Infant Mortality Rates Among African Americans Essay Example

The infant mortality rate (IMR) is more than just a measure of mother and child health; it is also a sign of the overall health of society (Matoba & Collins, 2017). In the United States, African American infants die at a rate 2.2 times higher than White infants and the IMR is higher compared to other industrialized countries despite developments in obstetrics and perinatal care leading to increased survival rate of preterm infants. So, what is the reasoning behind the increasing rates or infant mortality among African Americans? In this paper, I will discuss how nurses address a health disparity faced by African Americans based on their professional obligation.

Vulnerable Population

The increased IMR among African Americans, places African Americans as a vulnerable population. Low birth weight (LBW) and short gestation are the leading cause of infant mortality in African Americans versus congenital malformation being the leading cause of death for White infants (Matoba & Collins, 2017). Now, the social determinants of health (SDOH) are the environmental and social conditions in which people work and live (Savage et al., 2020). These include education, economic stability, health and heath care, social community and context and the neighborhood and the built environment. Nursing, with its holistic health-care paradigm, is well-positioned to be a leader in improving health by tying SDOH to outcomes through action and analysis (Olshansky, 2017). So, by knowing what SDOH impact infant mortality in African Americans can help explain the health disparity seen. First, it was previously thought that poor educational attainment negatively affected the infant mortality rate among African Americans while a higher educational attainment improved birth outcome (Matoba & Collins, 2017; Schoendorf et al., 1992). However, this is not the case for Black women. For example, the IMR of Black women with doctorates and professional degrees is higher than that of White women who never finished high school. Next, a life-course model can help explain the disparity in pregnancy outcomes between White and Black women in the U.S. in this model, African Americans have more prenatal risk factors and less protective variables than Whites, resulting in a racial gap in perinatal outcomes leading to cumulative wear and strain, also known as weathering (Matoba & Collins, 2017). The weathering hypothesis addresses the physical impacts of social inequality on reproductive outcomes in women. The risk of LBW increases with age in African American women. According to the weathering hypothesis, a reduction in health status contributes to lower reproductive outcomes as women age, and social inequities lead to an earlier and proportionally higher decline in health status of African Americans, culminating in an increasing health disparity with age. Lastly, one way weathering can occur is through the excess stress caused by discrimination. Racial segregation is linked to a higher incidence of preterm birth, LBW, and infant death among African Americans. Racial prejudice is a lifelong social setting for African American women. The underlying process appears to be stress-related; persistent stress can lead to increased inflammation, poor pregnancy outcomes and decreased fetal development. It has been previously discovered that African American moms who had preterm, LBW babies were more likely to face interpersonal racial prejudice than mothers who delivered term, nonLBW babies.

Social Justice

As a nurse, I am committed to addressing health disparities often created by social determinant of health. The American Nurses Association (ANA) defines the profession's social compact with society, offers a framework for decision making and ethical practice, educates the profession on ethical duties and leads the profession in self-regulation (Gillespie et al., 2020; Olson & Strokes, 2017). For example, the interpretive statement 8.3 states that nurses have a duty to reduce disparities and advance human and health rights. One way this can be done is by implementing social justice by establishing that health is a universal right regardless of what ethnicity, age, gender, disability, income, sexual orientation, or geographical location a person is from, which the ANA does in their interpretive statement 8.1. Now, not only does the ANA outline the importance of addressing health disparities, but so does the nation by creating national objectives that aim at improving health while addressing health equity and health disparities (Levine, 2021). Healthy People 2030’s framework includes the goal of eliminating health disparities and recognizes the effect of SDOH on health outcomes. 

Nursing Action at Systems Level

We, as nurses, can utilize the Healthy People 2030 framework to set and identify health priorities, use reliable date to assess trends, use national benchmarks to set targets and goals, and address health priorities using evidence-based resources (Levine, 2021). Now, once we identify a health priority such as improving the infant mortality rate among African Americans, we can begin to make a positive difference. One way we can advocate for African Americans is through policy and program recommendations. For example, as previously discussed racialized stress has been linked to increased rates of infant mortality among African Americans (Smith et al., 2018). So, we should focus on implementing a policy that focuses on enforcing laws that protect Black women against discrimination, such as the U.S. Equal Employment Opportunity Commission, and ensuring that they are properly funded to become powerful barriers against discrimination. Another way nurses can advocate for African American’s is by advocating for a program that focus on Black women’s perinatal and postpartum needs. As previously discussed, achieving higher levels of education and affluence has little impact on narrowing the White-Black infant mortality divide. Programs aimed at Black women prior to, during, and postpartum must be established, supported, and sufficiently funded. To enhance the impact of Black women-specific programs, state lawmakers and key stakeholders must fully support them.

The purpose of this paper is to explore how nurses address a health disparity faced by African Americans based on their professional obligation. In the United States, African American infants have a much higher infant mortality rates than White infants. The SDOH helps to provide insight on the role of community and environmental variables in racial disparities. Racism is a significant and growing source of stress for African American women, with negative ramifications for maternity and infant health. As nurses, it is our responsibility to decrease disparities and enhance human and health rights. This can be done by advocating for policies that focus on protecting Black women from discrimination and programs that focus on the needs of African Americans both before and after birth. Reflecting on what I learned about the health disparities seen in African Americans, I discovered that individual risk factors alone do not adequately explain this persistent gap, so to better understand the increased mortality rates among African Americans, I needed to look at the SDOH and how they related on a community and environmental level due to the racial disparity seen. As a nurse, I will use the information learned about the SDOH as a foundation for health care decisions.

References

Gillespie, G., Savage, C. L., Groves, S. (2020). Health program planning. In C. L. Savage (Ed.), Public/community health and nursing practice: Caring for populations (2nd ed., pp. 107-127). F.A. Davis Company. 

Levine, R. L. (2021). Healthy People 2030: A beacon for addressing health disparities and health equity. Journal of Public Health Management and Practice: JPHMP, 27(Suppl. 6), S220–S221. https://doi.org/10.1097/PHH.0000000000001409 

Matoba, N., & Collins, J. W. (2017). Racial disparity in infant mortality. Seminars in Perinatology, 41(6), 354–359. https://doi.org/10.1053/j.semperi.2017.07.003 

Olson, L. L., & Stokes, F. (2016). The ANA code of ethics for nurses with interpretive statements: Resource for nursing regulation. Journal of Nursing Regulation, 7(2), 9–20. https://doi.org/10.1016/S2155-8256(16)31073-0 

Olshansky, E. F. (2017). Social determinants of health: The role of nursing. The American Journal of Nursing, 117(12), 11–11. https://doi.org/10.1097/01.NAJ.0000527463.16094.39 

Savage, C. L., Baccelli, B., Groves, S. (2020). Health disparities and vulnerable populations. In C. L. Savage (Ed.), Public/community health and nursing practice: Caring for populations (2nd ed., pp. 157-190). F.A. Davis Company. 

Schoendorf, K. C., Hogue, C. J., Kleinman, J. C., & Rowley, D. (1992). Mortality among infants of Black as compared with White college-educated parents. The New England Journal of Medicine, 326(23), 1522–1526. https://doi.org/10.1056/NEJM199206043262303 

Smith, I., Bentley-Edwards, K., El-Amin, S., Darity, W. (2018, March). Fighting at birth: Eradicating the Black-White infant mortality gap report. Duke University’s Samuel DuBois Cook Center on Social Equity.

https://socialequity.duke.edu/portfolio-item/fighting-at-birth-eradicating-the-black-white-infant-mortality-gap/