Improving birth outcomes.

Although the second stated goal of the Healthy People 2010 initiative is to "eliminate health disparities", statistics consistently show that African-American babies are significantly more likely to be born at very low birth weights and have a higher infant mortality rate.

Why is there such a discrepancy? What are the causes? And, what are possible solutions? These were the specific concerns addressed in a seminar titled "Racial and Ethnic Disparities in Birth Outcomes" presented this past April 1, 2005 at the Boston University School of Medicine by Michael Lu, MD, MPH, assistant professor at the UCLA School of Medicine and Public Health.

In his research, Dr. Lu compared birth outcomes among several different racial and ethnic groups. He also examined factors that influence poor outcomes, including cigarette smoking, prenatal care in the first trimester, education, income and social-economic status. In every case, African-American babies had significantly higher rates of infant mortality that could not be attributed to simple behavioral or nutritional differences. For example, even though African-American women reported lower rates of cigarette smoking, they still had higher rates of infant mortality. In fact, non-smoking African-American women had higher rates of infant mortality than white women who smoke.

For women who received prenatal care in their first trimester, infant mortality rates were still higher for African-American women than for Hispanic or white Americans who received first trimester prenatal care. Nor did education seem to confer an advantage. African-American women with sixteen or more years of schooling had a higher infant mortality rate than white Americans with less than nine years of schooling. Nor did the mother's income have an effect on improving infant mortality rates.

Dr. Lu affirmed that "many birth outcomes had no clear genetic basis." Referring to research from the Human Genome project, Dr. Lu said that in regards to genetic distinctions between races, there are no specific breaks to define separate groups. Genetically speaking, we are one.

It is interesting to note that when he compared African-American infants who were foreign born to African-American infants born in America, the foreign born infants had significantly lower rates of mortality. Similarly, when comparing Mexican women giving birth in Mexico and Mexican women giving birth in the United States, there was a higher rate of low birth weight infants for those born in the United States.

A pregnant woman in her home country is more likely to have support from family and traditions, whereas in the United States there are fewer social structures that support her. This can be reflected in simple customs. For example, in Taiwan it is considered shameful, more than just impolite, to not give your seat to a pregnant woman on the bus. On a broader scale, cultural support is reflected in having an official paid family leave policy.

Poor social support, abuse, racism, long term poor nutrition, tobacco use, poverty, lack of health care, and a toxic environment are all stresses that influence poor birth outcomes. Continually dealing with stress, a condition called weathering, chemically affects the mother's body, placental function, her own abilities for sustaining a pregnancy and thus, will affect the growing baby. When these stresses affect young women in the formative years of puberty, it will have an effect on future pregnancies. The maternal grandfather's occupation had more of an influence on the grandbaby's birth weight than the partner/father's occupation. A young girl growing up in a family with solid economic and social conditions will be healthier and thus, more capable of growing healthy babies.

Improving birth outcomes is a long-term endeavor, spanning several generations. Seven months of good prenatal nutrition won't significantly remedy a lifetime of poor environment and stress. It is the conditions in which mothers and families are growing that need to be improved. The African-American community has consistently suffered these stresses in our culture and is the community most in need of fundamental changes.

Healthier birth outcomes require considerations much broader than a pregnant woman's lifestyle habits. In order to address this disparity, Dr. Lu concluded that African-American women need better access to health care throughout their whole lifetime, including preconception care and interconception care, that the daily stress levels of African-American individuals needs to be reduced, and African-American families strengthened.

This is not only a medical issue. Health is also influenced by how our cities are designed. For example, Dr. Lu described a clinic that, according to the map, was accessible because it was only one block from a bus stop. In reality, that one block meant crossing a three-lane highway. Thus, the actual route to the clinic required walking four blocks, crossing a busy street and walking back down another four blocks. In this regard, the clinic really wasn't accessible. Once this specific bus route was brought to someone's attention, it was changed and now is actually closer to the clinic. In this way, city planners and transportation planners, not only health officials, are part of the solution to make health care accessible.

Access to good nutrition is another example. What if one cannot get to a store with fresh produce? Most inner city neighborhoods have only a few vegetables in convenience stores at an inflated price. Few homes have space for gardens and the soil is often highly contaminated. These are city planning issues that affect maternal, child and community health.

At the end of the presentation, the audience gathered into groups to discuss more solutions. The recommendations included: universal health care, paid family leave, workplace support for breastfeeding mothers, better health education, more community green spaces, no junk food in schools, neighborhood clinics and smaller, more personal care. Enacting even one of these recommendations would benefit African-American mothers and children (and others as well).

The data confirms what we already see and know. Healthy babies are intimately linked to healthy communities. To improve birth outcomes, we need to improve living conditions for mothers and children. This is what we should hear when we talk about family values.

If the United States addresses the issues that wear on African-American families it will improve birth outcomes, narrow health disparities and ultimately achieve the other goal of the Healthy People Initiative: Increase quality and years of healthy life.

Robin Snyder-Drummond is a childbirth educator, labor assistant and breastfeeding counselor working with families in the Boston area.