How Racism Impacts Pregnancy Outcomes

Summary

The video script dispels the myth that socio-economic factors alone account for racial disparities in infant mortality rates. It highlights that even highly educated African-American women face higher infant mortality rates than less educated white women, suggesting a life course perspective on the issue. The script emphasizes the chronic stress of racism, its impact on health, and the need for prenatal care to start well before conception to address the cumulative disadvantages faced by women of color throughout their lives.

Takeaways

• 🧐 The common misconception is that racial and ethnic disparities in infant mortality are solely due to socio-economic factors and racial differences in socio-economic status.
• 📊 Infant mortality rates among African-American women with a college degree are alarmingly higher, at about 10 per 1000 births, compared to about 4 per 1000 births among white American women with the same education level.
• 🔎 The disparity is stark: African-American mothers with a college degree have worse birth outcomes than white mothers without a high school education.
• 👩‍⚕️👩‍🎓 Even highly educated and successful African-American women, such as doctors, lawyers, and business executives, face higher infant mortality rates than less educated white women.
• 🤔 The script calls for a reevaluation of the problem of racial and ethnic disparities in birth outcomes, suggesting that they are not just a result of the pregnancy period but are influenced by a woman's entire life course.
• 🧬 Chronic stress from racism is identified as a significant factor affecting health, potentially impacting hormonal, immune-inflammatory, and metabolic functions.
• 🚗 The analogy of everyday racism is likened to 'gunning the engine of a car' without rest, causing continuous wear and tear on the body's systems.
• 🤰 The stress of everyday racism can be embedded in the physiology of pregnancy and the developmental biology of the child, contributing to poor birth outcomes.
• 🤰🏻 Prenatal care alone is not enough to counteract the cumulative disadvantages from a life course of differential exposures; it needs to be complemented with care that starts before pregnancy.
• 👶 The importance of caring for women and families across their life course is emphasized to truly improve birth outcomes and reduce disparities.
• 🌱 The script suggests that efforts to improve pregnancy outcomes should start as early as possible in a woman's life, including during her own time as a baby, infant, child, and adolescent.

Q & A

What is the common misconception about racial and ethnic disparities in infant mortality?

The common misconception is that racial and ethnic disparities in infant mortality are solely due to socio-economic factors and are a consequence of racial differences and socio-economic status.

What is the infant mortality rate among white American women with a college degree or higher?

The infant mortality rate among white American women with a college degree or higher is about 4 deaths per 1000 births.

How does the infant mortality rate among African-American women with the same level of education compare to white American women?

The infant mortality rate among African-American women with a college degree or higher is about 10 per 1000 births, which is almost three times higher than that of white American women with the same level of education.

Why is it significant that African-American mothers with a college degree have worse birth outcomes than white mothers without a high school education?

This highlights that the disparities in infant mortality are not solely due to socio-economic status, as even highly educated African-American women face higher risks, indicating the influence of other factors such as systemic racism and stress.

What is the life course perspective on racial and ethnic disparities in birth outcomes?

The life course perspective posits that birth outcomes are the product of differential exposures across the life course of women of color, not just the 9 months of pregnancy.

How does racism impact health according to the transcript?

Racism is stressful and can impact health by creating chronic wear and tear on the body's systems, including the hormonal, immune-inflammatory, and metabolic functions, leading to suboptimal functioning over time.

What is the analogy used to describe the effect of everyday racism on the body?

Everyday racism is compared to gunning the engine of a car without ever letting up, causing continuous stress without rest, which wears out the body's systems.

How does the stress of racism affect pregnancy and the developing child?

The stress of racism gets embedded in both the pregnancy physiology of the mother and the developmental biology of the child, potentially leading to adverse outcomes.

What is the critique of focusing solely on prenatal care to improve birth outcomes?

The critique is that prenatal care, even when accessible, is often insufficient to reverse the cumulative disadvantages and inequities that have been experienced over a life course in less than 9 months.

What is the suggested approach to improving birth outcomes and reducing disparities?

The suggested approach is to start taking care of women before pregnancy, focusing on their health across their life course, from infancy to adolescence, and providing support to women and families throughout.

Why is it important to address the disparities in infant mortality from a life course perspective?

Addressing disparities from a life course perspective is important because it recognizes the long-term impact of systemic racism and stress on health, suggesting that interventions need to be comprehensive and start early in life to effectively improve birth outcomes.

Outlines

00:00

🔍 Socio-Economics and Racial Disparities in Infant Mortality

This paragraph addresses the common misconception that socio-economic status is the sole determinant of racial and ethnic disparities in infant mortality. It highlights the stark contrast in infant mortality rates between highly educated African-American women and less educated white women, emphasizing that even African-American professionals face higher infant mortality rates. The speaker calls for a reevaluation of this issue from a life course perspective, suggesting that the disparities are a result of cumulative stress and differential exposures over the life course of women of color, including the impact of racism on health and physiological functions.

Keywords

💡racial and ethnic disparities

Racial and ethnic disparities refer to the differences in outcomes or opportunities among different racial and ethnic groups. In the context of the video, these disparities are particularly evident in infant mortality rates, where African-American women, even with high levels of education, experience higher rates than their white counterparts. The video emphasizes that these disparities are not solely due to socio-economic status but are deeply rooted in systemic issues.

💡infant mortality

Infant mortality is the death of an infant before reaching one year of age. The video script highlights the stark contrast in infant mortality rates between white and African-American women with similar educational backgrounds, underscoring the significant impact of racial disparities on health outcomes.

💡socio-economics

Socio-economics is the study of how social and economic factors interact to affect human behavior. The script challenges the common misconception that socio-economic status is the primary determinant of infant mortality, arguing that racial and ethnic disparities are more complex and cannot be reduced to economic factors alone.

💡life course perspective

The life course perspective is a theoretical framework that considers the impact of experiences and exposures throughout an individual's life on their health and well-being. The video argues that birth outcomes are not just a product of the pregnancy period but are influenced by a lifetime of racial stress and disparities, affecting the health of both mother and child.

💡racism

Racism is the belief in the inherent superiority of one race over another, which often results in discrimination and prejudice. The video script discusses the stress caused by racism and its detrimental effects on health, including its impact on the physiological processes during pregnancy and the development of the fetus.

💡stress

Stress is a physical, mental, or emotional strain or tension resulting from demanding circumstances. The video explains how the chronic stress of racism can lead to wear and tear on the body's systems, contributing to poor health outcomes, including higher infant mortality rates among African-American women.

💡chronic wear and tear

Chronic wear and tear refers to the long-term damage or deterioration of the body's systems due to continuous stress or strain. The script uses this term to describe the cumulative negative effects of racism on the body, leading to a breakdown in optimal functioning of various physiological systems.

💡hormonal system

The hormonal system is the body's network of glands and hormones that regulate various functions, including growth, metabolism, and mood. The video script points out that the stress of racism can wear on the hormonal system, affecting health and potentially contributing to poor birth outcomes.

💡immune-inflammatory functions

These functions refer to the body's defense mechanisms against infections and inflammation. The video script suggests that the stress from racism can impair these functions, making individuals more susceptible to health issues, which can also impact pregnancy and infant health.

💡metabolic functions

Metabolic functions are the chemical processes in the body that maintain life, including energy production and substance breakdown. The script indicates that the stress of racism can negatively affect metabolic processes, which can have long-term health implications, including during pregnancy.

💡prenatal care

Prenatal care is the medical care and guidance given to pregnant women to ensure a healthy pregnancy and delivery. The video script critiques the current focus on prenatal care as being insufficient to address the deep-seated racial disparities in infant mortality, arguing for a broader approach that starts before pregnancy.

💡preconception care

Preconception care refers to the health and lifestyle interventions provided to women before they become pregnant to improve pregnancy outcomes. The video advocates for a more comprehensive approach to care that includes attention to women's health before they become pregnant, not just during the prenatal period.

Highlights

The myth about racial and ethnic disparities in infant mortality is often oversimplified as a socio-economic issue.

Infant mortality rate among African-American women with a college degree is nearly three times higher than among white women with the same education level.

African-American mothers with a college degree have worse birth outcomes than white mothers without a high school education.

The life course perspective suggests that birth outcomes are influenced by differential exposures throughout a woman's life, not just during pregnancy.

Racism is identified as a stressor that impacts health through chronic wear on the body's systems.

The hormonal, immune-inflammatory, and metabolic functions are particularly affected by the stress of racism.

The analogy of everyday racism as 'gunning the engine of a car without rest' illustrates the continuous stress it imposes on the body.

The stress of everyday racism is likened to elevated blood pressure that doesn't decrease at night, indicating a lack of rest for the body.

The impact of racism is embedded in both the pregnancy physiology of the mother and the developmental biology of the child.

Efforts to increase prenatal care access have not significantly reduced prematurity rates among communities of color.

Prenatal care is criticized for trying to mitigate the effects of life-long disparities in less than 9 months.

The call for a rethinking of racial and ethnic disparities in birth outcomes from a life course perspective is emphasized.

Improving birth outcomes requires taking care of women before pregnancy, starting from infancy.

The importance of caring for women and families across their life course to improve pregnancy outcomes is highlighted.

The transcript challenges the traditional view of infant mortality disparities, advocating for a broader, life-long approach to addressing them.

The transcript underscores the need for a systemic change in how we approach and address racial disparities in health outcomes.

Transcripts

LU: The biggest myth about racial and ethnic disparities

in infant mortality is that people think that this has

to do with just socio-economics and that the disparities

are really the consequences of racial differences

and socio-economic 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 1000 births,

but among African-American women with the same level of education,

infant mortality is about 10 per 1000 births.

Almost 3 times higher.

In fact, African-American mothers with a college degree

have worse birth outcomes

than white mothers without a high school education.

LU: Think about this:

We're talking about African-American doctors,

lawyers and business executives

and they still have a higher infant mortality rate

than non-Hispanic white women who never

went to high school in the first place.

So what I've been calling for is a rethinking of an old problem

from a new perspective.

And to really, rethink racial and ethnic disparities

in birth outcomes from a life course perspective.

Simply put, that the life course perspective posits that

birth outcomes are the product of not simply

the 9 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 of these organs and systems

so that they no longer function optimally.

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.

And 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.

LU: And then 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.

We certainly have done a lot in terms of increasing

access and utilization of prenatal care

especially among 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 are trying to cram all these good things

into less than 9 months of prenatal care

and then expecting everything to turn out alright in the end.

and to expect prenatal care, in less than 9 months,

to reverse all the cumulative disadvantages and inequities

that has 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 I'm not just talking about that one visit 3 months preconceptionally,

I'm talking about when she's a baby inside her mothers womb...

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 their pregnancy outcomes.