Exploring the factors that account for racial disparities in birth outcomes has been a passion of James W. Collins Jr., M.D., M.P.H., for decades. His research is uncovering some of the reasons why Black women have a higher risk of premature births, the leading cause of death among Black infants.
“If we're serious about improving pregnancy and birth outcomes … we have to begin to address the social and economic inequities that are the root cause of health disparities. This includes putting structural racism on our agenda,” said Dr. Collins, medical director of the neonatal intensive care unit at the Ann & Robert Lurie Children’s Hospital of Chicago and professor of pediatrics (neonatology) at Northwestern University’s Feinberg School of Medicine.
He made the comments Saturday during the Silverman Lecture “Racial Disparity in Birth Outcomes,” part of the AAP plenary at the Pediatric Academic Societies meeting. Equity as well as COVID-19 are the AAP themes this year.
In 2019, the rate of preterm birth among African American women (14.4%) was 50% higher than that of White (9.3%) or Hispanic (10%) women, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics. Infant mortality for African Americans exceeds that of the other racial and ethnic groups in the U.S.
As far back as residency, Dr. Collins wanted to better understand these statistics. He received an M.D. at University of Michigan, completed residency and fellowship at Northwestern and received an M.P.H. from University of Illinois at Chicago.
Transgenerational factors play a role in birth disparities. The conditions and environments experienced by one generation can impact the pregnancy outcomes of the next one. He cited slavery as the ultimate transgenerational process. “Historical insults contribute to current disparities,” he said.
Understanding the U.S.-born Black woman’s pregnancy disadvantage requires analysis of race as a social context: addressing racism in its various forms. Structural racism is the most insidious, with a more powerful impact but more difficult to measure and quantify.
Maternal education is not protective when it comes to preterm birth. Studying Illinois vital records, Dr. Collins and his team found that Black women with advanced education had higher rates of preterm birth than White women with less than a high school education.
Other factors that have been shown to impact birth outcomes are the following:
- Experiences of the mother from the time she was a child. Fathers’ lifelong socioeconomic position also may play a role.
- Aspects of a mother’s social environment may subject her to influences during fetal life that result in slowed growth in utero, programming her to have an infant who is preterm or small for gestational age.
- Chronic exposure to interpersonal racial discrimination in the workplace.
- Lifelong residence in low-income neighborhoods.
- Residence in states with more killings of unarmed Blacks.
However, no single factor explains the disparities, and more research is needed.
A frequent speaker on birth disparities, Dr. Collins often is asked what can be done. “I try to encourage people to think broadly — not so much thinking about having a white coat on, but really supporting public policy that improves neighborhoods. It’s really not a medical problem, per se; this is a social problem.”
Dr. Collins is hopeful that awareness of the effects of racism on maternal and child health is improving.
“There’s been a huge awakening with the Black Lives Matter movement for the past year and half … . It’s really been very palpable,” he said. “I think now people are opening their eyes more so than ever before.
“Once we start to address the health consequences of that, I think there’s going to be more of an impetus to address these issues. …For scientists and physicians, I hope it leads to funders actually investing in this type of research to get at some of the reasons why and, more importantly, to try to eliminate these disparities.”