Chandra White-Cummings, Managing Editor
Sometimes affecting change in the black community feels like a real-life version of whack-a-mole in which it seems like one issue has been put to rest, only to have another, or the same issue, pop up again and again.
For several years the rate of black infant mortality declined. From 2005 to 2012 the black infant mortality rate decreased from 14.3 to 11.6 per 1,000 births. But two years later in 2014, the rate started to inch up, going from 11.4 to 11.7 per 1,000 births in 2015. Additionally, attention has refocused on black maternal health and mortality with the news that black women die almost four times more often from pregnancy and birth related complications than white women. Mental health realities are both a significantfactor in and result of these alarming statistics. Researchers, physicians, and advocates are wacking away at these problems, but what will finally deal a death blow, or at least severely limit the death toll among black women and their children? Issues of health equity, including better access to prenatal care, and better pediatric and obstetric care for babies, are most often named as the solutions to these crises. But there is another reason the media and even some sectors of the medical community are loathe to mention: racism. Black pregnancy and birth outcome activists and advocates are pushing back to keep racism and its effects at the forefront of the discussion.
Recently the Black Mamas Matter Alliance (BMMA), in partnership with the Congressional Black Caucus and Congressional Caucus on Black Women and Girls, held a congressional briefing on black maternal health to raise awareness of the data on black mom and baby deaths and to seek funding for research and programming to address the race-related causes of both phenomena. Echoing themes associated with the Black Lives Matter movement, briefing moderator Dr. Joia Crear-Perry, founder of Louisiana-based National Birth Equity Collaborative summed up the group’s position, “Black women need government accountability. We need to know our lives are valued. Blackness isn’t the risk factor; racism is.”
One of the event’s panelists was Dr. Fleda Mask Jackson, a researcher and maternal health scholar who co-developed the Jackson Hogue Phillips Contextualized Stress Measure (JHP), an instrument designed to qualify feelings and reactions to race and gender based experiences in the lives of black women. The JHP was created after research by Dr. James Collins and Dr. Richard David refuted previous thinking and revealed that even black women with similar education and economic status as middle-class white women experienced the same level of maternal and birth risks as poorer black women. Dr. Jackson and colleagues conducted research to better understand the reasons for this and discovered that money and education were not strong enough protective factors to overcome the effects of constant stress black women experienced because of race and gender discrimination and expectations. This groundbreaking research gave voice to black women who thought “doing all the right things” would ensure healthier outcomes for them but who came to understand more clearly just how heavy a toll the stress of everyday living was taking on their lives and the lives of their unborn children. Connecting chronic, inescapable stress to maternal health and birth outcomes for black women deepened and strengthened policy work by giving greater context to fights already being fought by black women: closing the pay gap, stable and safe housing and communities, equitable education, and workplace equity. These things literally are a matter of life and death for black women and their children.
The women at the congressional briefing want to make the point that these frameworks are not just abstract theory; they have real-world applications. Take poverty. It is a widely reported measure used to explain disparities in education and health, reflects a synergistic relationship between socioeconomic indicators like employment, education, and housing, and therefore could be expected to be a strong source of life stress for black women. A look at the black child poverty and black infant mortality rates shows a shameful association:
State Poverty Rate/Blk Mult. Infant Mortality Rate/Blk Mult.
Wisconsin 44%/4.4x 14.1/2.9x
Michigan 47%/3.1x 14.3/2.9x
Ohio 47%/3.1x 15.1/2.7x
Louisiana 46%/3.0x 12.0/2.0x
Indiana 42%/2.8x 13.3/2.2x
Missouri 42%/2.8x 11.7/2.1x
Mississippi 47%/2.8x 11.2/1.9x
Arkansas 47%/2.5x 9.9/1.4x
Alabama 44%/2.75x 13.0/1.9x
Kentucky 46%/2.1x 10.1/1.5x
Solutions that have been suggested to reduce the death rates for mothers and children are finally including attacking the structural and institutional racism that lead to components of poverty, while keeping a focus on helping women to cope with the stress-inducing situations. Mental and emotional health concerns should be intimately involved in these discussions, and advocacy work must push for community based support and treatment systems to teach mental health literacy so that women can understand their own reactions and symptoms, and when and how to seek professional help; understand the serious effects of chronic and prolonged stress over the course of their lives on a current pregnancy; and how to talk with partners and family to get the support they need for a healthy pregnancy and birth.
Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality, Dr. Fleda Mask Jackson