Introduction
Infant mortality is among the most evident and acute threats during the early phase of human development, and the reasons thereof are an important topic to study. Moreover, the disparities in infant mortality may demonstrate the lack of equal access to healthcare opportunities and, thus, indicate the larger problems within the healthcare systems. This is definitely the case in the United States, where strong racial patterns in the distribution of infant mortality among the different racial groups. Despite the fact that the overall rates went down during recent decades, black infants continue dying at more than twice the rate of their white counterparts (Loggins & Andrade, 2014). To understand the causes behind this disparity, a proper review of scholarly literature on the matter is in order. The combination of quantitative and, to a lesser degree, qualitative studies indicates that social health determinants, stress, culture, and structural racism bear the responsibility but does not provide a definitive answer regarding their relative importance.
Methods
In terms of methods, the vast majority of studies concerning the black/white infant mortality gap are quantitative. The authors rarely gather the data on their own, preferring to rely on the government agencies that amass and store it. In most cases, the authors use the information provided by the Center for Disease Prevention (CDC) and the National Center for Health Statistics (NCHS) (Gillespie-Bell, 2021; Green & Hamilton, 2019; Kirby, 2017; MacDorman, 2011). Another possible avenue of approach is using birth certificates, as in the study by Blackeney et al. (2019). In either case, this reliance on large amounts of statistical data allows the researchers to amass large samples. These can reach hundreds of thousands, as in Blackeney et al. (2019), and even millions, as in Pabayo et al. (2019). In order to handle such volumes of data efficiently, the authors use various mathematical models, the description of which would go beyond the limits of the present literature review. Overall, quantitative studies relying on large samples procured from healthcare agencies comprise the majority of studies on the matter and seek statistical patterns behind the racial gap in infant mortality.
In contrast, qualitative studies about infant mortality and its occurrence in black and white mothers are not nearly as common as their quantitative counterparts, although there are still some exceptions to this rule. In a study by Stiffler et al. (2018), the authors study sudden infant death in black mothers, which is one of the foremost reasons for infant mortality. The researchers capitalize on several pre-existing qualitative studies to identify the causes behind the greater rates of sudden infant death in black mothers. According to the authors, the primary factor in this regard is the refusal to adopt better sleeping practices is primarily rooted in cultural norms and beliefs (Stiffler et al., 2018). Thus, qualitative studies may highlight aspects of the topic that are otherwise overlooked in quantitative ones, which comprise the majority of scholarly works on the matter.
Approaches & Trends
One of the notable achievements of the scientific community in its analysis of the racial gap in infant mortality is a solid understanding of its historical dynamics. Over the years, the researchers have established a well-outlined trajectory of the historical development of the problem. For instance, Singh and Yu (2019) traced the history of this disparity more than 100 years back to 2015 to establish that it was present for as long as the birth records themselves. The authors also point out that the current situation, in which the incidence of infant mortality in black mothers is twice as high as in whites, forms the severest disparity in history. Given that, it is not surprising that most authors focus specifically on the recent historical trends in this respect. A good example is a study by Loggins and Andrade (2014), which demonstrates that even despite the overall decline in infant mortality from the 1990s onward, the racial gap persists and even worsens. Hence, the scholarly literature not only identifies the problem but also outlines its severity and significance with excellent clarity.
In terms of the reasons behind this problem, there is no unanimity, but many studies tend to point to social health determinants as the most likely explanation. The determinants themselves may vary depending on a particular study, but the aim of establishing a correlation between infant mortality rates and socioeconomic factors moderating access to healthcare opportunities remains the same. Green & Hamilton (2019) explore the link between education and infant mortality and find out that, except for the lower access to education in general, black mothers also have the lowest return to education. Matoba & Collins (2017) point to other determinants, such as income and residential segregation, both limiting access to healthcare opportunities. The researchers who aim to be more specific often identify the lack or neglect of prenatal and postnatal care as a particularly important determinant. Blackeney et al. (2019) and Stiffler et al. (2018) are both good examples of this approach, although the former mention that the willingness to utilize this care depends heavily on education. However, the weakness of this obvious approach is that it easily establishes correlation but not necessarily identifies causation.
Another factor that emerges in the studies as an important cause of higher infant mortality rates is maternal stress. Admittedly, it is not as prominent in research as the social determinants of health discussed above – most likely because it is harder to measure and quantify and requires greater amounts of fieldwork. Still, there are studies that point toward the overall level of stress experienced by a mother as a reasonably strong predictor of infant mortality and an explanation of its higher incidence in blacks. For example, Matoba & Collins (2017) find a direct link between the levels of stress experienced, often due to racial prejudice, and the greater rates of infant mortality in black mothers. Although there are not as many studies on this particular subject as there are on education of residential segregation and their relation to infant mortality, they still provide a compelling point. Considering this, one may mark the greater attention being paid to maternal stress levels and its relation to infant mortality rates as one more tendency evident in the current scholarly consensus on the topic.
Apart from all that, one more development in the scientific analysis of the problem capitalizes on the explanations provided above to develop a more comprehensive outlook on the problem. The main premise of this approach is that the social determinants of health, as well as the levels of stress experienced by black mothers, are merely the symptoms of a broader issue. This issue is structural racism that moderates access to healthcare opportunities both directly and indirectly. Gillespie-Bell (2021) notes that, while individual social health determinants are important, racial bias within the healthcare system may also be a prominent cause of higher rates of infant mortality in black mothers. Matoba & Collins (2017) also point out how the American social environment as a whole, rather than the disparate health determinants. Kirby (2017) develops this approach to its logical conclusion and posits that technical access to healthcare opportunities is not enough on its own, and the solution should lie t the policy level. Overall, this approach utilizes the findings of the other ones discussed above to arrive at a more comprehensive view of the problem.
Conclusion
As one can see, the issue of racial disparity in infant mortality in the United States is an acute problem that is widely discussed in the scientific community. In terms of methods, the vast majority of studies are quantitative and based on large databases provided by healthcare agencies, although there are also qualitative studies highlighting the aspects that are otherwise neglected. The most obvious and popular approach is linking the disparity in question to certain social health determinants, such as education, income, residential segregation, and others. However, this approach is limited because it is better suited for establishing correlation rather than causation. Another trend is paying more attention to the psychological state of mothers and the interrelation between their levels of stress and the infant mortality rate. Finally, there is also a more comprehensive approach pointing to structural racism as the main cause behind the racial gap in infant mortality. Despite the number of studies on the matter, there is still no definite agreement on the leading cause of the disparity, suggesting that additional works on the subject are in order.
References
Blackeney, E. R., Herting, J. R., Bekemeier, B., & Zierler, B. K. (2019). Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010. BMC Pregnancy & Childbirth, 19(1):390.
Gillespie-Bell, V. (2021). The contrast of color: Why the black community continues to suffer health disparities. Obstetrics & Gynecology, 137(2), 220-224.
Green, T., & Hamilton, T. G. (2019). Maternal educational attainment and infant mortality in the United States: Does the gradient vary by race/ethnicity and nativity? Demographic Research, 43, 713-752.
Kirby, A. S. (2017). The US black-white infant mortality gap: Marker of deep inequities. American Journal of Public Health, 107(5), 644–645.
Loggins, S., & Andrade, F. C. D. (2014). Despite an overall decline in US infant mortality rates, the black/white disparity persists: Recent trends and future projections. Journal of Community Health, 39(1), 118-23.
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Pabayo, R., Ehntholt, A., Davis, K., Liu, S. Y., Muennig, P., & Cook, D. (2019). Structural racism and odds for infant mortality among infants born in the United States 2010. Journal of Racial and Ethnic Health Disparities, 6(6), 1095–1106.
Singh, J, K., & Yu, S. M. (2019). Infant mortality in the United States, 1915-2017: Large social inequalities have persisted for over a century. International Journal of Maternal and child health and AIDS, 8(1): 19–31.
Stiffler, D., Ayres, B., Fauvergue, C., & Cullen, D. (2018). Sudden infant death and sleep practices in the Black community. Journal for Specialists in Pediatric Nursing, 23(2), e12213.