“Look at the Whole Me”: A Mixed-Methods Examination of Black Infant Mortality in the US through Women’s Lived Experiences and Community Context

Abstract

In the US, the non-Hispanic Black infant mortality rate exceeds the rate among non-Hispanic Whites by more than two-fold. To explore factors underlying this persistent disparity, we employed a mixed methods approach with concurrent quantitative and qualitative data collection and analysis. Eighteen women participated in interviews about their experience of infant loss. Several common themes emerged across interviews, grouped by domain: individual experiences (trauma, grieving and counseling; criminalization); negative interactions with healthcare providers and the healthcare system; and broader contextual factors. Concurrently, we estimated the Black infant mortality rate (deaths per 1000 live births) using linked live birth-infant death records from 2010 to 2013 in every metropolitan statistical area in the US. Poisson regression examined how contextual indicators of population health, socioeconomic conditions of the Black population, and features of the communities in which they live were associated with Black infant mortality and inequity in Black–White infant mortality rates across 100 metropolitan statistical areas with the highest Black infant mortality rates. We used principal components analysis to create a Birth Equity Index in order to examine the collective impact of contextual indicators on Black infant mortality and racial inequity in mortality rates. The association between the Index and Black infant mortality was stronger than any single indicator alone: in metropolitan areas with the worst social, economic, and environmental conditions, Black infant mortality rates were on average 1.24 times higher than rates in areas where conditions were better (95% CI = 1.16, 1.32). The experiences of Black women in their homes, neighborhoods, and health care centers and the contexts in which they live may individually and collectively contribute to persistent racial inequity in infant mortality.

Sudden infant death and sleep practices in the Black community

“…There are those who believe that we will never achieve reduced Black infant mortality until we achieve Black birth equity. This will require addressing social determinants and racial equities (Wallace, Green, Richardson, Theall, & Crear‐Perry, , which is far beyond the scope of this paper; however, we do need to make whatever progress we can to save the lives of Black infants, one life at a time.…”

Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care

“…[1][2][3] Multiple factors have been implicated in these disparities at the individual level, often driven by upstream social determinants and socially structured systems. [4][5][6][7] Given the increasing rate of maternal mortality in the United States, particularly for women of color, there is a pressing need to find solutions to improving care quality and access for racially marginalized communities. 8,9 There is increasing evidence that health care system factors play a role in the health care experience and pregnancy and birth outcomes for women of color.…”

A Mixed-method Analysis of Community-Engaged Theatre Illuminates Black Women’s Experiences of Racism and Addresses Healthcare Inequities by Targeting Provider Bias

“… 1 , 2 This has been especially true for Black women with a history of substance misuse, particularly in the areas of pain management and prenatal care. 3 , 4 For instance, a recent study indicated peripartum cardiac mortality rates to be the highest for Black women, 5 and some have suggested this is the result of social structures/institutional racism. Healthcare professionals and consumers alike are situated within legal, political, and societal contexts that have a long-standing history of racial discrimination.…”