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When the Bough Breaks

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1. How are pregnancy outcomes affected by racism and chronic stress? How are racial differences in birth outcomes not reducible to class alone? 2. Dr. Jones says that the chronic stress of racism is like “gunning the engine of a car, never letting up.” What does she mean? How does this affect the body over time? 3. Birth outcomes, like other health indicators, follow the wealth-health gradient. Explain why wealthier and more educated mothers have better outcomes. According to the film, why do African American women at each income level have worse outcomes than their white counterparts? 4. Describe Dr. Lu’s “life-course perspective.” How does it broaden conventional approaches, which focus primarily on risk factors during pregnancy? a. What are the mechanisms by which experiences outside the body and before conception can affect birth outcomes? b. Describe how the life course perspective support a link between racism and premature birth or low birth-weight babies. 5. Neonatologist Dr. Richard David says: “there’s something about growing up as a Black female in the United States that’s not good for your childbearing health.” a. What evidence explains racial disparities in birth outcomes? b. Why is it significant that the daughters of African immigrants had worse birth outcomes than their mothers? c. Why do African American mothers have more low birth-weight babies than white American and African immigrant women?

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several years ago to physicians in Chicago set out to solve mystery why do African American women have babies that are born too small at twice the rate of white American women Richard David and James Collins are neonatologist pediatricians who specialize in the care of infants who come into the world too early or dangerously underweight and often both like virtually everyone in their field they were troubled by the Striking racial differences in rates of premature and low birth weight what could account for the differences originally thought that the disparity and premature delivery was really driven by socioeconomic the differences between African-Americans why well known that African Americans have lower collectively subscriber stats than whites are less likely to receive college education then why it's so I thought once you correct it for that the Gap to go away but Collins and David discovered Gap didn't go away we were very surprised to find that the Gap actually widened as education is still sick and I'm ecstatic improved and then begin to look at it from a bigger perspective realize or maybe it's something about lifelong minority status which is the driving Factor here there's something about growing up as a black female in the United States it's not good for your child bearing health I don't know how else to summarize it so the neonatologist began to explore whether being a member of a particular minority group might affect pregnancy outcomes and they came up with a controversial hypothesis what's behind the low birth weight premature birth for African American babies is the unequal treatment of African Americans in American society in other words racism taking a heavy toll on African American children even before they leave their mothers wombs it's an idea that's slowly gaining acceptance we're in the midst of a paradigm shift 15 years ago racism as a risk actor was almost never heard of in a scientific paper and where is now that's much more a possibility the story of Kim Anderson a successful Atlanta executive and lawyer illustrates exactly what Dave Collins are talking about we know that a healthy lifestyle should lead to a healthy baby women who eat well exercise get prenatal care avoid alcohol and drugs and cigarettes are more likely to have a good pregnancy but one of the best predictors for a healthy pregnancy outcome is higher education this is a picture of me American Dream lawyer with two cars 2 and 1/2 kids the dog port a good husband great family I've always been lucky to have good health always exercise smoke so when we look at Kim Anderson a well-paid lawyer in good health we would expect her newborn to be a healthy full-term baby it didn't turn out that way back in 1990 when she was pregnant with her first child Kim went into labor two and a half months early I just wanted to know at least that if she was born alive but at least we had a fight and I heard a cry thank God but she was so small and then I called her in the palm of your hand Kim's baby Danielle Wade only 2 lb 13 Oz is when she was born she doing the rants of almost 300,000 low-birth-weight infants born in the US that year about one out of every 14 babies all of them at a high risk of dying before their first birthday remember getting home and being in the bathroom just fell apart preterm and low birth weight are the leading reasons that the US claims the dubious distinction of having one of the worst infant survival rates in the industrialized world we fall behind dozens of countries babies born Lavinia Cypress Malta and Croatia stand a better chance of living to the age of one than a baby born here it is kind of like the canary in the mine it's the most sensitive of our health outcome indicators for the population and infant mortality is not just a problem for African American white Americans if they were separate country would still ranked 23rd in the world so how come you are very bad as a country can a normal price for a high rate of premature and low birth weight babies preterm birth is the second leading cause of death for infants if they're lucky enough to survive many it's a lifetime of learning and medical problems studies show that prematurity increases the risk for hypertension diabetes and coronary artery disease and the high cost of their medical care for the moment they're born one month stay in a neonatal Intensive Care Unit averages $68,000 now he's a lot of things are expensive is not one of them and then we spend a disproportionately high and one of our income as a society taking care of infants a lot of problems I could have been prevented if they had stayed in the room until term the current weight today Mom is 2 lb 6.3 Oz I have never seen a child in small before never be away but see how she is so happy everyday in the terminology of social scientists Kim Anderson family enjoys High socioeconomic status which increases the odds for overall good health persons who are higher in status of persons who have more income or more education or better jobs or more Wealth live longer and have few health problems than those who are lower and socioeconomic status education for example Britax infant mortality for both black women and white women and the more educated you are the less likely you are to have a low birth weight baby a preterm baby or an infant that women who are poorest and least educated are those whose babies are at greatest risk in any racial group but the babies of African-American mothers with higher education are still at greater risk than we'd expect infant mortality amongst them can women with a college degree or higher is about 4 deaths per thousand births but among African-American women with the same level of Education infant mortality is about 10 per thousand births almost three times higher in fact African American mothers with a college degree have worse birth outcomes than white mothers without a high school education think about this talking about African-American doctors lawyers and business Executives and they still have a high in the mortality rate than non-hispanic white woman who never went to high school in the first place as a mother you thinking vitamin vegetable they told me not to drink I didn't do all that and why is my kids sitting here with these needles and really feel helpless so doctors Collins and David ask themselves if the answer could possibly be genetic it's well known that prematurity can run in families is there something in the name of African American women that tends toward premature births regardless of Education prenatal care or lifestyle to answer the question they create a study based on a simple assault there was such a thing as a prematurity gene and it came from Africa than African should have more of it they compared newborns among three groups African American women immigrants to the US and US born white women it turns out that the Africans in the whites were about the same the African Americans on the other hand had babysit Wade 8 or 9 oz less than the other two groups in other words African immigrants to the US and white women born in the US had similar pregnancy outcomes so if there is any genetic predisposition for low birth weight babies it's doubtful that it falls along what we call racial lines it turns out they went African women immigrate to the it takes only one generation before their daughters are at risk of having premature babies at a significantly higher rate and with poor birth outcomes is a heart rate didn't in that range of the 181 generation women Factory descent are doing poorly this to us really suggest that something is driving distance from here to the social you that at American women live in throughout their entire life the news was once more hopeful during the 1960s and 70s with the Civil Rights and anti-poverty movements the health of African Americans are two whites improved overall government initiatives not only integrated hospitals but also opened up education opportunities and better jobs and housing the house of African Americans began to catch up with that of white and infant mortality rates in the African American Community declined mylifetime the Gap has closed okay and then I think it's as a result of social policies after the war on poverty and the Civil Rights Movement we had social policies that were allowing people more opportunity but in the 1980s comic growth stagnated and government begin cutting back social programs the impact on infant deaths was dramatic the ratio of infant mortality among African-Americans compared to whites began to climb and continues to climb today but that doesn't explain the case of middle-class African American women like Kim Anderson why should Highly Educated women with good incomes still have high rates of premature and low birth weight babies once again I study by Collins and David to racism as a key factor women have received that they had been treated unfairly on the basis of their race weather was looking for work I am in an educational setting or a variety of other settings had one and two fold increase risk of very low birth weight infant so if racism is contributing to premature births African American women how does it work how might racism take a physical toll on the human body over a lifetime increasingly researchers are looking at chronic stress the stress caused by living day-in-and-day-out with discrimination recent data suggests that chronic stress associated with being a minority particular being African-American for some logic and reason increases the risk of delivering a premature low birth weight infants when you that makes you gets you stressed out you not only have psychological or emotional reaction to that you also have a body reaction cause them and just can't escape it proper time to chronic stress the chronic back pain location of that response create wear and tear on your body organs and systems so that you created overload on the system so that they don't work very well researchers believe stress can affect pregnancy outcomes in several different ways stress hormones are part of the intricate chemistry of pregnancy under normal conditions when those hormones we just certain level they may help trigger labor but what might happen if you went into pregnancy already overloaded with stress hormones think about it is going to start pumping out extra stress hormone and so they reached that Tipping Point for labor to begin sooner stress can also constrict blood flow to the placenta which could limit fetal growth and mail two premature delivery chronic stress may also contribute to Serious inflammation inside the uterus which can trigger premature labor research suggests it's not so much stress during pregnancy then they determine the health of a mother's baby but the cumulative experiences of the mother over the course of her entire life regardless of race leading at all dr. Luke calls this the life course perspective the life course perspective posits that birth outcomes are the product of not simply didn't 9 months of pregnancy but really the entire life course of a woman in the coral for that is disparities in birth outcomes this really the consequences not only differential exposures during pregnancy but really the differential experiences Across the Life Course up on the color feeding and butt is racism so dominant throughout the lives of African American women that it can affect the birth outcomes of their children one recent study reports that the majority of white Americans believe racial nation is a problem of the past the evidence indicates otherwise for example African Americans at all income levels are more likely to be denied mortgage pay more for automobiles and receive fewer job interviews it was a fairly dramatic study done in Milwaukee Wisconsin where they sent black and white men always identical how to apply for 350 entry level jobs what this study found was that a black male with a clean record no criminal record was less likely to be off job then a white male with a felony conviction so it was a dramatic example of India 2004 of the Persistence of discrimination in American society the racial stress can have a lifelong impact on African-American families and their health racism is a societal level problem it's institutionalize it's part of our educational system is part of our media it's part of our culture it's one of the struts that reinforces inequality in the society we live in Anderson African American female went to Columbia they just see a black woman I was just or what let's walk around a castle by a pair of jeans why are you feeling I'm not going to steal anything leave me alone I am not going when you're confronted with racism covert racism your stomach just get sleep so tight feel it almost move into your body almost you could feel like going into your bloodstream very different kinds of clinical stressors in the world you can have a bad day and somebody else to have a bad day they can cut you out of a parking space it's an occasion but it's not promise any idea of second-class citizenship it's not something that is a repeated and reactivated insult that occurs 34 serious about improving birth outcomes in reducing disparities we got start taking care of women before pregnancy talking about that one visit 3 months preconception Ali talking about when she says baby inside her mother's womb but not again fun and a Child and Adolescent and I'm really taking care of women and families across their life course so how do we actually identify and measure the kind of subtle everyday racism that follows black women throughout their lives Camara Phyllis Jones is a family physician an epidemiologist at the hours for Disease Control she was among the first to investigate the connection between racism and health one study looking at chronic diseases in over 100,000 women pose the critical Quest to get a better understanding of how women internalized there racial experience how often do you think about your race for white women 50% saying that they never think about the race for black women percent think about the race once a day or more frequently with 21% thinking about the race constantly that's an eternity of experience apart recently there has been a coming together around the hypothesis that stress really does make a difference and that racism is a particular kind of stressor it's like an add-on to the other stressors of ones like losing a job losing a Etc the question is how do you dresses you have to measure it you know there's been times when I called on the phone and I can't do this today y'all somebody you know try and measure racism is a challenging task psychologist Plato Jackson sociologist Ramona Phillips and epidemiologist Carol Hogue have attempted to measure the impact of racism on middle-class African-Americans it's a first step in understanding how ordinary daily encounters with racism can affect women throughout their life course to collect the data decided we first needed to hear from African American women about what was the stresses in their lives and so we started with focus group and over a period of about 15 years the evolved this measure which is gendered it's only just for African American women I think constantly having to internalize the racism that we experience everyday is like to me You Escape 2 my daughter she's real open and friendly and so you know she'll run up to the white children is heartbreaking for me to see that if you have to take children outside of your neighborhood for the best educational opportunities if you have concerns that they will be racially profiled if there are concerns about the opportunities that they will have that represents serious kinds of stressors that are experienced by African-American women on a constant basis Define gunning the engine of a car without ever letting up wearing it out wearing out without rest and I think that the stresses of everyday racism are doing that you have a doctor that comes in and it doesn't really pay attention to what it is you're saying that invalidates what it is you say no matter how many times I made it to the final interview how many programs that has come out of my research it's just not enough and I think it's unfortunate but it does something to me internally I'm taking jobs I mean getting Payless in the people that I know don't have as much as you can. I don't know what kind of African American women's bodies from the wear and tear one program the family health and birth center in Washington DC provides Family Support employment and financial counseling and prenatal care the result preterm births were reduced by 1/3 and low birth deliveries cut in half and Kim Anderson's case it's impossible to pinpoint one cause for Danielle's premature birth the stress of racism genetic predisposition or factors but researchers work with averages not individuals and with thousands of examples the evidence pointing to the impact of racism and stress on pregnancy outcomes is becoming hard to ignore Danielle was discharged. She was so small but she just pull through Secrets I promise you could head learning disability she's a great student she doesn't have problems with health so different it could have been so different what kind of nation mean I have two daughters and question this what kind of nation do we want them to grow up in this nation was founded on the cell 7 and shoot that all men and women are created equal to 230 years later the truth still not quite so self-evident right you ain't created equal if you can't start sometimes I do worry what will happen if my daughter deliver preemie done looking at a second generation preemie who says she wants to be a cardiologist in the intelligence which to me is stress on top of stress and is the African American woman who now wears dreads so it's all those things that are going to Beyond her heart on her mind in her life you don't want to have to worry about what to do with a pre don't want to have to go through that experience then wonder what the outcome would be in and I hope I pray that if it happens to her outcome will be as blessed and successful as far as hard as it's been with her major funding for unnatural causes has been made possible by the Foot Foundation the John D & Catherine T MacArthur Foundation the California endowment WK Kellogg Foundation the Nathan Cummings Foundation Joint Center for political and economic studies I'm Kaiser Permanente additional funding cited by these fenders this program was also made possible by The Corporation for Public Broadcasting

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