An Ecological Approach to Understanding Black–White Disparities in Perinatal Mortality

• Published in: Maternal and child health journal 2010-07, Vol.14 (4), p.557-566
• Main Authors: Alio, Amina P., Richman, Alice R., Clayton, Heather B., Jeffers, Delores F., Wathington, Deanna J., Salihu, Hamisu M.
• Format: Article
• Language: English
• Subjects: African Americans; African Americans - statistics & numerical data; Babies; Black people; Childrens health; Community; Ecological models; Family Characteristics - ethnology; Female; Gynecology; Health aspects; Health disparities; Health Services Accessibility; Health Status Disparities; Humans; Inequality; Infant mortality; Infant, Newborn; Infants; Maternal Age; Maternal and Child Health; Medicine; Medicine & Public Health; Patient outcomes; Pediatrics; Perinatal Mortality - ethnology; Population Economics; Pregnancy; Pregnancy Outcome - ethnology; Prejudice; Premature birth; Public Health; Racial differences; Racism; Residence Characteristics; Respiratory distress syndrome; Risk Factors; Social Class; Society; Socioeconomics; Sociology; Stillbirth; System theory; United States - epidemiology; Women
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-009-0495-9

Despite appreciable improvement in the overall reduction of infant mortality in the United States, black infants are twice as likely to die within the first year of life as white infants, even after controlling for socioeconomic factors. There is consensus in the literature that a complex web of factors contributes to racial health disparities. This paper presents these factors utilizing the socioecological framework to underscore the importance of their interaction and its impact on birth outcomes of Black women. Based on a review of evidence-based research on Black–White disparities in infant mortality, we describe in this paper a missing potent ingredient in the application of the ecological model to understanding Black–White disparities in infant mortality: the historical context of the Black woman in the United States. The ecological model suggests that birth outcomes are impacted by maternal and family characteristics, which are in turn strongly influenced by the larger community and society. In addition to infant, maternal, family, community and societal characteristics, we present research linking racism to negative birth outcomes and describe how it permeates and is embedded in every aspect of the lives of African American women. Understanding the contribution of history to the various factors of life of Black women in the United States will aid in developing more effective policies and programs to reduce Black infant mortality.