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Texas Has a Premature Birth Problem, and Racism is to Blame

by: Genevieve Cato

Tue Dec 17, 2013 at 01:00 PM CST

Statistics from the March of Dimes 2013 Texas Premature Birth Report Card

Last week on The Root, Janell Ross reported on two studies from Emory University that linked racism to premature birth and the health outcomes for children born before 39 weeks. Premature birth can bring a whole host of health issues, ranging from difficulty in the classroom to cerebral palsy. In the United States - which ranks worst among industrialized countries according to the World Health Organization - Black women had significantly higher rates of premature birth in 2013 (16.8%) than their Hispanic (11.7%), White (10.5%), Native American (13.6%), or Asian (10.3%) counterparts.

This increased chance of premature birth can be deadly for infants. Premature birth is the second highest cause of infant mortality, and in Texas, Black children are twice as likely to die before they reach the age of one. Though other indicators certainly impact the likelihood of premature birth, such as poverty and access to healthcare, "Black women up and down the income and education ladder disproportionately deliver their children too early," Ross explains. The same holds true for Black women in Texas.

More on the results of the studies and the impact of racism on premature birth and infant mortality in Texas below the jump.

Both studies attempted to address gaps in health or achievement related to premature birth and chronic stress resulting from American racism. Elizabeth Corwin, Dean of Research at Emory University's Woodruff School of Nursing and Michael Kramer, an epidemiologist at Emory's Rollins School of Public Health are both interested in the difficult task of studying racism's impact on maternal and fetal health.

Corwin's research focused on the impact of race on the experience of chronic stress during pregnancy, and the intersection of chronic stress and premature birth. Corwin explains:

With 30,000 more African-American infants born prematurely each year compared to Caucasian infants, it is very clear there is a difference in birth outcomes in the US. This health disparity appears related to the exposure of minority and low-income women to chronic stress, which wears on the health of these women prior to pregnancy as well as during and after pregnancy.

Kramer studied the long-term impacts of premature birth on learning outcomes as children make their way through school. Looking at birth, school, and academic achievement records, Kramer found that children born prematurely were more likely to fail their standardized tests. Further, the earlier the child was born, the worse they were likely to do.

Texas has a problem with racial disparities in premature birth. For Black women, the rate is 16.8%, which is higher than any other racial group in the state (Hispanic women have the next highest rate at 13.1%, and all other identified races are below the state average of 12.4%). Not only can this set children up for greater obstacles later in life, especially if they do not have access to well-funded schools and programs to aid their learning challenges, premature birth can be a matter of life or death. In Texas, the disparity between Black children and children of other races is horrifying.

Racism could have broader reaching impacts beyond premature birth, infant mortality, and difficulty learning. According to the Texas Department of Health and Safety's 2013 Healthy Texas Babies Handbook, being Black was a risk factor "associated with a significant increased risk" for multiple health concerns, including low birth weight and lack of prenatal care in the first trimester.  

Racism in the United States, and in Texas, can be devastating to maternal, fetal, and infant health. As the University of North Carolina at Chapel Hill's Dr. Diane L. Rowley explains:

The research was at first just suggesting, but it's well-established today, something about living in the United States, something beyond poverty or health insurance coverage and health care access, is helping to shape pregnancy outcomes. And that something is racism.

The 2013 Texas legislative session saw many laws passed relating to premature birth, including one by Republican Sarah Davis specifically focused on continuity of care for pregnant women on Medicaid in certain areas of Harris County. However, none of this legislation can address the root cause of premature birth due to chronic stress resulting from racism. As Ross points out in her piece, this research makes ending racism a "public health imperative." Corwin acknowledges this is not an easy task, saying "I think that our research may be shocking to a lot of people, but I hope not dispiriting." The options are available to address this problem through policy and early intervention, but, says Corwin, "The question is really whether that is something that we are prepared as a country to do."  

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