Racial and economic inequality may account for large disparities in adverse birth outcomes, such as preterm birth, across zip codes in Fresno, Calif., according to an article published Aug. 23 in The Atlantic.
The article is part of a series highlighting racial and economic inequality in Fresno, reported on by students at UC Berkeley's Graduate School of Journalism.
Here are five takeaways from the report:
1. More than 400,000 women in the U.S. give birth to preterm babies, low-birthweight babies or infants who die before their first birthday, according to 2003 data cited by The Atlantic. Drug use, poverty and homelessness are commonly cited as risk factors for these adverse birth outcomes. However, there is inherent risk associated with pregnancy, and sometimes these cases occur for no specific reason, leaving mothers to feel personally responsible for uncontrollable adverse birth outcomes, according to The Atlantic.
2. Birth outcomes can gauge a community's health, and, in many areas, are often linked to "a history segregation and economic inequality," according to researchers. In Fresno County, Calif., rates of preterm birth — clarified as infants born before 37 weeks — vary greatly by location. For example, the preterm birth rate is 12 percent in one southwest zip code where 70 percent of residents are black or Hispanic. At a zip code 12 miles north with a 66 percent white population, the preterm birth rate is under 7 percent, according to the report.
3. Health experts argue racism and racial inequality, not race itself, is the source of these health disparities. One of these experts, John Capitman, PhD, director of the Central Valley Health Policy Institute in Fresno, helped found the Preterm Birth Initiative — a 10-year, $100 million research effort aimed at addressing adverse birth outcomes. Fresno is one of six areas in the world participating in the initiative.
"We're talking about the impacts of racism and poverty and how our public systems do or do not mediate those impacts on people's health status," Dr. Capitman told The Atlantic.
4. While targeted efforts like the Preterm Birth Initiative prove helpful for solving health disparities, they are also often the first programs to lose funding amid budget cuts, according to the Fresno Department of Public Health. Black Infant Health is a public health program for black women who are pregnant or new mothers in California. After the program's budget fell from $1.4 million in 2007 to $250,000 in 2010, the Fresno County's black infant mortality rate jumped to 27 per 1,000 births, representing a more than twofold increase.
5. Health experts told The Atlantic they believe clinicians must take more culturally specific care approaches and offer tailored support for expectant mothers to reduce disparities in adverse birth outcomes.
"We suffer at the local community level. We suffer at the state level. We suffer as a nation if we fail to acknowledge those disparities," Cassandra Joubert, director of the Central California Children's Institute, told The Atlantic. "There's all of this push for 'we need evidence-based approaches.' Well, what good is evidence if you won't use it?"
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