Rachel Hardeman has dedicated her career to fighting racism and the harm it has inflicted on the health of Black Americans. As a reproductive health equity researcher, she has been especially disturbed by the disproportionately high mortality rates for Black babies.
In an effort to find some of the reasons behind the high death rates, Hardeman, an associate professor at the University of Minnesota School of Public Health, and three other researchers combed through the records of 1.8 million Florida hospital births from 1992 to 2015 looking for clues. They found a tantalizing statistic. Although Black newborns are more than twice as likely to die as white newborns, when Black babies are delivered by Black doctors, their mortality rate is cut in half.
“Strikingly, these effects appear to manifest more strongly in more complicated cases,” the researchers wrote, “and when hospitals deliver more Black newborns.” They found no similar relationship between white doctors and white births. Nor did they find a difference in maternal death rates when the doctor’s race was the same as the patient’s.
“It is the first empirical evidence to describe the impact of the physician’s race on an outcome such as infant mortality,” Hardeman says. With 5.7 deaths per 1,000 live births, the United States has a high infant mortality rate, and Black babies are in the gravest danger, with an infant mortality rate in 2018 of 10.8 deaths per 1,000 live births, compared with a rate of 4.6 white babies per 1,000 live births.
Infant mortality is defined as death during the first year of life, and 66 percent of those deaths, for all races, occur in the first 28 days of life, with 14 percent within the first hour and another 26 percent within one to 23 hours. When Black doctors delivered Black babies, their mortality rate was more than halved from 430 per 100,000 live births to 173 per 100,000, Hardeman says. Although infant mortality in the United States has been decreasing, the gap between Black and white infants has persisted, Hardeman says. The root, she says, lies in structural racism.
She defines structural racism as the “normalization and legitimization of an array of dynamics — historical, cultural, institutional and interpersonal — that routinely advantage whites while producing cumulative and chronic adverse outcomes for people of color.”
Hardeman and the other researchers — Brad N. Greenwood, associate professor of information systems and operations management at George Mason University; Laura Huang, an associate professor at Harvard Business School; and Aaron Sojourner, an associate professor at the University of Minnesota’s Carlson School of Management — wrote that more research was needed to understand why Black physicians outperform their white counterparts. They cautioned that it wasn’t practical for all Black families to seek Black doctors to deliver their babies, not only because there are too few of them but also because the reasons for the disparity in care need to be understood and addressed.
“Key open questions include the following: 1) whether physician race proxies for differences in physician practice behavior, 2) if so, which practices, and 3) what actions can be taken by policymakers, administrators, and physicians to ensure that all newborns receive optimal care,” they wrote.
Common causes of infant mortality are premature birth, low birth weight, maternal complications and sudden infant death syndrome, according to the Centers for Disease Control and Prevention. Some of these deaths are caused by complications related to the mother’s health. Historically, Black maternal health has always been concerning, with Black women four to five times more likely to die during pregnancy and childbirth than white women, regardless of income, education or lifestyle. A Black woman does not have to be poor for her life or her baby’s life to be at stake.
The most recent figures, for 2016, show 40.8 pregnancy- related deaths per 100,000 live births for Black women and 12.7 per 100,000 for white women.