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Op-Ed: Finding Root Causes for High Preterm Birth Rates Among Black Women

Racial inequality is a chronic stressor that takes a cumulative toll on African-American women, increasing the chance they will have health problems at younger ages

Stephanie Annang
Stephanie Annang

The risk of preterm birth is a major concern for all women no matter their age or race; however, African-American women have consistently been shown to have the highest occurrence of premature births over any other racial or ethnic group, and New Jersey is no different. African-American women in this state have the highest rates of preterm births (13.2 percent), followed by Native Americans (10.4 percent), Hispanics (9.6 percent), and both whites and Asians/Pacific Islanders (8.8 percent). Although most African-American women do give birth at term (39-40 weeks), black women in New Jersey on average are 47 percent more likely to have premature babies than white or Hispanic women. Why is that? What is it about African-American women that we are at a considerably higher risk to give birth to premature babies?

A Race Against Time?

I worked as a unit secretary in labor and delivery for five years, and within my first few years at the hospital, I noticed whenever we had a patient in preterm labor at 27 weeks or 32 weeks, they were black women. Of course, it wasn’t a constant occurrence, but it happened often enough for me (an inexperienced 22-year-old fresh out of college) to notice. Needless to say, it was a pattern that was particularly concerning. As a black woman now in her late 20s, it does sit in the back of my head that I’m getting older. The more time I put off having kids, the more complications I may have trying to conceive, and if I do conceive, the worry then becomes carrying the baby to term.

While it may seem a little silly that at only 28 years old, I’m already starting to worry about my biological clock ticking, but according to research, as a black woman I am already at a higher risk of experiencing the same complications as women in the category of “advanced maternal age (35 years or older). There are many theories that try to explain this phenomenon, but the true answer as to why this disparity exists is still a mystery.

In the early ‘90s, a researcher by the name of Arline Geronimus proposed a theory known as “weathering” that offered a possible explanation for the disparity. For African-American mothers, the infant mortality rate was found to be lowest in the teenage years, increasing steadily with advancing maternal age. Although the 20s to early 30s are seen to be the optimal childbearing years, studies have confirmed worsening birth outcomes with increasing maternal age in multiple African-American populations, suggesting that the health of African-American women may begin to deteriorate in early adulthood as a physical consequence of cumulative socioeconomic disadvantage, thus resulting in adverse birth outcomes. Given that this disparity is seen to have racial implications, I do question if racism that is experienced at all three levels (institutional, interpersonal, and internalized) could be a factor that negatively affects birth outcomes.

The Real Deal

This disparity is a tough gap to close. Many other health disparities have distinct reasons with distinct evidence to prove why they exist and that information is used for education about prevention among those negatively affected. In all honesty, it upsets me that I can’t take any specific actions to improve my chances of carrying a baby to term. Since there is no recognizable reason as to why African-American women have the highest rates of low birth weight and premature births, there is no confirmed method of prevention. I can eat a clean/healthy diet, exercise regularly, live in an affluent neighborhood, and receive all educational degrees in the world and still have a much higher chance of going into preterm labor, having a baby that suffers from low birth weight or is small for gestational age. Although some research has identified racism as a risk factor for adverse birth outcomes, it hasn’t been fully established as a direct correlate of preterm births among African-American women. Some have argued that it’s is due to a vitamin D deficiency, and others believe we are genetically predisposed and that preterm labor is in our DNA. Which is it? No one knows for sure.

I’m a firm believer in education, so learning all we can about health disparities and their related injustices would be the best way to fight this problem. There is an incredible need for research when it comes to African-American women and maternal-fetal medicine. Some organizations have done a wonderful job of creating a general awareness of and basic research into preterm birth, but in the past 20 years, the numbers have stayed somewhat consistent, and that’s a clear indication that we need to do more.

I was born and raised in New Jersey and I know there are various hospitals and clinics that are affiliated with universities and nursing schools. We need to dedicate research opportunities and funding for clinical investigations of preterm labor and low birth weight among African-American women. A research study that specifically wanted to identify a direct association between racism and preterm labor would need to investigate the mental and physical effects of the various levels of racism over the course of a lifetime and focus on the common childbearing years of 16 to 32 years. Armed with feasible data and the appropriate scientific evidence, we could devise specific interventions and preventions that could be done at a more personal level, such as continuing education for doctors/midwives that would encourage communication and education for those at highest risk for preterm labor; patient education regarding low birth weight; and gestational age/size and actual risk factors for premature birth. Community outreach has always been shown to have considerable influence, and community health fairs and workshops are one of the best ways to promote awareness, educate, and screen those at risk.

Assuming that stress due to racism really is a direct factor that affects birth outcomes in black women, it’s just another reason to keep racism as a topic of public discussion. This may seem to be a very general solution and may make people uncomfortable, but many people argue that racism will never go away unless we keep talking about it. Society can never repair these racial, ethnic, and health disparities if we don’t discuss them to acknowledge that they exist. Ignoring or even trying to forget the problem will not fix anything as the effects of constant discrimination adversely affect every aspect of our lives. I agree that we need to move forward, but that can never be done if people do not open their eyes and see the effects of racism around them.

Racial inequality is a chronic stressor that takes a cumulative toll on black women, increasing the chance that they will have health problems at younger ages. Early childbearing might pose health risks for most women, but for black women it makes more sense to start earlier — before their health declines. That could increase the rates of teenage pregnancy and children living below the poverty line, but that’s a topic for a different day. In any case, racism may very well be the reason that black women endure preterm labor at almost twice the rate of any other racial/ethnic group and therefore should be a priority for research.

Stephanie Annang works in research and development at a global pharmaceutical company and is a graduate student at Montclair State University studying public health with a concentration in community health education. She has always been passionate about maternal-fetal medicine and hopes to make a contribution to the field.

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