According to the Centers for Disease Control and Prevention (CDC) (2017), African American mothers and their babies are at a higher risk for pregnancy and birth-related complications, such as preterm birth, than women and infants of any other race. Furthermore, the CDC (2009) states that, this health disparity further includes highest rate of infant mortality, highest rate of infant death under one year, highest rate of sudden infant death syndrome (SIDS), highest rate of maternal mortality, and highest overall death rate. This disparity is an important public health problem, affecting the wellbeing of not just individuals, but their families and communities as well. There are many contributing factors to and explanations of this disparity as well as consequences for those involved and explanations. Reducing this health disparity is linked to the goals and objectives of Healthy People 2020. It is important that research into this disparity continue and that new questions be addressed. Nurses have an important role in research, as well as advocacy, to contribute to the eradication of this disparity.
The disparity in birth outcomes among African American women and their babies is an umbrella encompassing many issues. Causes of these issues are physical, environmental, psychological, and even socioeconomic. To understand the disparity, one must first explore what it includes and contributing factors. Lee, Roberts, Catov, Talbott, & Ritz (2013) found a positive correlation between air pollution, cigarette smoking and adverse birth outcomes, with most impacts occurring during the first trimester. Furthermore, Lee et. al. (2013) found that African American women participating in their study had higher rates of adverse effects, including preterm delivery, preeclampsia, gestational hypertension, and small gestational size. Another study by Giurgescu, Zenk, Dancy, Park, Dieber, & Block (2012) showed a relationship between neighborhood environment, racial discrimination, psychological distress, and preterm birth in African American women. Giurgescu et. al. (2012) went on to explain that African American women in their study experienced “perceived social and physical disorder and perceived crime… [as well as] racial discrimination”, which led to psychological distress, which in turn increased rates of preterm births. This study shows that community and families play an important role in this health disparity. According to Lind, Godfrey, Rankin, & Handler (2013), another issue connected with increased risk of adverse birth outcomes in African American women is access to and use of prophylactic and emergency contraception in their population; generally if women have had prior adverse birth outcomes, they will use contraception to prevent future births or to terminate births if prophylactic contraceptives fail, however many of their study participants were lacking knowledge regarding emergency contraceptives, which made them reluctant to use contraceptives, although it is “an essential part of the reproductive toolkit for women at high risk of adverse birth outcomes who are not intending pregnancy”. Lind et. al. (2013) explained that many of the women participating in the study did not even have access to effective prophylactic contraceptives or reproductive life planning. According to Keenan, Hipwell, McAloon, Hoffmann, Mohanty, & Magee (2016), African American women living in low-income environments were “at high risk for poor nutrition during pregnancy” and did not have access to prenatal supplements, which were two factors contributing to birth complications. Furthermore, Keenan et. al. (2016) found that receiving DHA supplementation had a positive influence on birth outcomes for their study participants, including “more modulated cortisol response[s] to… stressor[s]”. There is a plethora of issues faced by African American women in relation to poor birth outcomes, and an equal variety of causes to be addressed.
Many of these causes are being addressed through their link to the goals and objectives of Healthy People 2020. According to the Office of Disease Prevention and Health Promotion (ODPHP) (2017), one of the goals is to “improve the health and well-being of women, infants, children, and families”. ODPHP (2017) goes on to say that “The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception…, prenatal… and interconception… care”. ODPHP (2017) explains that some of the factors influencing pregnancy and childbirth include “preconception health status, age, access to appropriate health care, and poverty” and continues by saying that “Racial and ethnic disparities exist in infant mortality [and] can be partly attributed to disparities in social determinants of health”. Furthermore, ODPHP (2017) recognizes that “child health status varies by both race and ethnicity, as well as family income[,]…health insurance coverage [, maternal health and more]”. Objectives entitled MICH-1 through 33 address this goal. The objectives that specifically address this disparity are described by ODPHP (2017) as MICH-1 “Reduce the rate of fetal and infant deaths”, MICH-5 “Reduce the rate of maternal mortality”, MICH-6 “Reduce maternal illness and complications due to pregnancy”, MICH-8 “Reduce low birth weight… and very low birth weight”, MICH-9 “Reduce preterm births”, MICH-10 “Increase the proportion of pregnant women who receive early and adequate prenatal care”, MICH-11 “Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women”, MICH-12 “Increase the proportion of pregnant women who attend a series of prepared childbirth classes”, MICH-13 “Increase the proportion of mothers who achieve a recommended weight gain during their pregnancies”, MICH-14 “Increase the proportion of women of childbearing potential with intake of at least 400 micrograms of folic acid daily from fortified foods or dietary supplements”, MICH-16 “Increase the proportion of women delivering a live birth who discussed preconception health with a health care worker prior to pregnancy”, MICH-25 “Reduce the occurrence of fetal alcohol syndrome”, and finally MICH-28 “Reduce occurrence of neural tube defects”. These objectives are not demographically specific, but since statistics show that African American mothers and their children are the demographic group most affected by the issues the objectives address, there is a clear connection between Healthy People 2020 and this health disparity.
Beyond the goals and objectives of Healthy People 2020, there is more that can be done to address this health disparity. One important measure is to explore research questions that have not been studied, and to support their importance. Another is for health care professionals to advocate for their patients, participate in committees, and serve underserved populations. Within the realm of research and implications of each study, there are specific actions nurses and other health care professionals can take. According to Lee et. al. (2013), reducing gestational exposure to “ambient air pollutant exposures”, cigarette smoke, and illicit drugs and alcohol are vital to addressing the health disparity, however there is more research needed in the area of how air pollution affect fetuses. Lee et. al. (2013) further explain, “We were unable to examine the influence of other gaseous air pollutants such as CO, NO2, and SO2, due to the scarcity of monitoring stations for these pollutants in the study area”. Lee et. al. (2013) add that research to examine links between obesity, diabetes, older maternal age and birth complications are needed. Giurgescu et. al.’s (2012) study has important implications for practice and public policies. Giurgescu et. al. (2012) explain that health care providers need to assess their patients’ neighborhood conditions and understand the link between these conditions and patient stress levels, providing coping assistance with relaxation techniques. Nurses can make part of their patient care plan for these women to teach specific relaxation techniques, such as listening to relaxing music on headphones. Furthermore, Giurgescu et. al. (2012) go on to explain that “referrals for social services should be considered for women who live in neighborhoods with high objective physical disorder”. Giurgescu et. al. (2012) further explain that one of the most important things health care professionals can do to help these patients is to “advocate for public policies that bring additional resources into [such] urban neighborhoods with high rates of disorder and crime to improve conditions and reduce sources of stress [by] partner[ing] with local businesses, churches, and police departments” as well as being active politically. Giurgescu et. al. (2012) detail the importance of future studies involving assessment of neighborhood environments and preterm birth in African American women “by includ[ing] participation of community partners in decreasing housing vacancy and crime rates”. Lind et. al. (2014) write that the most important action medical staff can take to combat this disparity is to help emergency contraception become increasingly available to and understood by African American women, “particularly those who have already experienced adverse birth outcomes and are therefore at higher risk of future adverse outcomes”. Finally, according to Keenan et. al. (2016), increasing care at all stages of pregnancy and increasing availability of prenatal supplements is the most important action to overcome this disparity. One further research question that the writer would like to see more research on is how can family and community members better support these women during their pregnancies? There are many questions to be addressed by researchers, and many actions to be carried out by health care professionals.
African American mothers and their infants face disproportionately higher risks of birth complications compared to every other demographic group. Researchers, Healthy People 2020, and health professionals are trying to combat this important health disparity. There is much more to be done to eliminate this health disparity, but positive actions are underway, and nurses have an important role to play.