Infant Mortality & The Stresses of Everyday Racism

I think that the national discussion about racism and health care reform gets so abstract sometimes that we forget that when we’re talking about health, we’re talking about people’s lives. And, as this short clip (about 4 minutes) demonstrates very powerfully, leading researchers contend that racism plays an important role in infant mortality among African American women, even when controlling for income and education. This clip, from Episode 2, “When the Bough Breaks,” in the video series “Unnatural Causes,” (2007), features UCLA obstetrician and gynecologist Dr. Michael Lu. Lu believes that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery, one of the leading risk factors for early infant death:

And, in an interesting piece of research by one of the experts featured in the full episode, Dr. Camara Jones, concludes that: “being classified by others as White is associated with large and statistically significant advantages in health status, no matter how one self-identifies.” So, there’s a very real, somatic level at which racism both takes a toll on some and provides an advantage to others.

I think we should keep this in mind as the health care debate rages on. What kind of society do we want to create?


  1. I can’t help but notice that there’s no mention of the fact that Mexican-Americans have a lower incidence of infant mortality than non-Hispanic white Americans, as do Cuban, Japanese, and Chinese Americans.

    The latter two may be explainable by their relatively high SES, but the fact that Mexican-Americans have significantly lower SES and access to health care than do non-Hispanic whites, on top of having to deal with anti-Mexican sentiment arguably as strong as or stronger than the racism blacks face, presents serious problems for the “it’s because of racism” hypothesis.

    You can’t just control for N factors and then decide that the residual difference must be due to your pet issue. The residual difference may be a combination of any number of the factors you didn’t control for.

    “Being classified by others as White is associated with large and statistically significant advantages in health status, no matter how one self-identifies.”

    That could be because being socially classified as white confers play a causal role in health outcomes, but there’s an obvious alternative explanation: Social classification may well be a fairly reliable proxy for racial makeup. People who are, say, 1/4 to 1/8 Amerindian and 3/4 to 7/8 white may self-identify as Amerindian, Latino, or mixed-race for any number of reasons, but they’ll generally be socially classified as white because…well…they look white. Because they are, mostly.

  2. Tyan Parker Dominguez

    Thank you, Mr. Berg, for your comments regarding the relatively favorable birth outcomes of Asian and Latino subgroups vis-a-vis African Americans. To name racism as a social determinant of racial disparities begs the question of why these other racial/ethnic groups fare so well in terms of their reproductive outcomes when they, too, as people of color, are subject to race-based prejudice and discrimination in this country. I am not aware of any published findings on minority group differences in perceptions of racism and its reproductive health consequences (if anyone knows of any, please let me know!). However, there is literature that tells us the following:
    1) Immigrants to this country enjoy substantially better reproductive health than do their US-born counterparts. This could be attributable to a “healthy immigrant effect” (ie, the most hardy immigrate) and/or a variety of culturally based health protections (eg, traditional cultural orientations that promote highly positive attitudes toward childbearing, strong familial support, healthier diets, etc).
    2) The more favorable birth outcomes of Asians and Latinas is largely a function of the substantial numbers of births to immigrant women in those populations.
    3) Immigrant health erodes with increasing acculturation, time in the US, and across successive generations born here.
    4) Even Black immigrants’ birth outcomes are closer to those of Nonhispanic Whites than to Nonhispanic Blacks’ (which also undermines a genetic cause for the apparent African American reproductive disadvantage).

    These nativity patterns in birth outcomes highlight the critical role that the social environment plays in shaping health and disease risk. As Michael Lu suggests in the “Unnatural Causes” video, African Americans are subject to racism from birth to death, which is not necessarily the case for other racial/ethnic minority groups. Interestingly, the group with the next highest incidence of adverse outcomes is Native Americans who also have a long-standing history of racial/ethnic oppression in this country. Conceptualizing reproductive health within a life course paradigm that considers the health protections and health risks accrued across the totality of a woman’s life may better enable us to understand these persistent patterns of disparate health.


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