Black–White Disparities in Birth Outcomes: Is Racism-Related Stress a Missing Piece of the Puzzle?

DOI: 10.1007/978-1-4419-9616-9_10 In book: Handbook of African American Health, pp.155-163


For decades, large disparities in birth outcomes have been observed between babies born to African- American (black) women
and those born to European-American (white) women. Adverse birth outcomes – being born “too early” (premature or preterm birth,
before 37 completed weeks of pregnancy) or “too small” (low birth weight, less than 5½ pounds) – are powerful predictors not
only of infant survival, but also of child health, development, and serious disability (Institute of Medicine, 2007). Recent
research reveals that low birth weight and premature birth also are strong predictors of chronic disease in adulthood, including
cardiovascular disease and diabetes, which are major causes of premature mortality (Barker, 2006; Phillips, Jones, & Goulden,
2006; Whincup et al., 2008). As shown in Figs. 10.1 and 10.2, the disparities generally have been persistent, until recently
when relative disparities began to narrow somewhat, for undesirable reasons: the rates of both preterm birth (PTB) and low
birth weight (LBW) worsened among white women, with little (PTB) or no (LBW) improvement among black women. (For simplicity,
throughout this chapter “black” and “white” are used to refer only to non-Hispanic women.)

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    • "Among both Blacks and Whites, preterm birth rates decline with higher maternal educational attainment or income, but at each socioeconomic level, a BlackeWhite disparity persists. The relative BlackeWhite disparity, however, is highest among births to higher-education/-income women and lowest among women of lowest income or education levels (Braveman, 2011). Furthermore, despite being generally less advantaged socioeconomically than Whites, Black immigrants to the U.S. from Africa or the Caribbean have relatively favorable birth outcomes, more like those of U.S.-born Whites than those of (U.S.born ) African Americans (Acevedo-Garcia, Soobader, & Berkman, 2005; David & Collins, 1997). "

    Preview · Article · Mar 2012 · Social Science [?] Medicine
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    ABSTRACT: During the past two decades, the public health community's attention has been drawn increasingly to the social determinants of health (SDH)-the factors apart from medical care that can be influenced by social policies and shape health in powerful ways. We use "medical care" rather than "health care" to refer to clinical services, to avoid potential confusion between "health" and "health care." The World Health Organization's Commission on the Social Determinants of Health has defined SDH as "the conditions in which people are born, grow, live, work and age" and "the fundamental drivers of these conditions." The term "social determinants" often evokes factors such as health-related features of neighborhoods (e.g., walkability, recreational areas, and accessibility of healthful foods), which can influence health-related behaviors. Evidence has accumulated, however, pointing to socioeconomic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes. This article broadly reviews some of the knowledge accumulated to date that highlights the importance of social-and particularly socioeconomic-factors in shaping health, and plausible pathways and biological mechanisms that may explain their effects. We also discuss challenges to advancing this knowledge and how they might be overcome.
    No preview · Article · Jan 2014 · Public Health Reports
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    ABSTRACT: Objectives: We investigated the role of socioeconomic factors in Black-White disparities in preterm birth (PTB). Methods: We used the population-based California Maternal and Infant Health Assessment survey and birth certificate data on 10 400 US-born Black and White California residents who gave birth during 2003 to 2010 to examine rates and relative likelihoods of PTB among Black versus White women, with adjustment for multiple socioeconomic factors and covariables. Results: Greater socioeconomic advantage was generally associated with lower PTB rates among White but not Black women. There were no significant Black-White disparities within the most socioeconomically disadvantaged subgroups; Black-White disparities were seen only within more advantaged subgroups. Conclusions: Socioeconomic factors play an important but complex role in PTB disparities. The absence of Black-White disparities in PTB within certain socioeconomic subgroups, alongside substantial disparities within others, suggests that social factors moderate the disparity. Further research should explore social factors suggested by the literature-including life course socioeconomic experiences and racism-related stress, and the biological pathways through which they operate-as potential contributors to PTB among Black and White women with different levels of social advantage.
    No preview · Article · Sep 2014 · American Journal of Public Health
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