Inequity at Birth

Ama Chandra knows firsthand the dangers black women and their babies face during pregnancy and infancy: Six of her eight pregnancies ended in miscarriages, for reasons including preterm labor. Her two children, Tano and MaeLee, were born at 27 and 24 weeks, respectively, early births that put them at elevated risk of myriad health problems. 

“Our communities deal with a lot of stress and trauma, and there is a huge impact on the body,” said Chandra, a registered nurse and professional singer.  

Black women are almost twice as likely to give birth prematurely as white women in the U.S. Now, a first-of-its-kind study by researchers at the University of Maryland School of Public Health has identified a range of geographic, socioeconomic and maternal health factors that contribute to unbalanced outcomes in many of the births. Together, the study found, they account for nearly 40% of preterm births (37 weeks or earlier) and almost a third of very preterm births (32 weeks or earlier) among black women. 

The study, published in the November issue of the American Journal of Preventive Medicine, takes a new approach to examining the disparity, the researchers say. Instead of analyzing the various associations with social, geographic and health factors, it quantified how much the disparity between white and black premature births could be reduced by addressing those issues. 

“This is important because there are limited public health funds for interventions, and we need to make sure that we are focused on the right things,” said Marie Thoma, assistant professor of family science and the study’s lead author.

Reducing racial and ethnic disparities in preterm birth and infant mortality are priorities for public health programs. To unravel and quantify the contributing factors, Thoma and colleagues analyzed data on all live births during 2016 in the U.S. 

They found that the largest contributors to the disparity included differences in maternal education, marital status and paternity acknowledgment, source of payment for delivery, and hypertension in pregnancy.

Existing evidence links stress and experiences of racism to higher blood pressure and other negative health outcomes among African Americans. 

“We found that pre-pregnancy hypertension was a significant driver in black-white disparities in preterm birth,” Thoma said. “This suggests that we need to be focusing on interventions that can support women’s health and well-being before they become pregnant.” 

Chandra said she’d love to see health care practitioners have care managers who work with clients. 

“People should be assigned a doula and have people who meet with them regularly to help manage stress,” she said. “If you have had a loss, you should be flagged and they should know to assess you.” 

Thoma hopes that the study will serve as a call for programs that better support women’s social and economic needs and provide enhanced preconception care specifically focused on hypertension: “What we need to focus on is reducing barriers in social and health care systems so that we can better support black mothers before, during and after pregnancy.” 

Thoma is part of a team of researchers from the School of Public Health’s Department of Family Science that conducted a study commissioned by the Maryland Health Care Commission to address infant mortality disparities in Maryland among African American and rural mothers. Their report, which includes 13 recommendations to improve outcomes for moms and babies in the state, was submitted to the governor’s office on Friday.