U.S. Black Maternal Hazards Tied to Social Stress

WASHINGTON, D.C. (WOMENSENEWS) — Regardless of their age, marital status, education or early prenatal care, African American women are more likely to bear premature and low-birth-weight infants, those under 6 pounds, whose survival odds are below the U.S. norm.

Nationwide, black women are three to four times more likely to die giving birth than either white or Latina women. Their infants’ mortality risk is doubled, according to the Centers for Disease Control and Prevention. The disparity has persisted even as infant mortality rates for the nation as a whole have fallen.

In the face of such statistics, Eleanor Hinton Hoytt says the standard definition of maternal health–pregnancy through the first six months after delivery–doesn’t suffice.

"Prenatal care alone doesn’t solve the problem," said Hoytt. "It’s the life course of women in our communities that is making us give birth prematurely to sick babies. The gap (between black and white women) persists because we haven’t done enough. We need to reframe the policy issues. We need to address maternal health first, then talk about infant mortality."

Hoytt is president of the Black Women’s Health Imperative, a network of activists, community organizations and researchers which last weekend marked it 25th anniversary with a conference in Washington.

Historically, researchers have explored infant mortality–versus maternal mortality–because more infants than mothers die during delivery.

Out of 4.1 million births in 2004, 540 mothers died, compared to nearly 28,000 infant deaths. Black infants died at the rate of 13.7 per thousand; white infants, at the rate of 5.7 per thousand, and Latino infants at 5.6 per thousand.

Doctors usually blame the mothers for the deaths of their infants, citing teen pregnancy, smoking and other drugs, lack of education, poverty–and most recently–genes.

But now–on the heels of research finding health woes pervading all strata of black American society–a growing body of researchers is looking beyond socio-economic factors to explain the higher twinned rates of infant and maternal mortality among African Americans.

Crop of New Findings

Over the last 10 years, the National Institutes of Health’s Office of Research on Women’s Health, led by its first full-time director, Vivian Pinn, an African American appointed by President Bill Clinton in 1991, has encouraged a body of research indicating that the roots of black maternal ill health run deep. Among the findings:

• Black immigrant women have fewer low-birth-weight babies than native-born black women.

• Pregnant African American women are most likely to develop hypertension and diabetes. They are also most likely to retain weight gained during pregnancy.

• The problems get worse as the mothers get older, indicating a cumulative effect of stress. (Women of Color Health Data Book, 2005).

At the forefront of those seeking psychosocial explanations is Fleda Mask Jackson, a research methodologist at the Rollins School of Public Health at Emory University in Atlanta, who presented at the weekend conference.

Jackson, along with colleagues Carol Hogue and Mona Phillips, published the Jackson-Hogue-Phillips Contextualized Stress Measure in 2005. The 71-question peer-reviewed survey is designed to help doctors assess the pregnant mother’s concerns about the racial experiences of children; racial and gendered discrimination in the workplace; and the mother’s history of emotional, physical and sexual abuse.

"Patients who answer it give their health care provider context for assessing stressors before, during and after pregnancy," Jackson said in an e-mail.

Tribute to Byllye Avery

Jackson traces her determination to find wider social explanations to Byllye Avery, who stresses the intergenerational aspects of black women’s health. In 1981 Avery first founded the Black Women’s Health Imperative as an offshoot of the National Women’s Health Network in Washington. In 1989, Avery won a MacArthur "genius" award for leadership in health care for women and was named a Women’s eNews 21 Leader for the 21st Century 2004.

"She pushed me to quantify the impact of being black in America," said Jackson.

"We as black women have a different perspective," Avery has said. "When white women got together, really most of the things they wanted to talk about were reproductive health issues. But when black women got together, and we started talking about health, we started talking about things that had to do with psychological well-being, that placed an emphasis on our ethnicity, our culture, our subculture, the way we were reared, the things that go on in our life and how that affects our health."

Last fall, in a report on nutrition, stress and black maternal health for the Washington-based Joint Center for Political and Economic Studies, Jackson recommended more employment, and better housing, education and safety in black communities as one way to deal with the stressors on black women.

But she also emphasized one simple idea: Mothers, especially black mothers, need someone to talk to, a chance to blow off steam and to commiserate with those who understand what it means to be dismissed or disrespected because of the color of their skin.

With 50 percent of African American women in their childbearing years now overweight,

Shiriki Kumanyika, another conference participant, also emphasized the value of nutrition and exercise. She said that overeating during pregnancy, then failing to lose the weight afterward, is a huge problem because of the illnesses that accompany obesity among mothers: diabetes, hypertension and reproductive system cancers.

Overweight black women are twice as susceptible to these diseases as their white counterparts. Taken together, these diseases help reduce black women’s life expectancy to 76 years, compared to 81 years for white women. Furthermore, overweight black mothers tend to have overweight children.

‘Obesigenic’ Environments

"Most black women live in what I call ‘obesigenic’ environments," said Kumanyika, a founder of the African American Collaborative Obesity Research Network and a professor of clinical epidemiology at the University of Pennsylvania’s medical school. By that she means neighborhoods filled with fast food chains and lacking parks or stores that sell fresh produce.

Annelle Primm, director of minority and national affairs for the American Psychiatric Association in Arlington, Va., gave a conference talk called "Black and Feeling Blue" touching on a reluctance among blacks to recognize depression as an illness in its own right. About 1 in 10 women experience depression at some point during or after pregnancy, but black women are less likely to be diagnosed and treated, Primm said.

"We talk about ‘feelin’ evil’," Primm told the audience, "but much of the time when we’re feelin’ evil we’re masking feelings: feeling guilty; blaming ourselves for things those in our family have done, or for our inability to do anything about things they have done; feeling hopeless, helpless and worthless."

Primm said depression often accompanies the other big three illnesses that strike black mothers: diabetes, hypertension and obesity.

Another conference participant, Rev. Renita Weems, a noted Methodist theologian, reiterated that improving maternal health begins with social connections. Women, she said, need to feel they belong to a community before they can raise whole children.

"We need to take care of women before pregnancy," she said. "A woman has to believe she’s got a right to live. She’s got to believe she’s got a reason to live before she will go to the doctor."

June Cross is a documentary filmmaker and an associate professor of journalism at Columbia University.

This series is supported by the W.K. Kellogg Foundation.

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