Running head: HEALTH CARE DISPARITIES

Health Care Disparities: Non-Hispanic Black Infant Mortality - Maternal Considerations Sherry A. Brabon Ferris State University

HEALTH CARE DISPARITIES Abstract Infant mortality remains high in the non-Hispanic black population. Some of the social determinates that contribute toward this disparity may be poverty, environmental, obesity, maternal age and chronic maternal health considerations such as hypertension. Despite many social programs available to assist in modifying health behaviors, infant mortality in nonHispanic blacks has decreased the least in the last six years when compared to other ethnic groups. These programs to aide in favorable birth outcomes include WIC, Medicaid, cash assistance, housing and utility stipends. On the other hand, Political beliefs such as capitalism versus socialism may contribute to continued disparities. Another contributing factor to continued disparity may be health care worker bias.

HEALTH CARE DISPARITIES Health Care Disparities: Non-Hispanic Black Infant Mortality - Maternal Considerations Non-Hispanic black infants have a mortality rate higher than any other race. NonHispanic black infants have a morality rate of 139% more than non-Hispanic white infants

(Centers for Disease Control [CDC], 2011). From 2000 to 2006 this rate declined only 1.8%, the least decline of mortality rates of all races except for Mexicans (CDC, 2011). Non-Hispanic white infants have a mortality rate of 5.58 per 1,000 live births whereas non-Hispanic black infants have a mortality rate of 13.35 per 1,000 live births (CDC, 2011). Rate of mortality is related to social determinants of black women. Maternal access to resources encourages a healthy pregnancy outcome. Many programs are in place to assist all mothers with healthy pregnancies. Unfortunately, these programs may be under utilized. Furthermore, racial and gender bias may contribute to continued infant mortality. Contributing Social Determinants Many reasons may explain why non-Hispanic black infants have a higher mortality rate. First, many African Americans live in poverty. In the United States, 35% of the Black population lives in poverty (The Henry J. Kaiser Family Foundation, 2011). This is the highest group across the United States living in poverty. Poor communities have more risk of being exposed to environmental pollutants and hazardous environments (Padmanabhan, Ranjit & Siefert, 2010). Poor communities also have a higher number of fast food restaurants and less resources for fresh fruits and vegetables. 23.6% of African-American households have food insecurities (Padmanabhan, Ranjit & Siefert, 2010). Furthermore, rates of obesity are highest in African American women (Kulie et al., 2011). 60% of African American women are obese (Dingfelder, 2013). According to The National Campaign to Prevent Teen and Unplanned Pregnancy (2013) 48% of non-Hispanic black teens are pregnant before 20 years of age; this is

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twice the national average. Finally, 47% of non-Hispanic black women suffer from hypertension (American Heart Association, 2013). These maternal considerations all contribute to intrauterine growth restriction, low birth weight and preterm birth leading to infant mortality. Non-Hispanic black women have most all risk factors leading to infant mortality (CDC, 2012). Poverty, environmental factors, lack of good nutrition, obesity, maternal age and co-morbidities all contribute to unfavorable birth outcomes including infant mortality. Some of the above risk factors are more easily modified than others, such as environment, diet, obesity, maternal age and hypertension. Contributing Policies Infant mortality has become a national issue. Michigan Department of Community Health (MDCH, 2013) is currently working on programs to improve mortality rates; this has become the focus for many departments at the state level including Childrens Special Health Care Services (Gregurich, personal communication, July 13, 2013). Currently the Women Infant and Children (WIC) program is available for all pregnant women, infants and children to age five years who are residents of the state in which they are applying for assistance and have an income at or below 185% of poverty (Food and Nutrition Services, 2012). This food program offers nutritional counseling and food benefits. Combined, WIC benefits are targeted to lower obesity and health related conditions associated with poor nutrition. Also, each state in the United States has some sort of state medical assistance than can assist with chronic medical conditions and prenatal care. In Michigan, Healthy Kids for Pregnant Women, Group 2 Pregnant Women and Maternity Outpatient Medical Services are all medical programs offered to pregnant women living in poverty conditions (Michigan Department of Community Health, 2013). Furthermore, Michigan Department of Human Services (2013) offers cash assistance to those meeting

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eligibility requirements. Another policy aimed at reducing disparities is Michigan State Housing Development Authority (2013). This program targets homeless and low-income families to create safe, affordable housing. Finally, MDCH (2013) offers services to prevent pregnancy through the Family Planning Program. This program can provide confidential services to teens and women. The Family Planning Program offers a general health assessment and screenings, contraception methods, pregnancy testing and client follow up and referrals for high-risk clients. These services can prevent unwanted, unplanned, teen pregnancies as services are provided on a sliding fee scale based on income or services can be billed to private or public insurance. All of these programs provide a positive impact on the disparities noted for non-Hispanic black women. Still, with these policies in place, non-Hispanic black infant mortality remains at an alarming level. This may be due to lack of maternal transport to agencies to register for the above-mentioned services. Most of the listed programs can be applied for online, however, not all households have a computer and Internet service. Also, all of the policies listed are funded by government grants or appropriations. When the government funding is cut, less people qualify for services. Budget cuts have become a reality at both the Federal and State government levels. This has a continued negative impact on clients accessing services and prevention of negative birth outcomes. Contributing Factors Despite several programs and policies in place to reduce infant mortality, these rates are not decreasing at a favorable degree. Politics can create disparities. For example, Capitalists seek the bottom line profit for themselves. Serving the disadvantaged population does not feed this belief system. Some within the general population feel that their tax dollars should be spent on other, more important items such as defense. This is the population that does not support

HEALTH CARE DISPARITIES social programs. Many people continue to have racial and gender bias. For example, the CDC (2013) claims simply being black increases risk of preterm birth. This alone may be considered racist, as there is no data to back up what causes the preterm birth other than skin color. Health care workers often classify certain patients. Beliefs that each race behaves a certain way can alter the type of care given or the way in which the care is provided; this may limit future access to care. For example, a health care worker may assume all black females are poor or uneducated. Also, when health care workers provide care in a cookie cutter approach it may limit a persons willingness to access future care. Many taxpayers also contribute to health care disparities. Often, workers complain that they are paying taxes for Medicaid recipients and they are without health care insurance for

themselves. This leads to general population distress that is perceived as racist or biased toward impoverished families. Many believe you should only get what you are able to afford. In summary, large portions of American born infants are dying due to health care disparities. There are many causes and recognizing these can lead to improved birth and infant outcomes. Increased access to current programs may alleviate some disparities. Despite values against social programs, this is what will reduce infant mortality.

HEALTH CARE DISPARITIES Reference American Heart Association. (2013). Statistical fact sheet 2013 update. Retrieved from http://www.heart.org/idc/groups/heartpublic/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf Centers for Disease Control. (2011). Infant deaths-United States, 200-2007. Morbidity and Mortality Weekly Report, 60, 49-51. Centers for Disease Control. (2012). Infant mortality. Retrieved from http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/InfantMortality.htm Dingfelder, S. (2013). African American women at risk. American Psychological Association, 44(1), 56. Food and Nutrition Services. (2012). WIC eligibility requirements. Retrieved from http://www.fns.usda.gov/wic/howtoapply/eligibilityrequirements.htm Gregurich, T. (2013, July, 12). RE: Michigans focus on health disparities. Personal communication. Kulie, T., Slattengren, A., Redmer, J., Counts, H., Eglash, A., and Schrager S. (2011). Journal of the American Board of Family Medicine, 24(1), 75-85. Michigan Department of Community Health. (2013). Family planning. Retrieved from http://www.michigan.gov/mdch/0,1607,7-132-2942_4911_4912_6216---,00.html

Michigan Department of Community Health. (2013). Health care program eligibility. Retrieved from http://www.michigan.gov/mdch/0,4612,7-132-2943_4860-35199--,00.html Michigan Department of Human Services. (2013). Cash assistance eligibility. Retrieved from http://www.michigan.gov/dhs/0,4562,7-124-5453_5526_61308---,00.html

HEALTH CARE DISPARITIES Michigan State Housing Development Authority. (2013). Welcome to MSHDA. Retrieved from http://www.michigan.gov/mshda Padmanabhan, V., Ranjit, N., and Siefert, K. (2010). Bisphenol-A and disparities in birth outcomes: A review and directions for future research. Journal of Perinatology, 30(1), 2-9.

The Henry J. Kaiser Family Foundation. (2011). Poverty rate by race/ethnicity. Retrieved from http://kff.org/other/state-indicator/poverty-rate-by-raceethnicity/ The National Campaign to Prevent Teen and Unplanned Pregnancy. (2013). Fast facts. Retrieved from http://www.thenationalcampaign.org/resources/pdf/FastFacts_TPChildbearing_Blacks.pd f