A recent study of deaths among black infants may provide another conscience jab to medical leaders who are confronted with mounting evidence of racial health care disparities in the United States.
As the Washington Post reported, researchers examined records of 1.8 million Florida hospital births between 1992 and 2015, finding in their published study these stark results:
“Although black newborns are three times as likely to die as white newborns, when black babies were cared for by black doctors after birth — primarily pediatricians, neonatologists and family practitioners — their mortality rate was cut in half. They found an association, not a cause and effect, and the researchers said more studies are needed to understand what effect, if any, a doctor’s race might have on infant mortality. ‘Strikingly, these effects appear to manifest more strongly in more complicated cases,’ the researchers wrote, ‘and when hospitals deliver more black newborns.’ They found no similar relationship between white doctors and white births. Nor did they find a difference in maternal death rates when the race of the doctor, usually an obstetrician, was the same as the mother’s.”
Rachel Hardeman, a health policy expert, Ph.D., and an associate professor at the University of Minnesota School of Public Health, noted of the study she and three other experts worked on:
“It is the first empirical evidence to describe the impact of the physician’s race on an outcome such as infant mortality.”
As the Washington Post reported, this is a topic of huge concern for experts and patient advocates focused on racial inequities in U.S. health care:
“With 5.7 deaths per 1,000 live births, the United States has a high infant mortality rate, and black babies are in the gravest danger, with an infant mortality rate in 2018 of 10.8 deaths per 1,000 live births, compared to a rate of 4.6 white babies per 1,000 live births. Infant mortality is defined as death during the first year of life, and 66% of those deaths, for all races, occur in the neonatal period in the first 28 days of life, with 14% within the first hour and another 26% within one to 23 hours. Under the care of black doctors, black babies’ mortality rate was more than halved from 430 per 100,000 live births to 173 per 100,000, Hardeman says. Although infant mortality in the United States has been decreasing, the gap between black and white infants has persisted, Hardeman says.”
Structural racism, in which white patients, including babies, hold inherent advantages across many aspects of medical care, may be to blame for black infants’ high mortality rates, Hardeman and her colleagues reported. They noted that further study is urgently needed, writing:
“Key open questions include the following: 1) whether physician race proxies for differences in physician practice behavior, 2) if so, which practices, and 3) what actions can be taken by policy makers, administrators, and physicians to ensure that all newborns receive optimal care. Reducing racial disparities in newborn mortality will also require raising awareness among physicians, nurses, and hospital administrators about the prevalence of racial and ethnic disparities, their effects, furthering diversity initiatives, and revisiting organizational routines in low-performing hospitals.”
Critics have prodded doctors, hospitals, and medical schools to significantly improve the care of black mothers and their babies, even before 2020’s widespread Black Lives Matter protests and the coronavirus pandemic refocused the nation on its challenges with racial inequity, including in health care.
Federal officials, for example, reported in 2019 that hundreds of mothers die of preventable pregnancy-related complications up to a year after delivering their babies, with black and native women experiencing notably high maternal morality risks. The New York Times reported then that “black women were 3.3 times more likely than white women to suffer a pregnancy-related death; Native American and Alaska Native women were 2.5 times more likely to die than white women.”
Public health officials have focused on improving maternal health care for black mothers, dealing with key issues like nutrition, their underlying conditions (especially excess weight and cardiovascular disorders), as well as their access to appropriate medical services. Black mothers, no matter their wealth, education, and accomplishment, struggle with inequities that can put them and their infants at risk — as prominent African American women’s publicized experiences have shown.
While it may be tempting for patients to conclude that they should seek out doctors of their own race, the researchers say this is not the path to pursue. Instead, experts must discover what makes black doctors more effective with black babies, and eliminate issues, so black women and their children can be in great hands, too, with white doctors.
Further, a pragmatic problem arises in same-race doctor shopping: Put simply, there are far too few black doctors to make it practical. As the Washington Post reported:
“According to the Association of American Medical Colleges, only 5% of doctors identify as black, and 4.9% of pediatricians do so. That is compared to the 579,174 black babies born in 2018, 15% of all births. While medical schools are seeing a steady increase of black students, as of 2020 they only make up 7% percent of students. Enrollment is affected by the wealth gap of black households … as well as the cost of maintaining a private practice.”
The dearth of black doctors, as well as in other parts of the U.S. health care system, is a historic wrong that the medical establishment lags in addressing. As Valerie Montgomery Rice, a doctor, and president and dean of the Morehouse School of Medicine, noted in a recent Op-Ed of the work of Historically Black Colleges and Universities, including Howard and its medical school in the District of Columbia:
“According to the Association of American Medical Colleges, black physicians comprise 5% of current, active practitioners and the four HBCU medical schools have graduated more black doctors over the last 10 years than the top 10 predominantly white medical schools combined.”
She went on to report:
“Out of 21,338 students entering medical school in 2018, only 1,505 of them were black Americans. That’s pretty much a flat line over the last 15 years. What’s more concerning is that only 572 of those medical students were black males. So, when you consider the ratio of black females going to medical school, compared to black males, it’s almost 3 to 1. Within all other demographics, it is nearly 50-50.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the soaring cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
While the U.S. health care system desperately needs our support as it gets battered by the pandemic, recent events and crises have underscored the need, too, for major reforms in this costly sector of American life. My colleagues and I deal with unacceptable medical-related injuries to babies and children. Women suffer disproportionate mistreatment in health care, and our system has far to go to address its deep, unrelenting problems with racial inequity, especially for black Americans. We need to ensure that from the very start, with black moms and their newborns, that the system on which we spend more than $3 trillion annually provides safe, quality, and equitable care. We have much work to do to end the pandemic, address its many and significant shortcomings, and to put the health care system in a far better place than it is now.
