Discussion 2 WK 4

How Racism Impacts Pregnancy Outcomes

How Racism Impacts Pregnancy Outcomes Program Transcript MICHAEL LU: The biggest myth about racial disparities and infant mortality is that people think that this has to do with just socioeconomics, and that the disparities are really the consequences of racial difference in socioeconomic status, and it isn't that simple. NARRATOR: Infant mortality among white American women with a college degree or higher is about 4 deaths per 1,000 births. But among African American women with the same level of education, infant mortality is about 10 per 1,000 births, almost three times higher. In fact, African American mothers with a college degree have worse birth outcomes than white mothers without a high school education. MICHAEL LU: Think about this. We're talking about African American doctors, lawyers, and business executives, and they still have a higher infant mortality rate that non-Hispanic white women who never went to high school in the first place. So what I've been calling for, re-thinking of an old problem from a new perspective, and to really re-think racial and ethnic disparities in birth outcomes from a life course perspective. And simply put, the life course perspective posits that birth outcomes are the product of not simply the nine months of pregnancy, but really the consequences of differential exposures across the life course of women of color. We know that racism is stressful. And we know that that stress can impact on health in many different ways. It creates this chronic wear and tear on your body's systems to adapt. It wears on the hormonal system, it wears on the immune inflammatory functions; it wears on your metabolic functions. And over time, it creates an overload on all these organs and systems so that they no longer function optimally. CAMARA PHYLLIS JONES: Everyday racism is like gunning the engine of a car without ever letting up. In fact, people who've looked at blood pressures, measuring ambulatory blood pressures for white folks and black folks, young folks, see that the blood pressures might be the same during the day, but at night the white folks' blood pressures would drop, and the black folks' blood pressures would stay the same. So it's like gunning the engine of that car, just wearing it out, wearing it out, without rest. And I think that the stresses of everyday racism are doing that. MICHAEL LU: And if you were to carry that into the pregnancy, then that gets embedded in both the pregnancy physiology of the mother and the developmental biology of the child.

© 2014 Laureate Education, Inc. 1

How Racism Impacts Pregnancy Outcomes

We generally have done a lot in terms of increasing access and utilization of prenatal care, especially amongst communities of color. And yet we've done very little to reduce prematurity rates. I think that the problem is that with prenatal care, you're trying to cram all these good things into less than nine months prenatal care, and then expecting everything to turn out all right in the end. And to expect prenatal care in less than nine months to reverse all the cumulative disadvantages and inequities that's been carried forth over a life course of differential exposures is probably expecting too much of prenatal care. So if we're serious about improving birth outcomes and reducing disparities, we've got to start taking care of women before pregnancy and not just talking about that one visit three months pre-conceptionally. I'm talking about when she's a baby inside her mother's womb, but an infant and a child and an adolescent, and really taking care of women and families across their life course, if we really want to do something about improving pregnancy outcomes.

© 2014 Laureate Education, Inc. 1