Chapter IV

Discussion

Trends in racial/ethnic disparities in infant mortality are consistent with the racial/ethnic patterns found in causes of infant mortality. Blacks and American Indian/Alaska Natives had the highest rate of infant mortality in 2002. Blacks had the highest rate of neonatal mortality while American Indian/Alaska Natives had one of the highest rates of postneonatal deaths. During the same year, preterm birth/low birthweight was the leading cause of neonatal mortality and Blacks had the highest rate of preterm birth/low birthweight. SIDS was the leading cause of postneonatal deaths in 2002; American Indians had the highest rate of SIDS.

The congruency in the data does not end with the racial/ethnic trends in infant mortality and causes of death. The racial/ethnic trends in causes of infant mortality correspond to the patterns of the risk factors for poor birth outcomes. For example, risk factors associated with preterm birth and low birthweight, such as late or no prenatal care, drug abuse, stress, depression, and bacterial vaginosis, are more prevalent among Blacks. Similarly, American Indian/Alaska Native women have the highest rates for risk factors associated with SIDS, such as smoking and binge drinking during pregnancy. Such data suggest that targeted interventions for these risk factors can help improve birth outcomes in the target population and reduce racial/ethnic disparities in infant mortality.

This paper has the same limitations as many literature reviews. For example, among the sources used for the paper, there were variations in research methods, categorizations of race/ethnicity, and years of information available. Moreover, using data from different sources made it difficult to isolate the direct contribution of each behavioral, biological, and social factor to the racial/ethnic disparities in infant mortality. For example, it would be interesting to further investigate the role that discrimination, genetic predisposition, life course, culture, or behavior play in producing the long-standing racial/ethnic disparities in birth outcomes.

Shiono et al. (1997) have studied the influence of many factors on ethnic differences in birthweight. Few researchers, however, have conducted similar studies that further the understanding of how behavioral, biological, and social factors affect racial/ethnic disparities in birth outcomes. The study by Shiono et al. (1997) controlled for 21 social, medical, socioeconomic, and psychological factors. It found that impoverished living environments, feelings of helplessness, and unstable social support were negatively associated with birthweight (that is, better living environments, feelings of hope, and stable social supports were associated with higher birthweight). Future studies to support such findings or provide further information about the mechanisms through which these factors affect birth outcomes will help researchers, health care providers, and other stakeholders to better understand the interplay between risk factors and birth outcomes.

Nevertheless, the data presented in this paper provide insight into the racial and ethnic trends in birth outcomes and the risk factors contributing to these outcomes. By showing how the factors associated with poor birth outcomes are associated with racial/disparities in birth outcomes, this information offers evidence to support targeted maternal and child interventions, such as those performed by Healthy Start and other perinatal health initiatives, to reduce racial and ethnic disparities in infant mortality.