Let’s be clear from the start, despite medical, pharmaceutical, and technological advances and improved public health infrastructure, the infant mortality rate in the Black population has grown to twice the nation’s average, and more than twice the average in the White infant population. And this gap represents an almost 400 year continuum. Therefore, we can immediately say that scientific achievements did not and have not benefitted all groups equally or equitably. Good health is of the utmost importance when it comes to human well-being and happiness. And good health in the first year of life is illuminating and critical to understanding disparities that exist in adulthood.
There are many factors that affect the ability of a country to provide its population with quality health services and ensure good status of health. Some of these factors include government departments, ministries of health, civil society, donor organizations, and communities. When evaluating the health status of a country, three statistical measures are considered: infant mortality rates, life expectancy, and longevity. These three statistical measures are referred to as the golden standards of health. This article, which is the first in a three-part installment centered on infant mortality, will discuss racial disparities in infant mortality rates in the United States.
What is the Infant Mortality Rate?
The infant mortality rate (IMR) is a reference to the number of deaths of children under the age of one for every 1,000 live births. As one of the golden standards of health, the IMR is commonly used to evaluate the health status and economic prosperity of a country. According to the United Nations, the world's infant mortality rate is 49.4, which means about 50 infants die out of every 1,000 live births.
When it comes to infant mortality, the United States is behind more than two dozen wealthy countries in the world. The infant mortality rate in the United States is 6.1, which is higher than the infant mortality rate of Greece, New Zealand, Slovakia, Italy, the United Kingdom, and more. A baby born in the United States is about three times more likely to die before the age of one than a baby born in Japan or Finland.
While the overall infant mortality rate of the United States is the lowest the nation has experienced—currently 6.1 per 1,000 live births, there are major variations in infant mortality rates between states, and more alarming, between races.
Emily Oster from the University of Chicago, Alice Chen from the University of South California, and Heidi Williams from MIT conducted research on the infant mortality rate and found that the neonatal mortality rate—infant death occurring before 29 days of life—of the United States is similar to that of other wealthy countries. However, the post-neonatal mortality rate—infant death from 29 days to under 1 year or age—in the United States is higher than that of Finland, Austria, and other countries. This suggests that there is a mortality gap that grows as infants get older in the United States.
Their research findings, however, still leaves the following question unanswered: What is the root cause of the disparities in infant mortality in the United States? To answer this question, we will focus our attention on four states: Massachusetts, New York, Pennsylvania, and California. This approach allows us, in part two and part three, to evaluate policies that influence maternal and child health outcomes in states that impact policy development and implementation across the nation.
The infant mortality rate of Massachusetts is 4.2 deaths for every 1,000 live births, which is one of the lowest IM rates in the United States. However, even though the IM of Massachusetts is low, there are still racial disparities that exist.
States tend to report absolute declines in infant mortality rates, but they often neglect to discuss relative rates. This is because the relative rates reveal disparities in infant mortality rates between different racial groups. For example, the infant mortality rate among white people in Massachusetts is 3.8 deaths for every 1,000 live births. On the other hand, the infant mortality rate among black people is 7.1 deaths for every 1,000 live births. This means that a black infant is almost twice as likely to die before the age of one than a white child.
This disparity can be explained by poverty and Opioid crisis, which are two epidemic issues that have been plaguing Massachusetts for years. In 2014, the fatal overdose rate in Massachusetts was more than twice the national average. Both of these public health issues disproportionately affect people of color.
The infant mortality rate of New York was 4.97 for every 1,000 live births. Among whites, the IM rate is 4.0 for every 1,000 live births. Among black people, the IM is 9.0. The reasons behind the higher infant mortality rates among African-Americans may seem intuitive. For example, African-Americans are more likely to be impoverished than white people. African-Americans also have less access to quality health care. African-Americans are more likely to suffer from diabetes, obesity, and other health problems and are also more likely to drink alcohol and do drugs while pregnant.
However, the association between health and class does not explain the mortality gap entirely. Hispanics, who face similar levels of poverty and health problems, have an infant mortality rate of 5.0, which is closer to the infant mortality rate of white people rather than black people.
One theory that is emerging is that black women face more psychosocial stress during pregnancy. Research suggests that stress triggers the production of hormones that play a vital role in triggering contractions and labor. High stress hormones in black women may lead to pregnancy problems and early labor, which are two factors associated with a high infant mortality rate.
The infant mortality rate of Pennsylvania is 6.7 for every 1,000 live births. The infant mortality rate among white people in Pennsylvania is 5.2 deaths for every 1,000 live births. On the other hand, the infant mortality rate among black people is 12.7 deaths for every 1,000 live births.
The infant mortality rate of California is 4.5 for every 1,000 live births. The IM among white people is 3.9 for every 1,000 live births while the IM among black people is 9.4. Therefore, the IM among black people is more than twice as high as the IM among white people.
The infant mortality rate among white people in the United States is similar to the infant mortality rate of other wealthy countries, such as the United Kingdom. However, racial disparities in infant mortality rates contribute significantly to the IM rate in the United States. If the United States hopes to achieve a low infant mortality rate for all racial groups equally, it will need to tackle the issue of racial disparities in almost every facet of life first.