Pediatric Health Inequities: The Case of Infant Mortality M. Norman Oliver, M.D., M.A. Associate Professor, Departments of Family Medicine, Public Health Sciences, and Anthropology; Director, UVa Center on Health Disparities

Wise P. The Anatomy of a Disparity in Infant Mortality. Annu Rev. Public Health 2003;24:

Oberg CN and Rinaldi M. Pediatric Health Disparities. Curr Probl Adolesc Health Care 2006;36;251-68

Infant Mortality Rates by Maternal Race and Ethnicity United States, 1995 and 2003 * Deaths of infants aged <1 year per 1,000 live births. † Includes persons of Hispanic and non-Hispanic origin. § Difference not significant at p<0.05 (z test). ¶ Persons of Hispanic origin might be of any race. Infant mortality rates decreased significantly (p<0.05, z test) in the United States from 1995 to The rate for non-Hispanic black mothers was significantly higher than for all other groups for both years; the rate for American Indian/Alaska Native mothers was significantly higher than for non-Hispanic whites, Hispanics, and Asians/Pacific Islanders for both years. SOURCE: Mathews TJ, MacDorman MF. Infant mortality statistics from the 2003 period linked birth/infant death data set. Natl Vital Stat Rep 2006;54(15).

Wise P. The Anatomy of a Disparity in Infant Mortality. Annu Rev. Public Health 2003;24:341-62

Birth weight: How do we intervene? Birth-weight specific mortality – improve high-risk obstetrical and neonatal intensive care Birth weight distribution requires prenatal and preconceptual interventions Our strategy must be to improve the health of the woman before she becomes pregnant or the fetus’ health during pregnancy or both

Prenatal care Widely perceived that improving access to prenatal care will improve birth outcomes Selection bias: Women receiving prenatal care are likely to be at lower risk for preterm birth for other reasons. Some evidence that prenatal care has little impact on preterm birth (Goldenberg RL, Rouse DJ. Prevention of premature birth. N Engl J Med 1998;339: ). Other important reasons to provide it.

Intervention targets to reduce risk of birth of VLBW infants Huge literature re: factors that increase risk of premature or VLBW infants -- Low income, poor housing, maternal age & parity, maternal smoking, cocaine use, STDs These factors tend to explain only a small proportion of the inequities in preterm or VLBW infants Psychosocial well-being of women of child- bearing age Genetics

Being a Black Woman in America is a Vast social science literature on role of racial discrimination and gender oppression on the psychological well-being of Black women. A little over a decade ago, Geronimus showed that these social inequities were associated with inequities in birth outcomes. (Geronimus A. Black/white differences in the relationship of maternal age to birthweight: A population-based test of the weathering hypothesis. Soc Sci Med 1996;42: )

Being a Black Woman in America is a Higher maternal education is associated with reduced prematurity rates. However, highly educated Black women have nearly twice the infant mortality rate of their white counterparts. Geronimus demonstrated that the inequities in the birth of LBW and VLBW increased with increased maternal age. The embodied effects of racial discrimination, therefore, seem to be cumulative.

Life-Course Perspective Lu MC, Halfon N. Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective. MCH Jour. 2003; 7:13-30.

Thanks to assistants Kristen Wells, MPH Kevin Vilsaint, MD

For more information on infant mortality CDC Office of Minority Health and Health Disparities: CDC’s SIDS Web page: National Center for Health Statistics Infant Health Page: US Department of Health and Human Services Office of Minority Health: National Institute of Child Health and Human Development: National Women’s Health Information Center: Back to Sleep Campaign:

Pediatric Health Inequities: The Case of Infant Mortality M. Norman Oliver, M.D., M.A. Associate Professor, Departments of Family Medicine, Public Health Sciences, and Anthropology; Director, UVa Center on Health Disparities