The impact of race on infant mortality.

Once I started "information digging," I came across some statistics that I always knew were true, but could never put any hard numbers behind.

The infant mortality rates as of 1992 for African-Americans (statistically referred to as blacks) is 16.8 per 1,000 live births and for whites (I am working on a better description.) is 6.9 per 1,000 live births. The most recent overall infant mortality rate (1993) is an astounding 8.3 per 1,000 live births. According to an international statistician with the National Center for Health Statistics, one of the biggest factors in the decrease in the infant mortality rates for the US and worldwide is the use of surfactants neonatally on low birth weight and very low birth weight infants that hospitals would have previously been unable to save.

As one can see, the infant mortality rates for African-Americans and whites are dramatically different. The risk factors associated with infant mortality are also risk factors for premature delivery and low birth weight in infants. Some of these factors are: (1) preconception maternal health-i.e., exposure to viruses and infections that could have negative effects on the life of the child; (2) availability of prenatal care and the actual time that it is sought; (3) financial factors-i.e., difficult, hard work that requires long hours; (4) maternal diet during pregnancy; and (5) other factors that are only now being investigated-i.e., stress, environmental dangers, abusive relationships, and intergenerational poverty.

The disparity in the infant mortality rates by race is also present in the percent of low birth weight by race (Table 1). Ending the cycle of premature delivery, low birth weight, and infant mortality amongst African-Americans should be one of the top priorities for anyone concerned with empowering women.

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I then decided to search for information regarding the use of midwives by race, educational attainment, age, and marital status, hoping to find more African-American women embracing the concept of empowerment, and opting for midwife-attended births, especially those at home. What I found out should not surprise anyone. The majority of women who use midwives for homebirths are white, 30 years or older, married, and have some college education (Table 2).

Table 2. Attendant and Place of Birth by Selected Characteristics: United

States, 1988

Selected             Physician in   Midwife out of
Characteristics      Hospital       Hospital
                     Percent        Percent
All Births           100.0          100.0
Race of child
White                 78.1           94.6
Black                 17.1            2.9
Age of Mother
Under 20 years        12.4            6.3
30 years or more      28.5           40.0
Marital status of mother
Married               74.6           90.3
Unmarried             25.4            9.7
Years of school completed by mother
Less than 12 years    20.0           21.4
16 years of more      17.8           25.6

I wanted to publish these statistics in Special Delivery not to depress those of us who are working so hard to change many of these rates, but to light a fire under others who have gotten comfortable in their "alternative health care" position without realizing that we are in danger of creating an alternative childbirth community reminiscent of the elitist medical establishment.

There will be more information in my column in the next issue about ways to find populations that are difficult to reach because of differences between educator and client.

The Association of Labor Assistants and Childbirth Educators has members in almost every state in the US and various countries in the world. If each of us tried, really tried to either find an existing program or designed one of our own to teach one or more workshops for free, imagine the results. An entire country of empowered women, regardless of any differences, either physical, or those engineered and sustained by our imaginations. Sounds like an excellent idea!

BIBLIOGRAPHY

Lieberman, E. "Low Birth Weight-Not a Black-and-White Issue," The New England Journal of Medicine 332:117-8.

Rothman, Barbara Katz, ed. The Encyclopedia of Childbearing. New York: Henry Holt, 1994.

_____Lewis, Caroline T. "Midwife-Attended Births." 247-9.

_____Prager, Kate. "Infant Mortality Statistics: United States." 191-3.

_____Simpson, Sharleen H. "Birth Certificates." 32-4.

Ventura, S. J. et al. "Advance Report of Final Natality Statistics, 1992." Monthly Vital Statistics Report 43 (5), supplement. Hyattsville, MD: National Center for Health Statistics, 1994:21.

Ventura, S. J. et al. Monthly Vital Statistics Report 42 (13), supplement. Hyattsville, MD: National Center For Health Statistics, 1994.

*Table 2 information was compiled from pre-1989 live births from birth certificate data. No differentiation was made as to whether birth was attended or planned to be out of hospital.