As communities around North America are grappling with racial inequalities, a new research paper shows that Black babies are less likely to die in infancy when they’re cared for by Black doctors.
Discrepancies in health outcomes are one way that systemic racism presents itself. Unfortunately, moms and babies are particularly vulnerable — Black women are 2-3 times more likely to die in childbirth than their white counterparts, and Black babies are twice as likely to die in infancy than white babies. Of course, health care discrepancies extend well beyond this — for example, Black and Hispanic people are more likely to die from coronavirus too.
The new research, published in the journal Proceedings of the National Academy of Sciences, found that the added risk for Black infants was cut in half when they were cared for by Black doctors.
Why that’s the case is a complicated question, according to study authors Rachel Hardeman, a reproductive health equity researcher at the University of Minnesota School of Public Health, and Brad Greenwood, who studies public and population health at George Mason University in Virginia. Speaking with ScienceNews they said that they’ve received some push-back on the findings, but since the data is strong they said it’s important to dig into why Black physicians might improve outcomes for Black babies.
“That’s not to say that we’re talking about good versus bad physicians, or racist and not racist physicians,” Hardeman said. “It’s that we need to be thinking about and exploring what this means in a broader context of how we ensure equity in our society.”
There are a variety of reasons for the increased mortality rate for both Black moms and babies. Racism likely plays a role, as does access to healthcare — Black people are more likely than whites to be uninsured, for example. Importantly, many Black patients have additional health risks that can increase their likelihood of complications from birth. This can be explained by a hypothesis called weathering — the idea that living in a systemically racist society for a lifetime causes Black people to age faster at a cellular level, increasing their risk for disease.
“That really brings Black birthing people into pregnancy looking physiologically older than they are,” Hardeman said. “This idea of toxic stress due to racism and socioeconomic disadvantage across one’s life can lead to wear and tear on the body that puts Black people at a disadvantage with respect to their health.”
When Hardeman gave birth, she specifically sought care givers who were Black, and she said that many Black people feel they’ll have better care from someone from a similar cultural background.
“I could speak from a personal level as a Black woman who has been pregnant, putting together the care team that I wanted for my pregnancy and birth. I wanted a doula who came from the same racial background as myself, and having someone who really understood my life experience was incredibly important,” she said. “Generally, that’s felt and sort of understood anecdotally. But having the opportunity to really dig into the numbers and the data was compelling for me.”
Interestingly, the research did not show improved outcomes for Black birthing mothers cared for by Black doctors.
The importance of recognizing healthcare disparities goes beyond this research, and is especially important during the pandemic. The Chicago Tribune recently reported that in Illinois, 70% COVID-19 cases during pregnancy are found in Black and Hispanic women. Socio-economic factors — like being unable to work from home or not having insurance — are amplified during the pandemic, medical professionals told the paper.
“COVID-19 brought its own set of issues around disparities, but also highlights issues that have been there all along,” Ann Borders, an OB-GYN and executive director of the Illinois Perinatal Quality Collaborative, told the paper.
Greenwood said that understanding the healthcare challenges that Black people face could explain how Black doctors interact differently with their patients. Other health care professional might learn from this, he added.
“Black doctors may be more in tune with the specific experience that black newborns are facing, [such as] more challenging births as the result of increased socioeconomic pressures,” he said. “Let’s figure out what practices are different and try to get them to everybody.”