Remarks

For Black Women, Education Is No Protection Against Infant Mortality

In contrast to whites, the most educated are the most likely to lose their babies

Education protects white women from losing their babies in infancy. The more education they have, the lower the infant mortality rate. Strangely, though, it’s the opposite for black women. The most educated face the greatest risk of having their children die at birth or in infancy.

Stress from dealing with racism and sexism seems to be a key reason that highly educated black women are far more likely lose their babies than are equally educated white women, says Keisha Bentley-Edwards, a co-author of a new report, which is titled “Fighting at Birth: Eradicating the Black-White Infant Mortality Gap.” The stress can lead to premature delivery of low birth-weight babies.

Duke University, Insight Center for Community Economic Development

“When you’re the only black woman in the room, when you’re often working in elite circles where you are the first or you are the only, there is a toll to be paid,” says Bentley-Edwards. Herself a black woman with a doctorate, she is a professor of general internal medicine at Duke University, as well as associate research director at Duke’s Samuel DuBois Cook Center on Social Equity. The research was done in concert with the Insight Center for Community Economic Development in Oakland, Calif.

The findings of “Fighting at Birth” aren’t entirely new. Researchers have known for decades that black mothers’ infant mortality rate is about twice that of white women, and that black women don’t get the same protection from education and higher socioeconomic status that white women do. Even many black women who have attained high rank carry the legacy of a lifetime of struggle. Damage to the body from stress, known as “weathering,” has wide-ranging health effects that may manifest themselves during pregnancy.

Bentley-Edwards says the report makes two contributions. It puts all the research together in what she calls a “digestible” form. And it advocates for solutions that the medical establishment has resisted. Bentley-Edwards says doctors and public-health officials tend to focus their efforts on poor women, regardless of their race. That’s a worthy effort, but it does nothing for black women who aren’t poor but nonetheless are at grave risk of losing their newborn babies.

“This is a push for a policy that’s directed at black women specifically,” she says.

The extremely high rate of infant mortality for black women with doctorates or professional degrees raises the question of whether there’s a fluke in the data. After all, there are relatively few black women with advanced degrees that give birth in any given year, and far fewer whose babies die in infancy. But Bentley-Edwards says statistical tests confirmed the result. And even if the disparity is somewhat smaller on average than these numbers show, the overall problem has been repeatedly confirmed by other researchers.

Bentley-Edwards says the report should not be taken as a message to black women to think twice about getting an advanced education. “We have to attack the stressor,” she says. “Eliminate job discrimination. We need allies to step in when we see a black woman at work not being treated the way she should be. The woman shouldn’t feel guilty that she’s complicit. It’s not the education that’s doing it.”

Infant mortality rates have fallen for all races over the decades, but the rate for black women overall has remained about twice that of white women overall. White American women have the same risk as women in New Zealand, while black American women have the same risk as women in Romania or Thailand. Black American women are far more likely to give birth prematurely, which is a major risk factor for infant mortality. Differences remain, even after accounting for factors such as poverty, obesity, age of mother, and illegal drug use.

A 2015 study in the Annals of Behavioral Medicine by researchers at the University of Pittsburgh, University of Wisconsin, and Emory University looked at markers of inflammation in the body and found that “the health ramifications of high anger, or poorly controlled anger, may be stronger in African Americans with more, compared to less, education.”

Last year, the International Journal of Environmental Research and Public Health published an article by researchers at Tulane University and other institutions that included interviews with 18 black women who had lost their children in infancy. Some said that they felt the medical establishment was insensitive to their loss. “I mean, we planned her. We wanted her,” one said. Another said, “It’s like, ‘No! We are human. We care about our well-being just like you do.’”

Even tennis star Serena Williams had problems when she gave birth. In her case, the life in danger was hers, not her child’s. She told Vogue magazine that when she insisted on a CT scan to check for blood clots, a nurse told her that her pain medicine might be confusing her. She insisted on the scan and was proven correct. “I was like, ‘listen to Dr. Williams!’” she said.

ProPublica and NPR News last year co-published a story that likewise focused on the risk of childbirth to black women. According to the Centers for Disease Control, it said, black mothers in the U.S. die at three to four times the rate of white mothers.

“Fighting at Birth” is more prescriptive about black infant mortality than most previous studies. It recommends support for programs and advocacy groups for black mothers; protocols to minimize bias by health-care providers; enforcement of laws against discrimination against black women; increased social support for expectant black women; and encouragement of breastfeeding, among other fixes. 

    Peter Coy
    Bloomberg Businessweek Columnist
    Peter Coy is the economics editor for Bloomberg Businessweek and covers a wide range of economic issues. He also holds the position of senior writer. Coy joined the magazine in December 1989 as telecommunications editor, then became technology editor in October 1992 and held that position until joining the economics staff. He came to BusinessWeek from the Associated Press in New York, where he had served as a business news writer since 1985.
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