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Racism is the Toxin that Triggers far too Many Preterm Births in America — New Powerful Data Presented for California Births

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August 8, 2018

The very powerful article by Danyelle Solomon that is attached to this media commentary for the Institute for InterGroup Understanding website is entitled — Racism: The Evergreen Toxin Killing Black Mothers and Infants. 

That article by Solomon explains the generally invisible and not widely understood or discussed link between racism and preterm births in this country clearly and well.

We can now confirm with important new research that she was right in her contention about that linkage.

New, exciting and extremely useful data that was presented to the California First Five Commission for Children and Families last month by researchers from the California Department of Health and the University of California in San Francisco not only confirmed her statements — but pointed in an extremely useful and explicitly quantified way to specific impacts of racism related stress relative to actual premature births in California.

It is worth reading the piece Solomon wrote to understand the context for the new data that was presented to the First Five Commission for Children and Families last month about the direct link between racism and higher levels of prematurity for births in America. 

Solomon wrote her powerful, persuasive and well researched piece explaining the differences in the preterm birth rates for African American mothers, and citing a wide and grim set of statistics about both economic and political disparities in our country that help create a sense of stress for African American mothers that she believed created biological consequences and damages that often included giving birth prematurely.

Stress is an extremely important factor to understand in looking at those births. Stress is an important issue for everyone dealing with public health issues to understand. 

Medical science related to the impact of stress on our lives is growing at a rapid rate and preterm birth rates are now included in that expanded understanding of those issues.  

Medical science is becoming much more competent and better grounded in both the short- and long-term impact of both Adverse Childhood Experiences (ACEs) and the direct current impact of stress on our neurochemical and biological functioning, processes and compositions for both births and other key areas of our health and lives. 

The ACE research, all by itself, needs to be understood by us all because we are becoming increasingly aware of the massive lifelong impact that Adverse Childhood Experiences (ACEs) have on many people’s health status, mental health status, physical functioning, emotional well-being and mortality rates. . 

The piece by Solomon and the new research given to the First Five Commission focuses on how stress affects our prematurity rates as a state and nation.

Everyone who looks at health status issues knows that our country has some of the worst rates of both infant prematurity and infant mortality in the world.

No one disputes the fact that we have very poor performance compared to other countries for both premature birth and infant mortality. People point to that data often — but no one explains why our numbers are what they are or suggests anything useful that we might do about them. 

We now have an answer that explains many of those premature births — and that answer leads to some important things that might help us reduce those numbers in the future. 

Answering that question about our premature birth rates is why both the attached article by Solomon and the new research report from UCSF and The California Department of Health that was just presented to the First Five Commission for Children and Familiesare both so important.

Danyelle Solomon makes the point very logically and very persuasively in her article that racism in our country is a key generator of stress for large numbers of people.

She ties that stress to the incidence of preterm birth very directly — including citing studies that show that higher education levels for mothers are a relevant factor that tends to significantly reduce the prematurity rates for Euro-American mothers, but then shows that higher education levels not only do not reduce prematurity levels for African American mothers, and might actually increase them.

That is a truly puzzling piece of data, and it is one of the evidence factors that she uses to point to racism as logically being part of the problem for the African American mothers.

She stated in her piece that she believed that the difference between the two groups of mothers that functionally overpowers the impact of education levels for each mother might be the impact of racism on the African American mothers.

That was an extremely good insight for her to have. 

We now know from this new research that she is actually right. 

We now have important data that shows that she was correct in making that assumption and identifying that particular link to premature births for those mothers.

The data that verifies both her contention and that shows a clear link between racism and premature birth levels is brand new and it is extremely important for us all to understand. 

Key data explaining those differences in preterm birth rates between those groups of mothers was presented last month to the First Five California Commission for Children and Families at their full commission meeting in Alameda. by researchers from The University of California in San Francisco and the California Department of Public Health.

We actually now have a very powerful and almost historic new piece of research that deals directly with that issue and measures the impact of racism on premature births in a very direct and persuasive way. 

Their report to The First Five Commission about the annual Maternal and Infant Health Assessment Survey (MIHA) — is attached. 

Additional back up data for their report is also attached and the results section of this paper should be reviewed by anyone interested in learning what their findings by group were. 

MIHA does good work.  

The MIHA team does annual in-depth surveys of more than 10,000 California mothers who had recently given birth. The researchers work to build a data base on a number of relevant behavioral and logistical issues for new mothers that can be used to help improve health for mothers and children in California.

They produce a valuable report.

That report has just become more valuable, because stress factor impacts on mothers have now been added to their research. 

The MIHA team decided to look at stress factors for expectant mothers as a major aspect of this year’s research and that turned out to be an extremely useful and important thing to do. 

They began their research design effort with the belief that stress factors could possibly create physiological impacts that could have both an epigenetic effect and a direct physical impact on the mothers they studied. They wanted to both see if stress impacts for individual mothers affected births in California, and they wanted to figure out which stress factors were most relevant to triggering premature birth in California moms.

They did brilliant research

Look at the results section of their paper on that research. 

The research team looked at very explicit and specific stress factors for each mother. The researchers built a very inclusive and useful list of possible causes of stress for each mother, and then they measured the impact of each stress factor as separate questions in their survey. 

They created a great, well-grounded, functionally appropriate and highly relevant list of maternal stress factors.

They looked at income difficulties and poverty levels for mothers.

They looked at housing difficulties and homelessness during pregnancy. 

They looked at job loss for both mother and fathers. 

They looked at food insecurity or shortages, and they looked at separation or divorce during pregnancy. 

They looked at intimate partner physical violence during pregnancy, and they looked at both smoking and binge drinking behaviors for expectant mothers in that time frame.

They looked at important medical events that happened during the pregnancy.

They also looked at chronic worry about racism. 

They asked each mother if she worried about racism and its impact on her and her family.

They broke out each of the stress factors for each mother by categories that tied and linked each factor to the percentage of federal poverty level, the personal education levels, and the age at giving birth that were relevant for each mother. 

Having relative numbers for each of the stress factors is an extremely good and important thing for the researchers to do. It was good and extremely useful for the researchers to be able to use that full set of data for all of those mothers as a resource to figure out both which factors and which combination of economic, education and stress factors actually triggered higher levels of premature births for the mothers in the survey. 

They did a very important thing.

They linked each of those very real and clear stress factors to prematurity levels.

The researchers who presented the data to the Commission stated in their presentation to the Commission that the data from their study pointed overwhelmingly to one major factor that had more impact than any of the other factors on preterm birth rates — and they told the Commission that one single factor actually had more impact on increasing the number of preterm births than all of the other stress factors combined.

Just like Danyelle Solomon stated and predicted in her attached racism piece, the education and economic levels of the mothers did not predict premature birth differences between African American mothers very well. 

Nor did violence from the mother’s significant partner or even homelessness for the mother at some point in the pregnancy.

Racism Was the Most Powerful Factor 

What did predict prematurity levels at a very high level for the women who gave birth was racism — as measured by the question about whether the mother worried about racism and perceived racism to be a problem in her life and for her family.

The specific question they used to determine that sense of worry is shown in the attached survey.

The reality is that all of the African American mothers functionally and practically experience some levels of racism in their lives because that tends to be a fact of life in a multiracial society — but that particular result in that MIHA survey shows us that racism does significantly more damage to some mothers than it does to others relative to giving birth prematurely and it says that racism is extremely relevant both to and for those mothers.

The overall group of African American mothers in California was 60 percent more likely to give birth prematurely. That data corresponds with national trends and numbers in that range have been seen in other settings around the country. 

To be specific for California, the overall prematurity rate for all African American mothers was nine point 2 percent of their births. 

That compared to an overall prematurity rate for all White mothers in the survey of 5.8 percent.

However, when the survey team looked at the premature birth rates for the 37 percent of the African American mothers who indicated in the survey that they personally worried about the impact of racism in their lives, the prematurity birth rate jumped to 12.5 percent of their births.

That number is more than double the white prematurity birth number for California.

When they looked at the African American mothers in the study who did not reflect that racism stress worry level in their responses, the prematurity rate dropped to 7.2 percent. That number is still 24 percent higher than the white prematurity rate in California.

Twenty-four percent higher than the number of white premature births is an important difference and needs to be understood and addressed in appropriate ways. 

But a premature birth rate that is well more than double the rate of premature births for white mothers is even bigger and that number is actually is large enough to make up most of the difference in overall premature births rates between America and other industrialized countries if it is true in other states as well.

This is extremely important information. 

Premature Birth Rates Linked to Chronic Worry About RacismThe survey data showed very clearly — with irrefutable data — that the African American mothers who are worried about the impact of racism on their family and lives are far more likely to give birth prematurely. 

We need to understand the significance of that data.  

Stress clearly made a difference. The researchers looked at a dozen risk factors for each mother — and several had a degree of impact, but stress related to racism turned out to be the biggest damaging factor for premature births in California. 

The impact of that worry for those mothers far outweighed the other dozen stress factors that were studied in the survey.

It is clear from the MIHA data and the data presented to the First Five Commission that racism actually is the kind of negative factor relative to giving birth prematurely that Danyelle Solomon predicted in her assessment and her description of the issue.

It is also now functionally clear in a very important and previously invisible way that racism affects people differently. We now know that that racism does more damage at a physiological, psychological and functional level to some women than it does to other women from the same group and we now know that those differences can have a massive impact on people’s lives.

That is amazing, powerful, unexpected and potentially extremely useful information about both premature birth and racism related stress

That information should be useful to us all at one level because if we think in terms of process improvement opportunities and if we want to develop public health and care improvement strategies for reducing premature births in America, that information gives us a possible pathway to identifying, much more effectively which mothers are at the most risk for being damaged by racism and for giving birth prematurely. 

That insight into which mothers are at the highest risk levels of giving birth prematurely should give us the possibility of doing some targeted inventions and creating and using some support approaches with those specific mothers that might change some lives and reduce the total number of premature births.

Some care systems who have just been exposed to this research are actually already incorporating this information into their thought processes about reducing prematurity rates. It will be interesting to see what those care teams develop as tools and strategies.

At a larger level, we can not simply act now to correct or end racism. 

Racism is a horrible and damaging and evil thing. We need to do everything we can to rise above those racist behaviors and beliefs to create a better world and a better country for America. We need to understand the instinctive behaviors and thought processes that point us in those directions — and we need to use our intellect to create strategies to rise to more enlightened behaviors as communities and as a country

We need inter group Peace and we need win-win results for all groups in America. We need to resist, reject, end and even transcend racism as part of that strategy.

But the functional reality is that we can’t end racism in time to help individual African American women who are pregnant today. 

So we clearly should figure out how to use this extremely powerful new set of insights into the highest levels of risk for premature birth to figure out what exactly we can do to help reduce the damaging impact on that specific set of women in real time, because their pregnancy is now, and we should be helping those particular pregnant women now because we now know the much higher level of risk exists for those women.

A wonderful overview piece done for nurse midwives also did an excellent job of pointing to multiple studies that have been done to look at the connection between racism issues and preterm birth. All of those studies in the midwife document would have been enhanced with the addition of this new insight into the impact on women who reported those levels of worry about racism.  

This new California information about which mothers are most affected by the racism stress adds a wonderful enhancement to the body of research work and related impact that is described in the Midwife piece. 

We need smart people to figure out next steps to use this insight in useful ways in every setting where births are happening and where mothers might be affected by this information. 

Some of that work is beginning as the result of this information being shared and we need to encourage it to happen and we need to share it with each other when we learn better ways of providing support that works to those high-risk mothers. 

We are all in deep debt to Christine Rinki, Kristen Marchi, and Paula Braverman for their wonderful research into California mother risk factors and for sharing their work with the First Five Commission in Sacramento last week. 

Both the California Department of Public Health and the leadership at the University of California in San Francisco should be saluted for supporting this entire research agenda and for sharing this information with the world.

This has the potential to be a seminal and extremely useful finding relative to reducing the number of premature births in America.

Well done, team. 

Please share this information with anyone who is wondering about the high rate of preterm birth in America and who is wondering about things that might be done to help and who wants to understand what can be done to reduce those births.

The link to racism for premature births is unexpected for many people — but it was entirely expected for many others.

We Need a Public Health Agenda to Help All Children

We now very much need an overall public health agenda and an overall science based educational development strategy and plan to help all kids. 

We need to figure out the next right steps to help women who perceive the damage and risk of racism to have a sense of risk reduction during their pregnancies. 

We also need to help every child who is born now to have the right sets of direct interactions and support in the first days, weeks, and months of life when the epigenetic processes kick in that will help determine both the emotional well-being and the intellectual capacity for each child. 

We have a very direct opportunity to close the learning gaps in our schools and to close some of the economic gaps in our economy if we do the right things for every child in the first days, weeks, and months of life.

The new brain science about the importance of the first weeks, months and years on the development of both brain strength and emotional security for each child are extremely important for all families in America.

Very basic and direct work to help every child in those first days, weeks and months of life very much needs to be done because we now know that cannot close the crippling learning gaps we have today in almost all American schools, and we will not be able to reduce the Adverse Childhood Event scores for our children if we don’t create those interactions for each child in those critical and essential developmental time frames for each child

We also will not end racism in America until we stop putting so many minority children in jail — and the brain development work that we need to do for the first three years for each child is also aimed directly and explicitly at that goal.

Racism damages us at multiple levels — and we need to rise above it together and we need to help every child from every group get the very best foundation for their lives. 

We need to start before each child is born and we need to help every child and family from the moment of birth. 

If we miss that opportunity, we will face massive problems that will damage us as a country and turn us into just another multi-group country at war with itself

This new and extremely important research into the effects of racism on premature birth completely affirms that agenda and confirms the absolute necessity for that approach.

Let’s save every child — and let’s start the saving process very intentionally before each child is even born.

Knowledge is power

Share this knowledge and generate the power of positive problem solving by intelligent and well intentioned and good-hearted people that will grow into a culture that does more to help all children and help all families succeed.


Document Download: Item-8---Maternal-and-Infant-Health-Assessment-Survey.pdf