Research indicating that stress from racism contributes to low birth weights and premature births was presented Feb. 22 at Children’s Mercy Hospital by Dr. James W. Collins Jr.
Collins, medical director for the Neonatal Intensive Care Nursery at Ann and Robert H. Lurie Children’s Hospital of Chicago, said pre-term birth rates in the United States had changed little in the past seven decades. The rate for African American women also has seen little change, remaining about 50 percent higher than for white women.
Collins’ presentation, titled “The Social Determinants of the Racial Disparity in Adverse Birth Outcomes: ZIP Code Eclipses Genetic Code,” reviewed several studies looking at possible causes or explanations for the persistent racial gap in low birth weights.
Those factors include age, education, income, upward economic mobility and geographic mobility, and they often correlate with rates of pre-term birth in predictable ways. For example, women living in low-income neighborhoods have more pre-term births than women in middle- or upper-income neighborhoods. But African American mothers in every type of income-bracket neighborhood still have higher rates of pre-term births than their white counterparts.
The results are much the same across the studies. Whatever factor is isolated and adjusted for, African American mothers still have higher rates of pre-term births. That leaves researchers looking for other causes, including racism and stress.
“Racism is kind of the elephant in the room,” Collins said. He presented research indicating that African American women who experienced racism more frequently and consistently in their lives were more likely to give birth prematurely.
“We are made to deal with acute stress pretty well,” Collins said. But when stress is chronic, such as from persistent racism, “you respond to acute stressors but you don’t come back down. I suspect this predisposes African American men to hypertension and African American women to pre-term birth.”
Collins said the biological mechanism for these ill affects was still unknown, but could be something that suppresses the immune system or otherwise fosters infections. But the exact mechanism doesn’t need to be known, he said, to see the problem as social rather than strictly medical, and to “go big” and “ecologic” in confronting and combating racism.
Medically, Collins said the day-to-day challenge for pediatricians is to provide comprehensive care for African American girls from before birth and to see them as potential mothers-to-be. Raising those girls for resilience, he said, while also working to change society, is work that requires everyone “to start slow and be tenacious.”
Collins closed with President John F. Kennedy’s reminder and exhortation that good and difficult work “will not be finished in the first 100 days … nor perhaps in our lifetime on this planet. But let us begin.” He then recited lines from Langston Hughes’ “Let America Be America Again,” with a gender switch:
O, let America be America again —
The land that never has been yet —
And yet must be — the land where every woman is free.