Panel discusses disparities of ethnic birth outcomes

In 1963, Martin Luther King Jr. famously said he had a dream that “little black boys and black girls will be able to join hands with little white boys and white girls and walk together as sisters and brothers.”

Today, the United States is still far from achieving that dream.

Dr. Michael Lu, a physician who studies health disparities in women and children, was the guest speaker at the UNT Health Science CenterÂ’s Distinguished Speaker Series and explained why KingÂ’s vision is stuck in limbo.

“Forty-five years later in that nation, all too many little black boys and black girls die before they learn to walk,” Lu said.

The presentation and panel discussion, held Oct. 14 on the Health Science Center campus, focused on the racial and ethnic disparities in birth outcomes. While birth outcomes — such as healthy birth weights or infant death — can vary from race to race, Lu discussed the wide gap between white babies and black babies.

Researchers in various health fields, from physicians to epidemiologists, have found black babies nationwide are more than twice as likely to die before their first birthday than white babies. Additionally, black babies are almost twice as likely to have a low birth weight and almost three times as likely to be born at a very low birth weight as white babies.

Even in Texas, there are disparities; according to 2005 data, there are 5.7 white infant deaths per 1,000 live births and 14.1 black infant deaths per 1,000 live births.

Many explanations have been posited for the disparities, such as genetic factors, maternal behavior, access to prenatal care, socioeconomic status, stress and infections, but even the most upper class, well-educated and stable black families experience more bad birth outcomes than the poorest, least-educated and least stable whites.

“If we can’t explain what’s going on, how can we expect people to go out and do something about it?” Lu said.

The problem with past research on birth outcome disparities comes from focusing on pregnancy-only factors, instead of looking at the entire life course of the mother and seeing how that can affect her pregnancy, Lu said. Even if a woman receives the best possible care during pregnancy, it may not have a big enough impact on the pregnancy to help ensure a healthy birth, he said.

“Nine months can’t erase a whole life of disparities,” he said.

In Fort Worth, organizations and local governments are keeping an eye on disparities. The Fort Worth Public Health DepartmentÂ’s Outreach Division created the WomenÂ’s Health Initiative in 2007 with the goal of improving womenÂ’s health and thereby reducing the cityÂ’s infant mortality rate. A WomenÂ’s Health Assessment was done, looking at certain Fort Worth zip codes that had high rates of infant mortality.

Although Texas and Fort Worth have infant mortality rates that may be considered acceptable — 6.6 and 8.7 deaths per 1,000 births, respectively — the numbers are likely skewed by the high numbers of Hispanic women in the state, who usually have very good birth outcomes, said Kathryn Cardarelli, panelist and assistant professor of epidemiology at the Health Science Center’s School of Public Health.

Amy Raines, coordinator for the WomenÂ’s Health Initiative and also a panelist, said the WomenÂ’s Health Assessment included surveys from more than 400 women and pointed out a multitude of places to improve. The first recommendation of the assessment is to focus on comprehensive health for women of all ages.

“The women really lack coverage, health care coverage,” Raines said.

Cardarelli said the assessment was a necessary step to actually working to bringing down infant mortality and poor birth outcomes.

“I think that the ground has been laid by the city,” she said.

Lu’s recommendations for addressing outcomes also involve comprehensive care for women, “before pregnancy, during pregnancy and beyond pregnancy.” A baby appears to be “programmed” by a mother before birth, and so a woman exposed to high levels of stress her whole life and suffers physically due to that is likely to have a child with similar responses.

Just as almost everyone knows that cramming before a test wonÂ’t really make a lasting impact on retaining knowledge, treating a woman during pregnancy only wonÂ’t have a lasting effect on the health of her child, he said.

“For some reason what we learned in grade school has been lost on the field of gynecology and obstetrics,” he said.