Infant Mortality among Black Babies

Utibe Effiong, MPH ’14, Ekemini Hogan, and Obasi Okorie

October 29, 2020

One painfully clear reality about infant mortality shared across developing and developed nations¹ is this: Black babies die at higher rates than White babies.

Even in the US where the infant death rates for all age groups is shown to be dropping, Black infants still die at twice the rate as White infants.²

Infant mortality refers to the death of a child under the age of one—death before a first birthday. Infant mortality is measured by the infant mortality rate (IMR), the number of deaths of children under one year of age for every 1,000 live births, referenced against age-specific mortality rates within the same period under review.^3,4 It is not in actual sense a rate, which would measure deaths against the total population at risk. Instead, IMR is a probability that gives important information about maternal and infant health and is a key marker of the overall health of a society.¹

The leading causes of infant deaths vary from developed to developing countries.⁵ Globally, the causes revolve around problems of prematurity, birth complications, neonatal sepsis, pneumonia, diarrhea, malaria, malnutrition, and HIV.⁶ In the US, the five leading causes of infant mortality include low birth weight (LBW), birth defects, maternal peripartum complications, accidental and nonaccidental injuries, and sudden infant death syndrome (SIDS).^1,7 In developing countries, mortality among children under 5 is observed to be highest during infancy.⁸ About 80% of these deaths occur in the first six months of life. Sub-Saharan Africa has the highest risk of death in the first month of life and is one of the regions showing the least progress in IMR reduction.

Infant mortality is unacceptable anywhere in the world.

Despite overall global reductions in IMR, we must address the unacceptably high racial disparity in infant mortality. In the US, there has been a decline in infant mortality, but Black infants are observed to have about 2.1 times the infant mortality rate of White infants. Black infants are 3.8 times more likely to die from low birth weight complications, and Black mothers are more likely than White mothers to receive late or no prenatal care.⁸

Socioeconomic status—including education level, employment, occupation, and income—are fundamental determinants of health because they influence many other intermediate factors. Furthermore, maternal demographics and behavioral factors—birth out of wedlock, low maternal age, alcohol use during and after pregnancy, and access to prenatal care—are important predictors of maternal and infant mortality. Some of these factors are more prevalent in Blacks. And even after adjusting for differences in maternal socioeconomic status and behaviour, significant disparities exist in IMR between Black and White babies in the US.

In a study of all births to Black and White mothers between 1989 and 2005,⁹ it was noted that socioeconomic status, maternal demographics, and health access differences accounted for one-third of the White-Black differences in infant mortality. During pregnancy the mother’s health environment—a direct translation of her socioeconomic status—affects the outcome of the pregnancy and the infant’s health. Higher Black IMR, therefore, reflects the poor health status of Black mothers.¹⁰

Being racially or ethnically Black has been linked in some studies to certain social inequalities that determine socioeconomic status: income, maternal education, maternal age, marital status, parity, smoking, alcohol and substance use, and health insurance coverage.^10,11 Household income status is often low among Black families compared to White households, and this impacts the ability of the mother to provide appropriate health care. Parental education is also a significant contributor to infant mortality among normal-weight babies, with most Black mothers possessing a lower educational status. Even among college-educated parents, different rates of low and very-low birth weight babies account for higher Black IMR when compared to White populations.¹²

Contributing, upstream risk factors must be addressed as we attempt to eliminate racial differences in infant mortality. We must continually translate epidemiological data into enforceable public health policies by actively engaging today’s policymakers and providing transparent data to them.¹⁰ Efforts are being made at state and federal levels through programs like WIC, which provide support and risk-appropriate care for pregnant women and children.¹³

Interdisciplinary research teams must continue to investigate the links between social and biological determinants of infant mortality. We must unravel the true social determinants of health disparities and provide alternative explanations for observed racial disparities in IMR so that effective mitigating policies can be developed and implemented.¹⁰

Improved educational opportunities, professional training, and economic empowerment of Blacks will directly narrow gaps in IMR racial disparity and also create safer home environments, thereby reducing the incidence of postnatal conditions like SIDS. Such interventions could be applied broadly in developed and developing countries alike, leading to global improvements in how societies care for children.

Notes

1. Centres for Disease Control and Prevention. Infant Mortality.
2. Driscoll AK, Ely DM. "Effects of Changes in Maternal Age Distribution and Maternal Age-specific Infant Mortality Rates on Infant Mortality Trends: United States, 2000-2017." Natl Vital Stat Rep. 2020;69(5):1-18
3. UNICEF. Child Mortality. Under-Five Mortality Data.
4. World Health Organization. Global Reference List of 100 Core Health Status Indicators, 2015.
5. UNICEF, WHO, World Bank, UN-DESA Population Division. Levels and Trends in Child Mortality Report, 2019.
6. Vakili R, Khademi G, Vakili S, Saeidi M. "Child Mortality at Different World Regions: A Comparison Review." Int J Pediatr. 2015;3(4):2.
7. Ashworth A, Waterlow JC. "Infant Mortality in Developing Countries." Arch Dis Child. 1982;57(11):882-884.
8. U.S Department of Health and Human Services. Infant Mortality and African Americans. 
9. El-Sayed AM, Finkton DW Jr, Paczkowski M, Keyes KM, Galea S. "Socioeconomic Position, Health Behaviors, and Racial Disparities in Cause-Specific Infant Mortality in Michigan, USA." Prev Med. 2015;76:8-13.
10. Wise PH, Pursley DM. "Infant Mortality as a Social Mirror." N Engl J Med. 1992;326(23):1558-1560.
11. Eberstein IW, Parker JR. "Racial Differences in Infant Mortality by Cause of Death: The Impact of Birth Weight and Maternal Age." Demography. 1984;21(3):309-321.
12. Schoendorf KC, Hogue CJ, Kleinman JC, Rowley D. "Mortality among Infants of Black as Compared with White College-Educated Parents." N Engl J Med. 1992;326(23):1522-1526.
13. Kitsantas P, Gaffney KF. "Racial/Ethnic Disparities in Infant Mortality." J Perinat Med. 2010;38(1):87-94.

About the Authors

Utibe Effiong, MD, MPH ’14, is an internal medicine physician, public health scientist, and clinical assistant professor of medicine at Central Michigan University. He is also a Senior Fellow at the Aspen Institute. Read more about Dr. Effiong in A Desire to Be More: How Public Health Connects Medicine to Patient Communities.

Ekemini Hogan is a pediatrician at the University of Uyo Teaching Hospital in Uyo, Nigeria. She is a graduate of the College of Medical Sciences at the University of Calabar in Nigeria and a Fellow at the National Postgraduate Medical College of Nigeria.

Obasi Okorie is a pediatric endocrinologist at King Abdulaziz Specialist Hospital in Sakaka, Saudi Arabia, and a Fellow at the National Postgraduate Medical College of Nigeria.

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