Socio-economic levels affect premature birth rates across races
The infant mortality rate in New Jersey is significantly below the national average for Black, white and Hispanic babies, but there are large racial disparities between the demographics.
The infant mortality rate among Black babies is three times that of white babies, meaning Black infants are three times more likely to die, according to New Jersey State Health Assessment Data.
The data shows that in 2015 there were 5.9 deaths per 1,000 births nationally compared to 4.8 deaths per 1,000 births in New Jersey — but New Jersey has one of the largest disparities between Black and white children in the nation.
Barbara Ostfeld, a professor at the Rutgers Robert Wood Johnson Medical School (RWJMS), said that one reason why the disparity is so large is because the white infant mortality rate is so low. According to the health assessment data, white infant mortality in New Jersey is the lowest in the nation.
She also said that multiple factors drive disparity.
“Poverty contributes and there is disparity in poverty,” Ostfeld said. “Preterm birth contributes and there is disparity in that. Smoking contributes and there is disparity in that. And racism counts too.”
She said poverty is a big factor, and that the higher the poverty rate in a county is, the higher the infant mortality rate will be too.
People are living in a community with limited access to healthcare — not just prenatal healthcare — but lifelong care, which can raise the risk of complications, Ostfeld said.
For example, she said that if a woman has not been able to go to the dentist due to limited access or resources she could be at risk for periodontal disease — a serious gum infection. These infections do not just impact oral health. Periodontal disease produces inflammation in the body, which raises the risk of premature birth.
“There’s disparity in the presences of periodontal disease in the United States,” she said. “Black women are more likely to have it than white women. And again, nothing to do with race, but the disproportionate presence of poverty.”
Premature birth is a major cause of death among infants in general, Ostfeld said. But disparity also exists within the frequency of premature births between races.
She said the risk of a Black baby being born prematurely is 2 in every 1,000 live births. But for a white baby, the risk of being born prematurely is 1 in every 2,000 live births.
Factors that can raise the risk for premature births relate back to poverty, making it a significant driver of disparity between Black and white babies in infant mortality rates.
Ostfeld said that if a family lives in poverty it has an increased chance of living in a high-crime area. This can affect the way a family decides to care for its child — making it balance different risks.
“So, you may know that it is not safe to bed share, but if you are living in substandard housing in a high-crime area, you may feel that it is even less safe to keep the baby even inches away from you,” she said.
Living in poverty can be stressful, and high stress can increase the risk of preterm birth. There is a link, Ostfeld said.
Smoking can also lead to health complications for babies, but not just as a result of the mother smoking. The issue loops back to poverty again. Ostfeld gave an example.
If someone lives in substandard housing and their neighbor outside smokes, the fumes could waft through to the child inside. She said that household smoke is a prevalent risk factor that also drives disparity.
The final reason for the difference in infant mortality rates between Black and white infants is racism, she said.
Anjanette Vaidya, president and founder of Rutgers Students with Children (RSWC), said her organization works from a “reproductive justice framework,” meaning it works off the assumption that social justice for a young mother includes things like the right to access quality healthcare and the right to access an education.
She said that these disparities disproportionately affect Black women, and intersect with other issues like maternal morbidity, racism and discrimination regarding class, gender and age.
She shared her own story of experiencing discrimination in the hospital.
Being a teenage mother with her first child, she said she had educated herself on the topic, read up on childbirth, attended classes and went to the hospital with a childbirth plan.
“Because of my age, class and race, the nurses really treated me with complete contempt and disrespect,” Vaidya said.
Her childbirth plan was thrown down, and her knowledge and research on childbirth was mocked. She was left to labor alone during the delivery. She said that after her daughter was born, all of her requests were challenged.
“I signed myself out early … I got the okay from the pediatrician, and I left,” Vaidya said.
She said she has had two more children, and both were birthed at home and tended to by midwives. A decision she made as a result of her negative experience in the hospital.
Ostfeld said that experiencing racism can deter people from reaching out to healthcare services in the future, but work is being done to move past just addressing the issue and to take action going forward.
Vaidya said that RSWC has made progress on its campaign to get Rutgers to provide student parents with support and basic services, as . The organization now has more than 600 signatures on its and has a meeting scheduled with University officials.
“Until we address racism in our country, the issues of poverty are not going to be fixed,” Vaidya said.