The Centers for Disease Control and Prevention (CDC) defines infant mortality as the death of a child before reaching his or her first birthday. Since the year 2000, neonatal deaths have declined by 44%. However, the decline has not been proportionately distributed across all ethnicities. The rate of infant mortality in the Black community is still 2.4 times higher than the infant mortality rates among whites. In fact, Sub-Saharan Africa and southern Asia accounted for more than 80% of the 4.9 million under-5 deaths in 2022, according to the World Health Organization.
A November 2024 report from the National Center for Health Statistics (an arm of the CDC) suggested the rate of infant mortality remained unchanged between 2022 and 2023. The report highlighted infants born to Black mothers still had a higher death rate compared to those born to Asian or white mothers.
According to the CDC report, 10.9 Black infants die per 1,000 live births. The rate for white and Asian infant deaths were 4.5 and 3.4 respectively. The only other ethnic groups that recorded infant death rates close to that of the Black infants were infants born to Pacific Islander or Hawaiian women and American Indian at 8.2 and 9.2 deaths per 1,000 live births, respectively.
Despite increasing awareness, the rate of infant mortality among infants born to Black mothers has remained significantly higher—and this has left many health professionals asking more questions. Beyond advocacy, it is important to dig deep to identify the factors that contribute to higher infant deaths in our community and tackle the problem from the root.
Factors responsible for higher infant deaths in Black community
Yale New Haven Children’s Hospital’s pediatric emergency medicine physician, Dr. Kirsten Bechtel, believes the higher infant mortality in our community has something to do with a higher rate of pre-term birth among Black mothers. Generally, pre-term births are linked to higher infant mortality.
According to Bechtel who is also an expert in infant mortality, pre-term births is associated with timely access to evidence-based prenatal care. She added that there are elements of structural racism in some of the care women in our community receive. In addition to structural racism that impedes easy access to prenatal care, other factors fingered for the high mortality rate in our community include:
1. Exposure to toxins and pollution
Data from the U.S. Environmental Protection Agency shows that the Black community and other ethnic minorities are disproportionately exposed to fine particulate matter (PM2.5), a regulated air pollutant—regardless of their income levels. The report believes that this is because over time people of color and pollution have been pushed together through housing policy and other factors.
When pregnant women inhale PM2.5, the inflammatory response it triggers in the mother’s body can adversely affect fetal development. PM2.5 is of greater concern because it goes deeper into the respiratory system.
Studies have shown that when pregnant women are exposed to PM2.5 it can have adverse effects on the fetus including leading to developmental issues (like congenital defects), preterm birth, and low birth weight. PM2.5 can disrupt fetal growth mechanisms and placental function, especially when the exposure happens in the first and second trimester. These factors have all been associated with higher infant mortality.
Exposure to pollutants can be reduced by wearing specialized masks like the N95 Masks, staying indoors when the outdoor air quality is poor, and using air purifiers. However, that brings us to the second reason why that may not be achievable by women in our community.
2. Economic instability
When it comes to the effect of economic instability on our community, there is so much to unpack. First, our adults are often forced to work in unstructured settings where health insurance is not part of the bargain. Thus, we have to pay out-of-pocket healthcare costs. However, because of the below average wages, that also seems farfetched. It is not surprising that many of our families are now resorting to crowdfunding platforms to finance health costs. This makes it harder for our pregnant women to get access to vital prenatal care.
Economic instability is also a stumbling block that can affect our pregnant women’s access to important nutrition and crucial medication necessary for fetal development. Raising a child is always hard. Throwing economic instability into the equation makes it harder—especially because some of our women can’t take time off work after birth.
3. Chronic health conditions in mothers
The difficulty in accessing healthcare means a large number of adults in our community are living with chronic health conditions. Several studies have shown how unequal access to healthcare has allowed several health conditions to disproportionately affect the Black community. A 2024 publication in the Obstetrics & Gynaecology journal shows that the rate of pre-existing chronic conditions in pregnancy jumped threefold between 2022-2006 and 2016-2019.
Pregnancy can exacerbate easily treatable health conditions like viral hepatitis, high blood pressure, malaria, and several bacterial infections. Having these preexisting conditions can also increase the risk of infant mortality.
We address higher infant mortality rates in our community, by advocating for policies that improve access to affordable, quality healthcare for all; raising awareness about the root causes such as racism and socioeconomic factors, is crucial in fostering understanding and support for change. Also, we must actively support community health initiatives, such as those offering prenatal care and mental health services to empower families and reduce risk factors. Encouraging regular prenatal care and helping ensure that pregnant individuals have access to healthcare is essential for improving outcomes. Also, we must address and combat racism and implicit bias in healthcare systems. This is key to ensuring that Black mothers and infants receive fair and respectful treatment. Finally, we need to advocate behavioral change like quitting smoking and heavy intake of alcohol while pregnant as well as any substance that can affect normal fetal development.
For more reading
https://www.cdc.gov/mmwr/preview/mmwrhtml/00000850.htm
https://www.sciencedirect.com/science/article/pii/S2773049223000053
https://minorityhealth.hhs.gov/infant-mortality-and-african-americans
https://ww2.arb.ca.gov/resources/inhalable-particulate-matter-and-health
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.17885
