Notes Washed Up in a Bottle

Don. W. MacCorquodale M.D. M.S.P.H.

Periodic Notes From the Field on Philosophy and Science.

D. C.’s Infant Mortality Rate

          Those of us who live in the District of Columbia got some good news recently when a news item in the Washington Post announced that the infant mortality rate in the District was the lowest in recorded history.  There was bad news, too.  Our infant mortality rate, 6.9 deaths per, 1,000 is appreciably higher than the infant mortality rate for the nation.    There was more bad news.  The death rate for black infants during the first year of life is six times as high as that for white infants.  The latest available data from the National Center for Health Statistics for black/white infant mortality differences is for 1989-91.  During that period black infant mortality in D. C. was 23.9 per 1,000 live births, just about three times that for white infants, 8.2.  Black infant mortality for the nation as a whole was 17.2 per 1,000 live births, slightly more than twice that for white infants, namely, 6.9.
          Why do proportionately more black infants die in the first year of life than white infants?  It has been known for decades that the infant mortality rate was higher for babies born to lower class women, i. e., those with limited education and income, than it was for upper class women.  Since more black women in our country had less education in comparison to white women and less income as well, it was widely held that the black/white infant mortality differences were essentially due to differences in social class.
          Back in 1992 a group of investigators at the Centers for Disease Control, CDC, decided to take a look at the infant mortality rates for black infants born to mothers and fathers who were college-educated and to compare them with the infant mortality rates of white infants born to mothers and fathers who were college educated.  The two groups consisted of slightly more than 42,000 black infants and over 865,000 white infants all of whom were born during the 1983-1985 period.  During that period the black infant mortality rate for the nation as a whole was about 19 per 1,000 live births not quite twice that of the white infant mortality rate, about 10.
          When researchers at CDC looked at the mortality experience of infants, whose parents were college-educated, the infant death rates plummeted.  Infant mortality rate for all black infants born during the same period, namely, 10.2 per 1,000 live births, was about half that for the nation as a whole.  The infant mortality rate for white infants born to college-educated parents was also strikingly lower than that for all white infants born during the same time frame, 5.4.  Interestingly, after the exclusion of low birth weight infants, the mortality rates for black and white infants were the same. 
But, take another look at the rates.  The infant mortality rate for the black infants of college-educated parents is just about twice that as that for white infants born to college-educated parents.  Obviously, social class does make a difference in survival of both black and white babies, but something else is also going on. 
          Some years ago several researchers suggested that the higher infant mortality rates among infants born to black mothers were largely the result of racial discrimination.  The idea is reasonable.  A racial slur can evoke a stress response, which results in pumping several potentially harmful substances into the blood stream.  Repeated episodes of racial confrontation could adversely affect an infant in the womb of a pregnant black woman resulting in the delivery of a low birth weight infant.
There is considerable evidence to support the theory.  The infants born to black women in Chicago, who are native born, like black women in D. C. have higher mortality rates in the first year of life than infants born to white women.  The infant mortality rate among babies born to black women who are immigrants from West Africa is comparable to that of white infants.  Black women who feel that they are frequently the objects of racial discrimination are more likely to have their infants die during the first year of life than black women who think they are seldom subjected to such treatment.
There are, of course, other racial/ethnic groups in our country who are subjected to discrimination.  Hispanics immediately come to mind.  When I served my residency in general practice in Denver, Colorado, I witnessed many acts of cruelty inflicted on Chicano men and women.  Yet, while the family incomes of Hispanic Americans and black Americans are comparable, babies born to Hispanic women have infant mortality rates far lower than those of black infants.
Few immigrants to our country have suffered such vehement discrimination as the Chinese.  The vicious treatment of the Chinese workers, who built the transcontinental railway, was legendary.  That we still discriminate against the Chinese is apparent in many of the fine novels produced by Chinese-American authors.  Now, guess which racial group of women in our country is least likely to have their infants die during the first year of life.  If you said “Chinese,” go to the head of the class.