New Jersey Department of Health and Senior Service

(WOMENSENEWS)–University of Michigan researchers are undertaking a three-year interdisciplinary study to understand why black women are three times more likely than white women to die during pregnancy and why twice as many black babies die before their first birthdays.

At least 25 researchers from the university will be on the team and they will be forming partnerships with researchers and practitioners across the country. They will be studying at least 100 women to collect primary data and plan to also use so-called secondary data–information from databases–from a much larger population.

“Not a lot has been accomplished despite millions of dollars spent and a good-hearted effort,” said Dr. Scott Ransom, the project’s principal investigator. “New approaches to this problem; that’s what this study is about.”

The study, which began in October, pulls together 17 colleges, schools and institutes at the University of Michigan, including researchers ranging from the business school to medical doctors and psychologists. The study will take an interdisciplinary approach to the problem.

“Rarely have various disciplines looked at this problem from a variety of perspectives simultaneously,” Ransom said. “Individual disciplines have been able to pick the easy fruit and now need a piggyback to get the high apple. This requires teamwork.”

Nothing New

Kristine Siefert, a social-work professor on the team, has been studying health disparities around pregnancy since 1979. But she says the issue has been around long before she got involved.

“It goes back to the early 1900s,” she said. Siefert said an article in a 1925 issue of the American Journal of Hygiene looking at racial disparities and pregnancy concluded that certain racial groups, including “Negroes,” had a predisposition toward infant mortality.

“There are huge disparities between people of color and whites. Why this has been allowed to persist is a very important question. This is something we hope to get out of the study,” said Siefert.

Beyond examining the health of newborns, the researchers will investigate why white women are more likely than black women to seek prenatal care. Though this gap has narrowed in recent years due to increased awareness, only 75 percent of black women seek prenatal care, compared to 89 percent of white women, researchers say.

Clinical Issues

Many black women don’t visit the doctor because they feel clinicians regard their lifestyles as risky and their questions as stupid, according to research done by the Northern New Jersey Maternal Child Health Consortium, a women and children’s health nonprofit group in Paramus, N.J., for a 1997 report on black infant mortality.

“There was a consistent feeling that the medical community wasn’t welcoming of black women,” said Ilise Zimmerman, the group’s president. “How you treat someone determines if they will return . . . We need to teach physicians to encounter their own bias and be aware of their misconceptions. Not every black woman is poor, single and raised by her grandma.”

Many black women felt that posters and brochures in the doctor’s office didn’t represent them, according to the same research.

In response, the Black Infant Mortality Reduction Resource Center, which is affiliated with Zimmerman’s group, released a brochure in May for black mothers-to-be. It discusses issues such as bacterial vaginosis; a vaginal infection twice as common in black women, which can affect a woman’s pregnancy.

Gap Based on Stress, Access

Professionals in the field also have strong ideas about the gap that are based on their experience.

Dr. Tonja Hampton, wellness coordinator at the Center for Black Women’s Wellness, in Atlanta, works with mostly low-income women. She blames stress and a lack of health care access for her patients’ inability to obtain better services. “The stress of day-to-day living and competing priorities in these women’s lives–as well as learning to get around the health care system–all affect their care and birth outcomes,” she said.

A distrust of the government by black women was also detected in various surveys by the Center for Black Women’s Wellness. The roots of this distrust, according to Hampton, go back to the Tuskegee syphilis experiment: For 40 years, from 1932 to 1972, the federal government studied about 400 black men with syphilis without their knowledge and without offering them readily available treatments.

“Lots of minorities are afraid of doctors and medicine, because of the idea that they may be a guinea pig,” said a resident doctor at Brooklyn Hospital in New York. “Many actually relate better to me when I’m the physician because I’m a black American.”

Nothing Conclusive

Researchers, however, caution against an over-emphasis on socioeconomic factors.

“We used to think that poverty alone explained why black women have worse birth outcomes, but middle-class black women still have worse outcomes than white women of the same income level and background,” said Siefert. “Higher socioeconomic status doesn’t give the same protection for black women that it does for white women. So now one pathway to investigate is bias and discrimination.”

The researchers hope to develop the whole picture, as well as increase awareness and stimulate action, through their work.

“You need education, will, real employment opportunities, health insurance, etcetera,” said Siefert. “This problem must be acknowledged and addressed at the institutional and individual levels, at the policy level, organizational level and the provider level.”

Juhie Bhatia is a writer based in New York City.