Shortly after giving birth to her son in August 2017, 27-year-old activist and Black Lives Matter icon Erica Garner suffered her first heart attack. Garner, who entered the public eye in 2014 after a police officer choked her father to death, had an enlarged heart The stress of pregnancy—and perhaps the strain of her father’s death—further weakened it. Four months later, she suffered another heart attack. This one put her into a coma from which she never awoke. On December 30, 2017, she died.
Although all deaths are tragic, Erica Garner’s death illuminates a devastating problem in the United States: African American mothers are dying at three to four times the rate of non-Hispanic white mothers, and infants born to African American mothers are dying at twice the rate as infants born to non-Hispanic white mothers. These two trends hold true across education levels and socioeconomic status. Even tennis star Serena Williams—a wealthy and remarkably powerful woman—nearly died from pregnancy-related complications.
African American women of all backgrounds—including Garner and Williams—share experiences of racial and gender discrimination. A growing body of research suggests that stress induced by this discrimination plays a significant role in maternal and infant mortality. This issue brief synthesizes research explaining the racial disparities in maternal and infant mortality rates and articulates how institutional racism contributes to both. It reviews empirical literature on maternal and infant mortality, concluding that the greater prevalence of maternal health risk factors among African American women cannot account entirely for their higher mortality rates. Instead, the impacts of institutional racism and sexism compromise women’s health across time, leading to poorer outcomes for African American women and infants. A fractured and unequal health care system and gaps in health workforce training further aggravate these racial disparities. It is racism, not race itself, that threatens the lives of African American women and infants.
Protecting the health of mothers and infants is a critical measure of a country’s development. By most accounts, however, the United States holds the worst records for maternal and infant mortality in the developed world. (see text box) Women in the United States are two to three times more likely to die than Canadian women in the maternal period—from the start of pregnancy to one year after delivery or termination. Similarly, infants in the United States have a 76 percent higher risk of death compared with infants in other wealthy nations. Disaggregating data by race reveals that higher rates of maternal and infant death among African American women drive the United States’ mortality crisis.
Maternal mortality rates in the United States plummeted over the 20th century; however, non-Hispanic white women experienced a steeper decline in maternal mortality than did African American women—introducing a racial gap that persists today. After decades of dramatic progress, maternal mortality in the United States is once again climbing for women of all races, increasing nearly 27 percent from 2000 to 2014.Importantly, the United States is the only developed country for which this is true.Like maternal mortality, infant mortality in the United States sharply declined over the 20th century. However, the racial gap in infant mortality rates has been present since these data started being collected by the government and hospitals more than 100 years ago, and it has not significantly changed in more than 50 years. Higher rates of preterm births and low birth weights among African American women drive this gap: African American infants are 3.2 times more likely than non-Hispanic white infants to die from complications related to low birth weight. Across racial groups, more deaths occur in the neonatal period—from birth to 1 month—than in the postneonatal period—from 1 month to 1 year.
Most research on health disparities in maternal and infant mortality focus on African American women’s greater exposure to risk factors around the time of pregnancy, including poverty and low socioeconomic status; limited access to prenatal care; and poor physical and mental health. Although African American women are more likely than non-Hispanic white women to experience these interrelated risk factors, research shows that this greater likelihood does not fully account for the racial gap in outcomes; rather, these disparities stem from racial and gender discrimination over the lifespan of these women.
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