Infant mortality rates among the African American population are higher than those of the Caucasian population in this country. Part two of this infant mortality podcast addresses some theories that explain this disparity, including the issues of poverty, education and racism in the African American community. These stressors affect a woman’s overall health and as a result, the health of her baby before, during and after pregnancy. Listen in as Dr. Arthur James delves into these and other environmental factors that all contribute to very specific birth trends among this population. Dr. James also addresses how the genetics of this population are affected by environmental factors, and in turn, influence the infant mortality rate.

Transcript

[Music]

Dr. Rick McClead: Welcome to Children’s on Quality. This is your host, Dr. Rick McClead, Medical Director for Quality Improvement Services at Nationwide Children’s Hospital. A few months ago, I had the pleasure of interviewing one of our nation’s leading authorities on the problem of infant mortality in the United States, Dr. Arthur James.

Dr. James is an Associate Professor of Obstetrics and Gynecology at the Ohio State University College of Medicine and at Nationwide Children’s Hospital. He is co-director of both the Ohio Better Birth Outcomes project and the Ohio Department of Health’s Collaborative to Prevent Infant Mortality. He’s also the Director of the new Teen and Pregnant program or TAP at Nationwide Children’s Hospital.

Please join me for part 2 of my interview with Dr. James about the high rate of infant mortality in the United States.

When we speak about, I guess, basically busting certain people’s beliefs about why these disparities exist, specifically issues around socio-economic status, the difference between whites and blacks, genetic issues, education, address that for our audience.

01:25

Dr. Arthur James: OK. I don’t know that I really bust anybody’s bubbles, because I think most of those things that there is some contribution. But here is the perspective that I take – first of all, where the genetics issue is concerned, I don’t think that there’s any data, any current data that suggest to us that the belief that the black infant mortality rate is so significantly higher than the white infant mortality rate because blacks are genetically just predispositioned to have poor birth outcomes.

I don’t think that that argument holds any water. I don’t think that for several reasons – first off, if it was the case, just generally looking at the data in the United States, if that was the case, then how do we explain why blacks in Ohio in 2010 had an infant mortality rate of 15.5 while blacks in Northern Manhattan Perinatal project had an infant mortality rate of six; or why blacks in California for 2010 had an infant mortality rate of 8.5.

Are we suggesting that the black folks who live in Ohio are genetically inferior to black people who live in California or who live in New York City? Are we genetically more fragile? I don’t think that’s the case.

If we stay with the genetic issue for a while and look at a study done by Dr. Jim Collins out of Chicago who looked at comparing both birth cohorts over 15-year period of time for the entire State of Illinois, looking at the incidents of low birth weight, births for whites, for blacks who were born and raised here in the United States, as well as for African immigrants, so these would be women who were from Africa living in the State of Illinois and had babies.

During this period of time he looked specifically at low birth rate because we believe low birth weight to be a risk factor for infant mortality. The higher the incidents of being born with a low birth weight the higher the risk of infant mortality.

And what Dr. Collins’ study showed was that the birth weight distribution curves for white and for African women who had babies here in the United States that the birth weight distribution curves are more similar for those to than it was. For African-American women, the birth weight distribution curve was disfavorably shifted to the left, meaning there was a much higher incident of babies being born with low birth weight.

04:56

Dr. Rick McClead: So if you’re from Africa but you deliver here, you have an infant mortality rate that’s very similar to the Caucasian…

Dr. Arthur James: That’s absolutely correct.

Dr. Rick McClead: But if you’re African-American and lived here all your life and you give birth you have this two and a half times.

Dr. Arthur James: That’s correct. And Dr. Collins actually from that suggested to us that there was some other contributor that wasn’t genetic for sure and that there was some other contributor to why the disparity ratio was what it was. And he actually went as far as to suggest that one of the significant contributors and to that disparity ratio was actually racism.

Now subsequently, the Center for Disease Control published a study and said in essence, wait a minute, Dr. Collins, if you look at any immigrant group who comes to the United States and have babies, for those immigrants their infant mortality rates are good. We think that they’re good in part because it takes some level of financial independence for them, first of all, to move to the United States that there’s a higher incidence of therefore graduating from high school and going on and having a college degree that they’re a less teen births, so that there are things that we’ve selected out in terms of the immigrant group that comes here and that probably applies to the Africans who come here and have babies and that probably contributes to why for this that first generation why those babies born to Africans who deliver here in the United States have infant mortality rates and birth weight distribution curves more similar to whites.

And so Dr. Collins said, OK, so let’s look at the subsequent generation. Let’s look at the girls that these African women had who stay in the United States and then have a baby, let’s compare those babies to African-Americans and to whites.

07:18

Dr. Rick McClead: So this is will be the first generation of those, of the women who came here who delivered their daughters who were raised here in the United States, have a baby, that’s the population we’re talking about.

Dr. Arthur James: That’s right. And so when he looked at that group what he found was that the birth weight distribution curve for the daughters of the African women who had babies here in the United States was unfortunately much more similar to the birth weight distribution curve for African-Americans as it was for whites.

So whatever that protective factor was that initial generations who moved here enjoyed was essentially lost in one generation. Dr. Collins believes and many or the rest of us have jumped on that bandwagon that at least one of the significant contributors for that loss of protection was because of the experience of racism in this country.

But I want to go back to some of the other things that you mentioned because you talked about poverty, you mentioned socio-economic status, you talked about smoking.

Dr. Rick McClead: Education level.

Dr. Arthur James: Yeah. Education level. There are a lot of other things that contribute to the disparity, but they don’t contribute so much that they totally explain the disparity that exists. So the point that I’m trying to make here is that I think those other things also need to be addressed, that we need to be vigilant about trying to improve those circumstances.

But if we really want to eliminate the disparity in terms of black-white infant mortality then we have to address those things; we have to address what goes on clinically; we have to incorporate a social determinant of health perspective because if just try to improve infant mortality by only addressing, for example, poverty, which I think is a significant contributor, there are many of us who believe that poverty and racism are intricately intertwined with each making the other worse.

And in my opinion, racism is the venom in the bite of poverty. So that for groups who experience that in addition to being poor their outcomes are going to be much worse than we believe generally acceptable in this country.

10:37

Dr. Rick McClead: One of the things that you mentioned in your presentation at the Infant Mortality Awareness Conference that I thought was fascinating was this issue over the education that a graduate level educated black woman has an infant mortality rate that is higher than a white woman who didn’t graduate from high school.

Dr. Arthur James: That’s correct. That’s correct. And that’s been confirmed by a number of studies. It takes to a whole another level, much of which is more theoretical at this point, but it is believed and we take this from models that looked at the effect of stress on us physiologically, the effect of stress on us biologically and we believe that chronic ongoing stress has a detrimental effect overall on our health.

How does that occur? Dr. Michael Lewis is pretty infamous in his talk of asking us to imagine ourselves in a room where suddenly there’s a saber tooth tiger that jumps in and comes into the room. And for most of us our bodies automatically go into that fighter fight kind of response where our heart rates would significantly increase or depth of breathing and the rate at which we breathe would go up. Where we would look to