Childbirth deadlier for Black families even when they’re rich, expansive study finds
In the United States, the richest mothers and their newborns are the most likely to survive the year after childbirth — except when the family is Black, according to a groundbreaking new study of 2 million California births.
The richest Black mothers and their babies are twice as likely to die as the richest white mothers and their babies.
Research has repeatedly shown that Black mothers and babies have the worst childbirth outcomes in the United States. But this study is novel because it is the first of its size to show how the risks of childbirth vary by both race and parental income, and how Black families, regardless of their socioeconomic status, are disproportionately affected.
“This is a landmark paper, and what it makes really stark is how we are leaving one group of people way behind,” said Atheendar Venkataramani, a University of Pennsylvania economist who studies racial health disparities and was not involved in the research.
The study, published last month by the National Bureau of Economic Research, includes nearly all the infants born to firsttime mothers from 2007 to 2016 in California, the state with the most annual births. For the first time, it combines income tax data with birth, death and hospitalization records and demographic data from the Census Bureau and the Social Security Administration, while protecting identities.
That approach also reveals that premature infants born to poor parents are more likely to die than those born into the richest families. Yet there is one group that doesn’t gain the same protection from being rich, the study finds: Black mothers and babies.
“It suggests that the well-documented Blackwhite gap in infant and maternal health that’s been discussed ... is not just explained by differences in economic circumstances,” said Maya Rossin-slater, an economist at Stanford University and an author of the study. “It suggests it’s much more structural.”
If anything, the study’s findings understate the dangers of childbirth in much of the U.S., several researchers said, because California’s maternal mortality rate has been declining over the past decade, as deaths have gone up in the rest of the country.
‘It’s racism’
The researchers found that maternal mortality rates were just as high among the highest-income Black women as among low-income white women. Infant mortality rates between the two groups were also similar.
The babies born to the richest Black women (the top one-tenth of earners) tended to have more risk factors, including being born premature or underweight, than those born to the richest white mothers — and more than those born to the poorest white mothers.
“As a Black infant, you’re starting off with worse health, even those born into these wealthy families,” said Sarah Miller, a health economist at the University
of Michigan. She was an author of the study with Rossin-slater and Petra Persson of Stanford, Kate Kennedy-moulton of Columbia University, Laura Wherry of New York University and Gloria Aldana of the Census Bureau.
Black mothers and babies had worse outcomes than those who were Hispanic, Asian or white in all the health measures studied: whether babies were born early or underweight; whether mothers had birth-related health problems like eclampsia or sepsis; and whether the babies and mothers died.
The study, although unable to prove exactly what causes poor outcomes for certain mothers and babies, demonstrates that disparities are not explained by income, age, marital status or country of birth. Rather, the data suggests broader forces at play in the lives of Black mothers, Rossin-slater said.
“It’s not race, it’s racism,” said Tiffany L. Green, an economist focused on public health and obstetrics at the University of Wisconsin-madison. “The data are quite clear that this isn’t about biology.”
There is clear evidence that Black patients experience racism in health care settings. Mothers are likely to be given different access to interventions. Black infants are more likely to survive if their doctors are Black. The experience of tennis star Serena Williams — she had a pulmonary embolism after giving birth, and said clinicians did not address it at first — drew attention to how not even the most famous and wealthy Black women escape this pattern.