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Black Infant Mortality Is a Problem Still Unsolved Abstract: As Figure 1 clearly shows, infant mortality rates have declined significantly in the United States for the past two decades.1 In 1970, there were 20 deaths for every 1,000 live births. By 1995, that rate had dropped to 7.3. It is important to note, however, that in 1993 the United States ranked only 22nd out of 25 developed countries in overall infant mortality.2
As shown in Figure 2, the rate of decline has not been the same for blacks and whites. In fact, Carmichael points out that the difference in infant mortality rates between black and white infants increased from 2.1 in 1983 to 2.4 by 1991.3
In New Jersey, the 1996 infant mortality rate for blacks (14.9) was 2.8 times the rate for whites (5.3), as seen in Figure 3. In that year, New Jersey ranked 16th out of 35 states in BIM rates.
Direct causes for infant mortality include preterm birth, which occurs in 11 percent of all pregnancies.4 Preterm delivery's relationship to infant mortality is paralleled in its incidence rates between blacks (18.4 percent in 1992) and whites (9.1 percent).5 Medical science has not yet found interventions that are fully effective in preventing preterm birth. Despite all the advances in maternal care, preterm birth rates have slowly increased, as shown in Figure 4. However, Goldenberg points out that most interventions designed to prevent preterm birth are not highly effective. Some interventions are effective, including treatment of urinary tract infection, cerclage, and treatment of bacterial vaginosis in high-risk women, but are not universally so and are applicable to only a small percentage of women at risk.4
The risk of infant mortality increases sharply as birth weight decreases.6 Kleinman examined 1983 national data to find that the black/white ratio was 3.0 for very low birth weight (VLBW, under 1,500 g) and 2.3 for moderately low birth weight (MLBW, 1,500 to 2,500 g). From 1983 to 1991, decreases in birth weight–specific mortality rates among infants weighing from 500 to 2,499 g occurred in both groups but were smaller among black than white infants.3 Recently, many studies have shown that bacterial vaginosis approximately doubles the risk of spontaneous preterm delivery. Furthermore, this disease is more common in some populations than in others. For example, data from the Vaginal Infections in Prematurity Study have shown that pregnant black women had nearly three times as much bacterial vaginosis as did pregnant white women. Meis et al. have also confirmed that the rate of bacterial vaginosis in black women is at least double the rate in white women.7 In other research, stress has been shown to be a significant risk factor for preterm delivery.8 Berkman cites several studies linking low psychosocial assets with complications in pregnancies.9 Dunkel-Schetter's study showed that the frequency of preterm deliveries was 17 percent in women with high stress and high medical risk, whereas it was 6 to 9 percent with either high medical risk or high stress, and 3 percent in women with neither risk factor.8 The association of stress with spontaneous preterm birth and low birth weight is evident even after adjustment for maternal demographic and behavioral characteristics.10 Sandman's studies suggest that high levels of maternal stress between 28 and 30 weeks of gestation are associated with poor birth outcomes. Increased levels of psychosocial stress were significantly related to lower gestational age at birth and lower infant birth weight.11 For decades, medical and social science have been perplexed by this discrepancy in mortality rates. Many studies have been conducted to attempt to isolate the root causes of BIM, with only mixed and sometimes confusing results. This has contributed to an overall lack of clarity on the issue, which sometimes gives rise to incorrect presumptions, or "myths." Click here to review Myths vs Facts.
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