Racial Disparities at Birth: The Puzzle Persists (Perspectives) (Report‪)‬

A baby born to an African-American (black) mother in the United States is twice as likely to die before reaching her first birthday as a baby born to a European-American (white) mother. A range of conditions contribute to infant mortality, but the most powerful predictors are being born too early (before 37 completed weeks of pregnancy) and/or too small (with a birth weight of less than 2,500 grams). Black infants are two to three times as likely as their white counterparts to be born prematurely and/or with low birth weight. Premature or low-birth weight infants who survive beyond infancy are far more likely than other infants to suffer major developmental problems, including cognitive, behavioral, and physical deficits during childhood, with lasting consequences in adulthood. They also have poorer prospects for employment and wages as adults. Prematurity and low birth weight (together referred to as adverse birth outcomes) also predict poor adult health, including diabetes, high blood pressure, and heart disease, all of which raise risks of disability and premature mortality. Caregiving to chronically ill and/or disabled survivors of adverse birth outcomes is a tremendous economic burden on families and society. A growing body of research has been conducted in recent years into the causes of the racial disparities. The research has examined a wide range of possible factors, including differences in prenatal care, differences in women's health before they become pregnant, and infections. This research has produced useful insights but has not identified a clear cause for racial disparities. More recently, researchers have hypothesized a role for stress and adverse experiences throughout life, not just during pregnancy, as possible explanations. Much greater research investment is necessary if we are going to solve the puzzle of why racial disparities in birth outcomes persist.