Monday, October 17, 2011

"Tackling Infant Mortality Rates": A response

B/c my daughter has been monopolizing my kindle, I did not read this NYT article from Saturday, Tackling Infant Mortality Rates Among Blacks, until I read Denene Milner's impassioned critique of it this morning - "Tackling Infant Mortality Rates—Without Stereotyping Black Mothers" - on her blog, My Brown Baby.

The NYT reports on a serious problem that is not unfamiliar to me as an anthropologist, but that receives not enough public attention and frankly (I think) not enough outrage: In America, the babies of black women die at twice the rate of the babies of white women. The article also describes efforts (in Pittsburgh) to address what public health officials call a "differential" or a "disparity" in the rates of infant mortality.

Echoing the perspective of critical medical anthropologists like Merrill Singer, I think it ought to be called "inequality":

While the term "health disparities" references differences in health across groups, the term "health inequalities" points, as well, to underlying structural causes in disease distribution, namely, that social inequalities produce health inequalities (Singer and Baer 2007:152).


The higher rate of infant mortality has been observed for all black women, regardless of their income, education, access to prenatal care, and so on.

Denene Milner responds to the portrayal of a particular pregnant black woman in the article, who comes to stand for all pregnant black women:

Witness the subject the Times story highlights: A poor, uneducated, 20-year-old pregnant black woman from Pittsburgh who the reporter suggests had to be talked into actually wanting her baby, and has so little self-control or pre-natal intellect that she’s spent the last seven months gorging on chips, soda, tacos and her “mama’s cooking,” gaining 50 unhealthy pounds that could put her baby at risk. Her baby has a chance of surviving only because of Healthy Start, a nonprofit group that, despite scant federal and absolutely no local financial support, manages to give in-home pre-natal care to moms-to-be who qualify for and need their services.

The piece makes the story of that mom-to-be all of our stories—puts the black infant mortality onus squarely on our shoulders by suggesting if we planned our pregnancies, ate better and were smart enough to seek out and follow up with quality health care, our babies would live.


This is pretty awful, but also, unfortunately, not surprising. A favorite rant that I like to go on in my medical anthropology class is that introducing the concept of "lifestyle" was possibly one of the worst mistakes for public health b/c it deflected attention from political, economic, and social concerns and shifted responsibility entirely to individuals making "bad" choices. "Lifestyle," esp. when crossed with class and race and gender, produces some ugly stories.

Not to mention that I find myself reminding my students at least two or three times in a semester of medical anthropology and anthropology of reproduction that almost half of all pregnancies in the U.S. are unintended - with higher rates of unintended pregnancy among younger women and women of color, which itself is another sign of another disparity / inequality.

I agree with Milner's point also that there is a missed opportunity in the NYT article, which itself reports:

Recent studies have shown that poverty, education, access to prenatal care, smoking and even low birth weight do not alone explain the racial gap in infant mortality, and that even black women with graduate degrees are more likely to lose a child in its first year than are white women who did not finish high school. Research is now focusing on stress as a factor and whether black women have shorter birth canals.


The point about stress, I will return to in a moment. First, to address the suggestion that black women might have shorter birth canals - I was not aware previously of any research along these lines, but as an anthropologist, I felt more than a twinge of nervousness reading this in the NYT, especially with no further explanation offered. So, on the one hand, my nervousness arises from the awareness that race historically has been and continues to be biologized - and that science, including anthropology, has been used to legitimize reductionist understandings about race-as-biology. (In the PBS documentary series, "Race: The Power of an Illusion," which I use in introductory anthropology classes, there is a discussion of the ways in which there has been hardly an anatomical feature that has not been examined - from brow to brain to heart and so forth - in search of the "essential" difference between black and white races.)

On the other hand, there might in fact be a legitimate question to ask about the biological variation that is exhibited across all humans. As my colleagues in biological anthropology emphasize, humans exhibit biological variation that ought to be viewed as a continuum, not as either / or. The classic example is skin color, which differs in gradation from darker to lighter, not either dark or light, and which we recognize as variable even within a given cluster or group of individuals.

From the perspective of medical anthropology, there should be no doubt that social conditions produce health and sickness. A social condition we ought to be taking far more seriously is racism itself (and the stress it causes) and the effects of it has on biology. This video clip, "How Racism Impacts Pregnancy Outcomes," from the PBS documentary series, "Unnatural Causes," explains.

The NYT article and Denene Milner's response also make me think about the interventions that anthropologists in particular might make. Clarence Gravlee published a piece that I encourage anyone teaching the concept of race to read (and assign) - "How Race Becomes Biology: Embodiment of Social Inequality." In it, Gravlee challenges scientists (esp. anthropologists) "to explain how race becomes biology. Our response to this challenge must deal with with two senses in which race becomes biology: Systemic racism becomes embodied in the biology of racialized groups and individuals, and embodied inequalities reinforce a racialized understanding of human biology" (Gravlee 2009:54).

The fact that in America, the babies of black women die at twice the rate of the babies of white women ought to impress upon us that the social practices and ideas that we call racism have biological consequences.

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