STATE OF OPPORTUNITY. Can Kids in Michigan Get Ahead?
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This special reporting project wrapped up in May 2017. Read more.
State of Opportunity will be shining a spotlight on the issue of infant mortality this winter. Check back for news, resources, and personal stories.

Three reasons why disparities exist in infant mortality rates

Michigan Resident Birth and Death Files, MDCH Division for Vital Records & Health Statistics
MDCH MCH Epidemiology Unit, 6/28/2012
In Michigan, black babies are two and a half times more likely to die than white babies. In some cities, the disparity is even higher.

Tomorrow, State of Opportunity's Jennifer Guerra will report on Michigan's infant mortality rate. The one-hour documentary will air Tuesday, Oct. 9 at 3 p.m. and 10 p.m. on Michigan Radio.

During the documentary, Guerra will interview many public health workers and researchers who will offer their hypotheses on why racial disparities exist in infant mortality rates. Here's a list of some of the top arguments.

#1: The 'social determinants of health'

Even controlling for economic status, health status, neighborhoods, and level of education, there is still an unexplained difference in the pregnancy outcomes of women of color versus white women

Why is this?

One theory that seems to be gaining more traction is called the social determinants of health.

Social determinants are the "economic, social, and contextual factors that influence a woman's ability to have a healthy pregnancy," says Dr. Renee Branch Canady, director of the Ingham County Health Department.

Canady argues that too many women of color have poor social determinants. Women of color are more likely than white women to live in high-poverty urban neighborhoods and attend low performing schools. They are also less likely to live near a park or a place to exercise, and have less access to quality medical care.

All of these factors have a huge impact on African American women and their chances of delivering healthy babies, says Canady.

"The choices people make are determined by the choices people have," Dr.  Canady says. "Many women [of color] live in settings where they don't have very good choices." 

Dr. Canady isn't the only professional who believes environmental factors affect a woman's pregnancy. There's a growing consensus among health care professionals and educators that deeper societal issues are to blame for disparate infant mortality rates. Just take a look at the next point.

#2: The 'weathering' effect

When University of Michigan School of Public Health professor Arline Geronimous published her weathering hypothesis in the 1980s, critics called her "the biggest threat to youth in this country."

Today, Geronimous and her work seem less a threat, and more a promising avenue of research.

According to Geronimous, black women experience unhealthy levels of stress because of how they're treated. These stressors prematurely age - or weather - them.

"Chronic stress means you're endlessly flooded with stress hormones," Geronimus says. These hormones can damage the heart, raise blood pressure, and lead to unexpected weight gain. All of these things can have a harmful impact on infant and maternal health.  The side-effects are so severe, Geronimus agrues, that by the time African American women are in their 20s or early 30s, they have a greater risk of having poor birth outcomes.

But not all experts are convinced that race is the primary variable responsible for varying infant mortality rates, which leads me to my third and final point...

#3: Control factors simply aren't controlled enough

A number of experts say race plays a significant role in the chances of a baby making it to his or her first birthday. But Harvard health economist Amitabh Chandra isn't one of them.

Instead of blaming race, Chandra prefers to look at things that can be empirically measured like education, neighborhood environments, and behaviors.

"The bar for having demonstrated racism is much higher than saying 'even when I control for poverty status and college degree, there are persistent gaps in infant mortality,'" Chandra says. "That doesn't tell me it's racism. It just tells me I didn't do a good job of measuring the quality of schooling or neighborhood circumstance."

Chandra goes on to say that he's open to the idea of racism playing a part in the infant mortality disparity, but he thinks there's "a lot more work" that needs to be done before we have evidence that "rises to the level of having firmly determined this is why we see what we do."

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