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African-American women are twice as likely to give birth prematurely as white women. These births often coincide with low birth weight and, together, are linked to other developmental delays and health effects that would account for almost one-fifth of all infant deaths nationwide. .
The trend continues regardless of socio-economic factors. This means, for example, that a black woman with a university degree and a comfortable income is more likely to give birth prematurely than a white woman who did not graduate from high school.
Previous research has highlighted other factors contributing to the difference, such as post-traumatic stress disorder. In an article in the winter issue of Journal of Health Disparities Research and PracticeAmelia Gavin, Associate Professor at the School of Social Work at the University of Washington, badociates racial discrimination with PTSD, and therefore at pre-term birth.
"Pregnancy is a stress test for the body.If you have been stressed during your life because of discrimination, poverty and residential segregation, the likelihood of having healthy births has been compromised, "said Gavin.
A typical pregnancy lasts about 40 weeks; a birth before the end of the 37th week is considered "premature". According to the Centers for Disease Control and Prevention, 10% of babies born in the United States in 2016 were born prematurely – a slight increase that year, after a steady decline several years earlier. While the CDC attributed this decline to the decrease in the number of teenage mothers, the agency noted a steady difference in premature birth rates between African American women and white women. In 2016, the pre-term birth rate for African-American women was 14%, compared to 9% for white women. There are medical causes at premature birth, "but the majority of cases have an unknown cause," said Gavin.
Over the years, research has focused on biological and behavioral risk factors related to prematurity, including access to prenatal care, substance abuse and stress. The PTSD, badociated not only with combat experiences but also with other traumatic events such as natural disasters, badaults and abuses, affects more women than men. Several studies have linked PTSD to a higher risk of premature labor.
When it is broken down by race and ethnicity, PTSD affects African Americans more than any other group and more African American women than men.
At the same time, studies have linked racial discrimination to poor health, particularly the health of African-American women. Daily experiences of discrimination, as well as the legacy of racism – neighborhoods with higher crime and fewer resources, generational poverty and limited access to health care – can create stress and incite unhealthy behaviors.
Gavin hypothesized these links: if discrimination is badociated with PTSD, and if PTSD is badociated with premature birth, racial discrimination, via PTSD, may also be related at premature birth.
The racial disparity between premature births has sparked his interest in research in higher education, Gavin said. By studying poverty and badual abuse in childhood, as well as maternal depression, Gavin is geared to the issue of PTSD.
"I try to explain, from the point of view of the evolution of life, how risk factors in the lives of black women can impact the next generation," he said. she said. "Exploring the mechanisms by which racial discrimination affects the next generation is really important.This means that one has to take into account the mental health status of the mother.When we talk about racial disparities in the results for health, we need to think about how we will build post-traumatic stress and how different racial and ethnic groups live it. "
One of the challenges has been the definition of PTSD, usually by members of the mental health community, Gavin said. PTSD is not always linked to a devastating physical or emotional event; events can recur and continue to affect a person in the long run. Little research has been done on how racial discrimination could manifest itself in post-traumatic stress and affect early delivery, she said.
Future research could more definitively demonstrate the role of PTSD as a channel between racial discrimination and premature birth, Gavin said.
In this article, Gavin and his coauthors recommend that health care providers begin screening for prenatal PTSD in all pregnant women to identify people at risk for preterm birth. Of course, the continuing role of racial discrimination requires broader strategies that focus on social justice. The authors suggest that the government invest more in the amount of affordable housing and access to housing, as well as in the funding of K-12 education and health care. The authors write that by attacking these social factors, the health of African-American women and their offspring can improve.
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Nancy Grote and Taurmini Fentress from the School of Social Work at the University of Washington and Kyaien Conner from the University of South Florida also collaborated.
For more information, contact Gavin at [email protected] or at 206-616-8847.
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