Racism Creates Inequities in Maternal and Child Health, Even Before Birth
July 2021 correction note: On page 14, the authors removed language referring to a specific group prenatal care model but added a reference to a pilot evaluation of this model in our description of what group prenatal care can achieve. We also modified the citations associated with these sentences.
The State of Babies Yearbook aims to bridge the gap between science and policy with national and state-by-state data on the well-being of America’s babies. The data are clear: The state in which a baby is born makes a big difference in their chance for a strong start in life. However, location is only one factor to consider in ensuring that our youngest children have a healthy start. Another critical factor is the influence of race, ethnicity, and racism on the quality of care that parents and babies receive. Wherever possible, the State of Babies Yearbook disaggregates national and state averages for key indicators of infant well-being by race/ethnicitya to explore disparities and better identify areas that warrant further examination and action.
Whether babies are born healthy and with the potential to thrive as they grow greatly depends on their mother’s/birthing person’s well-being—not just before birth, but even prior to conception. To have a healthy pregnancy and positive birth outcomes, mothers require access to appropriate health care services before, during, and after pregnancy. The well-being of mothers and babies are intrinsically interdependent, although they are often considered separately. The connection between maternal and child well-being is particularly important among women of color and their babies due to the intergenerational effects of and lived experiences with institutional and interpersonal racism. Racism influences maternal health before and throughout pregnancy and affects babies’ starts in life. Institutional and interpersonal racism are pervasive and present in the policies, practices, and systems of care that families of color encounter.
In addition to disparities in maternal and child health within the United States, the nation stands alone among its peers in markers of maternal and child health: The United States is the only high-income country in which the maternal mortality rate has risen over the past two decades.1 Relatedly, the United States has a shortage of maternity care providers (Ob/Gyns and midwives),b an overrepresentation of Ob/Gyns to midwives,c no paid family leave, and inadequate postpartum support (e.g., home visits).2 Similarly, the overall infant mortality rate in the United States is twice the rate in the European Union, on average; for Black infants in the United States, the infant mortality is nearly four times the overall rate in the European Union.3,4
Footnotes and References
a Race and ethnicity are distinct parts of identity and we refer to them separately when feasible. However, we often use this combined term as it matches the data, which usually groups them together. Hispanic people include people of all races and other racial categories include only non-Hispanic people.
b Obstetricians and gynecologists (Ob/Gyns) are medical doctors; midwives can have varying levels of training but are commonly nurses with additional graduate training in midwifery.
c Midwives are associated with lower costs and similar or better outcomes compared to Ob/Gyns for uncomplicated births.
1. Tikkanen, R., Gunja, M. Z., FitzGerald, M., & Zephyrin, L. (2020). Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries#:~:text=In%202018%2C%20there%20were%2017,%2C%20
2. Tikkanen, R., Gunja, M. Z., FitzGerald, M., & Zephyrin, L. (2020). Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries#:~:text=In%202018%2C%20there%20were%2017,%2C%20
3. Annie E. Casey Foundation, KIDS COUNT Data Center. (2020). Infant mortality by race in the United States [Data set]. https://datacenter.kidscount.org/data/tables/11051-infant-mortality-by-race?loc=1&loct=1#detailed/1/any/false/1729,37/10,11,9,12,1,13,185/21385,21386
4. The World Bank, World Development Indicators. (n.d.). Mortality rate, infant (per 1,000 live births) [Data file]. https://data.worldbank.org/indicator/SP.DYN.IMRT.IN
5. Andrews, K., Parekh, J., & Peckoo, S. (2019). How to embed a racial and ethnic equity perspective in research. Practical guidance for the research process. Child Trends. https://www.childtrends.org/wp-content/uploads/2019/09/RacialEthnicEquityPerspective_