth weight was almost identical for infants of African-born black women and infants of U.S.-born white women, but it significantly differed from the distribution of birthweight for babies of U.S.-born black women:

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Source: David & Collins 1997

The data presented provides evidence against the theory that black women are genetically different than white women in their ability to bear children. Furthermore, it suggests that the unique experiences of black women in the United States, not their genetics, shapes the disparity in birth outcomes that is not fully accounted for by differences in social and economic risk factors. This blog serves to explore such differential experiences of black women that contribute to poorer perinatal health.