An Ecological Analysis of Racial Differences in Low Birthweight:Implications for Maternal and Child Health Social Work

The gap in the incidence of low-birthweight babies (defined as less than 2,500 grams or 5.5 pounds) between black and white women in the United States has widened over the past two decades, and historically black women have been twice as likely as white women to give birth to a low-birthweight infant (Guyer, Martin, MacDorman, Anderson, & Strobino, 1997). Reductions in infant mortality and low birthweight have been targeted in the Healthy People 2010 goals for the nation (U.S. Department of Health and Human Services, 2000). Furthermore, the President's Initiative to Eliminate Disparities in Health reinforces the principle of equity by moving the nation from the goal of reducing racial disparities in health to one of eliminating disparities in health. Despite numerous studies that have sought to elucidate these racial differences, the racial disparity in the incidence of low birthweight has not been adequately explained (Collins & David, 1990; Geronimus & Bound, 1990; Goldenberg et al., 1996; Hessol, Fuentes-Afflick, & Bacchetti, 1998; Hogue & Yip, 1989; Kleinman & Kessel, 1987; Murrell, Smith, Gill, & Oxley, 1996; Shiono, Klebanoff, Graubard, Berendes, & Rhoads, 1986). One possible contributor to these large disparities may be inequality of living conditions between different racial groups. Ecological indicators that characterize the environment in which a woman resides have been previously neglected in birth outcome research. During the past several years, however, there has been growing interest in neighborhood environments and their effect on birth outcomes (O'Campo, Xue, Wang, & Caughy, 1997; Roberts, 1997), as well as interest in the role that economic, political, and cultural factors play in the low-birthweight gap between black women and white wome n (Cooper, 1993; Krieger, Rowley, Herman, Avery, & Phillips, 1993; Muntaner, Nieto, & O'Campo, 1996). This study examined the effect of previously unstudied neighborhood risk factors that influence low birthweight among black women and white women in New York City. The study presents new information on neighborhood risk factors and attempts to explain racial differences in birth outcomes among black women and white women in an urban environment. We also suggest ways that social workers can intervene through practice and policy to promote healthy births to vulnerable and oppressed low-income women of color. LOW BIRTHWEIGHT Low birthweight is a major determinant of infant mortality and contributes disproportionately to the overall burden of childhood handicaps in the United States (Paneth, 1995). Infant mortality rates are higher for black infants compared with those of white infants in the United States. Despite the decrease in the national infant mortality rate, the gap between black and white infant mortality rates has increased from a ratio of 1.6 in 1950 to more than 2.3 in 1995 (Guyer et al., 1997). Whereas black infants constitute 17 percent of all births in the United States, they account for 33 percent of all low-birthweight infants and 38 percent of all very low birthweight infants (Paneth, 1995). Moreover, black women are 2.2 times more likely to have a low-birthweight infant than their white counterparts. Low-birthweight and very low birthweight infants (less than 1,500 grams or 3.5 pounds) are more likely than normal-birthweight infants to die within the first month of life and to have a higher incidence of neuro-developmental disorders and other health problems later in life. Most studies examining racial and ethnic differences in low birthweight and infant mortality focus on individual factors that place women at high risk of these adverse outcomes (Kramer, 1991; Shiono et al., 1986; Starfield et al., 1991). These factors include smoking, drug use, prenatal care use, number of previous births, and a host of other demographic variables that have been associated with low birthweight. …