Corran Brown was 22 and just five months pregnant with her second child when she started having contractions. Doctors gave her medication to stop them, but then Brown’s health took a turn for the worse. She developed high blood pressure and had frequent nosebleeds and headaches.
At seven months, doctors gave Brown, who is African-American, an injection to speed up development of the fetus’ lungs. Then they induced labor. For six weeks, Brown went to the hospital to see her baby lying in an incubator.
Seeing her son struggling to breathe, able to touch him only by sticking gloved hands through holes in the incubator's panels, she was pretty sure she knew what had gone wrong.
Brown had ignored signs that she might be pregnant. Instead, she drank alcohol and smoked with her baby’s father, because the thought of being abandoned by him had stressed her out. Her first child’s father had been sent to prison.
Now, her baby was behind glass. But he pulled through. By the grace of God, Brown said.
“I was able to take my son home at 4 1/2 pounds."
A troubling disparity
Nationwide and locally, African-American women experience worse birth outcomes than any other major ethnic group, by far. And while Brown’s baby survived, black infants are between two-and-a-half to three times more likely to die within their first year than white infants, due largely to premature birth, low birth weight or birth defects. It's a disparity that's existed as long as health officials have kept statistics, and it's both troubled and confounded them.
On the surface, the reasons might seem intuitive. African-Americans tend to experience poverty at higher rates than whites, and have less access to health care. They also are more likely to suffer health problems like obesity and diabetes, and more likely to use drugs while pregnant.
“We know that there’s a strong association between class and health, so that’s one of the more popular thoughts about what could be driving the disparity,” said Tyan Parker Dominguez, a University of Southern California professor who researches racial disparities in infant mortality.
But she said while there’s no doubt socioeconomic status is an important factor, some startling findings in the data suggest a socioeconomic explanation is insufficient to explain the disparity.
One is that infant mortality for blacks is not only high when compared with whites. It’s also more than double the rate recorded among Latinos, despite the fact that Latinos also tend to experience poverty and health problems at elevated levels.
The other surprising finding, and the one that has long stumped public health officials, is that the risk of poor birth outcomes does not diminish as a back woman’s socioeconomic status improves.
In fact, Parker Dominguez said, “You see, almost paradoxically, a larger disparity between African-American and non-Hispanic white women at the higher end of the socioeconomic ladder than you see between women at the lower end."
Despite being well documented for decades, to this day the disparity remains poorly understood.
“It’s really been a public health puzzle,” Parker Dominguez said.
An emerging theory
But research emerging by Parker Dominguez and others is zeroing in on one possible explanation.
The theory is that black women, regardless of socioeconomic status, are simply exposed to more psychosocial stress. Stress produces hormones that are believed to play an important role in triggering labor in pregnant women. And in black women, the elevated buildup of stress hormones may trigger early labor and other pregnancy problems.
“That’s the theory,” Parker Dominguez said, adding that studies that have controlled for poverty and other socioeconomic factors appear to back it up.
For poorer black women, elevated stress may come from dealing with poverty and unstable families. For middle-class women, from having to work harder to prove themselves at work and having to battle preconceived notions about their abilities. And across income levels, black women experience stress due to real or perceived racism. The theory goes that over time, elevated stress from all of these social factors has a "weathering" effect that takes a toll on black women's bodies.
Not everyone agrees with this theory. Some researchers have argued that black women may experience poorer birth outcomes because they're genetically predisposed.
But Parker Dominguez argues that theory unravels when you compare birth outcomes between African-Americans and African immigrants to the U.S.
“You see these adverse outcomes in African-American women who are U.S. born. You do not see them in their counterparts who also are of African ancestry but come from a very different social context,” she said.
And that’s leading researchers to focus in on what it is about being black in the U.S. – not necessarily poor, or unhealthy, or uninsured, but black – that contributes to a woman being more than twice as likely as a white or Latina woman to lose her infant.
One clue might actually come from looking at Latinas. Latino culture tends to place great importance on the role of motherhood, Parker Dominguez said, and pregnant Latinas tend to be nurtured by family, which may lead to low-stress pregnancies. That may help explain Latinas' favorable birth outcomes despite elevated poverty and health risks.
Trying to close the gap
Though the race-stress theory is far from settled, it's one that appears to be gaining traction in policy circles, as health officials search for new ways to tackle a seemingly intractable problem. One of the leading researchers on black infant health, a UCLA obstetrician named Michael Lu, was recently hired by the Obama administration to develop maternal health policy.
In Los Angeles County, health officials have partnered with nonprofits to explore the links between racism, stress and infant mortality. The work is ongoing.
One nonprofit trying to address the black infant health disparity is called Great Beginnings for Black Babies, in Inglewood. It's one of several nonprofits countywide that administers the state-designed Black Infant Heath Program. The nonprofit works with women at high-risk for failed pregnancies from their first trimester until the baby is 18 months.
Recently, about a dozen new or expectant mothers came to Great Beginnings' offices to participate in a social support group. One of the women was Johnetta Duckworth.
“I’ve been pregnant 12 times. I’ve lost all but four,” she told the group.
Great Beginnings director Rae Jones said that aside from poverty and health issues, much of the risk for the women here comes from not knowing how to cope with daily stress.
“We understand the role that stress plays in birth outcomes,” she said. “We’re trying to help them recognize when they’re going through a stressful period and to do some things to calm themselves down so they don’t hurt their babies when they’re carrying them.”
That includes helping women find housing and jobs, setting up pre-natal appointments, providing transportation, and just connecting them with other women going through pregnancy. Jones said the top request she gets from women is for help finding a place to live.
Corran Brown, the woman whose son was born two months premature, was at the recent support group. Twelve years after her baby spent six weeks in an incubator, she’s pregnant again, this time with twin boys. She said she’s getting a lot of rest, going to all of her prenatal appointments and not stressing out.
“I know they’re going to be healthy, by the grace of God," she said. "I’m prepared and I’m ready for all this that God got for me."
Correction: An earlier version of this story stated that African-American women were more likely than white women to smoke and drink alcohol while pregnant. A 2012 study by the Substance Abuse and Mental Health Services Administration found that African-Americans were more likely to use illicit drugs and only slightly more likely to drink while pregnant, but less likely to smoke. We regret the error.