Running head: HEALTH DISPARITIES 1

Health Disparities amongst African American Women- The Role of Depression

Atoosa Benji

Midwifery College of Utah

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Researchers have long been aware of the role of stress on the human body. The bodys

sympathetic nervous system is quick to react, not being able to decipher the danger of being

attacked by a lion from the danger of being evicted from ones apartment due to not being able to

afford the rent. Chronic stress causes an inflammatory response in the body, in turn increasing

the risk of disease and death. Much likes stress, depression causes an increase in cortisol

production in the body. For a pregnant woman, stress can cause harm to her unborn baby both

epigenetically and from the dangers that stem from preterm birth and low-birth weight babies.

As compared to white women, black woman are four times more likely to die from

pregnancy-related causes than white women (Amnesty International, 2010). Babies born

prematurely, before 37 weeks gestation, and babies born weighing less than 2500g are

particularly at risk for bad outcomes (Giurgescu, Engeland, & Templin, 2015). In the United

States, black women are more likely to give birth prematurely and to a low-birth weight baby

than white women (Amnesty International, 2010). There are many factors that contribute to this

statistic including medical factors such as hypertension, diabetes, and preeclampsia. However,

we cannot undermine the social and economic factors facing black women in America today.

These factors range from poverty to both inequality and inequity in health care, to unsafe living

conditions, lack of education and a lack of community resources. In a nutshell, they are the

price-tag paid by many black people in the US as a result of Institutionalized Racism.

In a 2015 study published in the Journal of Midwifery & Womens Health, researchers

concluded that African American women have higher rates of low birth weight babies and higher

rates of preterm birth as compared with non-Hispanic white women. This is a classic health

disparity. Symptoms of depression have been correlated to these negative birth outcomes.

Findings also showed that pregnant African American women are more likely to experience
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symptoms of depression as compared to pregnant non-Hispanic white women (Giurgescu et al.,

2015). In the study, pregnant women who reported feeling depressed had higher levels of

cortisol in their blood stream than pregnant women who did not report feeling depressed. At

times of chronic stress, cortisol is ineffective at suppressing the immune system thus increasing

the chance of infection in the mother, which in turn increases the risk of a negative birth outcome

(Giurgescu et al., 2015).

African American women are more likely to live in poor living conditions. They face

poverty, crime, and a lack of social support. Women who used maladaptive coping strategies

such as avoidance of their feelings, isolation and not following healthy lifestyle behaviors had a

higher chance of suffering from depression (Giurgescu et al., 2015). It becomes a vicious cycle.

Women are stressed, scared, they feel hopeless or powerless and they stop taking care of

themselves. By not taking caring of themselves they increase their rates of depression due to

high cortisol levels. The more depressed they feel, the less they can take steps to get help, so

they isolate of avoid or abuse and therein the cycle continues all over again.

The study concludes that interdisciplinary collaborations with advocacy groups to

improve neighborhood conditions may improve the mental health and well-being of African

America women and their infants (Giurgescu et al., 2015, p. 575). This is nothing new to the

ears of public health workers. We can keep making concluding remarks like the one above, but

until we take actions and provide African American women health equity by means of

community resources, access and transportation to medical care, home visitation, education, and

basic human rights such as safe living conditions, women will suffer, babies will die and nothing

will change. As midwives, we are on the front lines of change. Becoming advocates through

policy writing and evidence-based research, we can make change. In the words of Dr. Marsden
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Wagner, (advocates) can demand that policy decisions be based on scientific evidence- and even

bring specific studies to policy makers attention when necessary (Wagner, 2006, p. 226). We

can and we will.

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References

Deadly delivery: The maternal health care crisis in the USA. (2010). New York, NY: Amnesty

International USA.

Giurgescu, C., Engeland, C.G., Templin, T.N. (2015). Symptoms of depression predict negative

birth outcomes in African American women: A pilot study. Journal of Midwifery &

Womens Health, 60, 570-577. doi: 10.1111/jmwh.12337

Wagner, M. (2006). Born in the USA: How a broken maternity system must be fixed to put

women and children first. Berkeley & Los Angeles, CA: University of California Press,

Ltd.