Black babies have a greater chance of survival if the hospital doctor responsible for their care is also black, according to a new study.
In the US, color-faced babies have less severe clinical outcomes than white newborns.
Earlier research by the Centers for Disease Control and Prevention (CDC) published last year shows that black babies are more than twice as likely to die before they reach their first birthday than white babies, despite the mother’s income as an education level.
Although infant mortality over the past century has generally fallen due to improvements in hygiene, nutrition, and health care, the black-and-white differences have grown.
Several interrelated factors contributing to these differences include structural and social racism, toxic stress, and cumulative socioeconomic disadvantages.
The new study published in the Proceedings of the National Academy of Sciences suggests that the race of the attending physician also plays an important role.
Researchers checked 1.8m hospital birth records in Florida from 1992 to 2015, and established the doctor’s race in charge of caring for each child.
When cared for by white doctors, black babies are about three times more likely to die in the hospital than white newborns.
This inequality halves when black babies are cared for by a black doctor.
Strikingly, the biggest drop of death occurred in complex births and in hospitals that produce relatively more black babies, suggesting that institutional factors may play a role.
The study found no statistically significant association between the risk of maternal mortality – which is also much higher for black and brown women – and the mother’s race.
Why racial concordance is so important in black child mortality requires further research, but it may increase trust and communication between doctor and mother, and black doctors may be more attuned to social risk factors and cumulative disadvantages that may affect neonatal care , according to Brad Greenwood, lead author of George Mason University in Virginia.
Unconscious racism among white doctors against black women and their babies may also be at stake.
For white newborns, their doctor’s race does not make much difference to their chances of survival.
Despite the harsh findings, black women seeking a black doctor to minimize the risk to their babies will struggle because the medical worker remains disproportionately white. Only 5% of physicians are black, according to the Association of American Medical Colleges.
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The study underscores the urgent need for more diversity in the medical profession, according to Greenwood.
“In the sense that research suggests that stereotypes and implicit bias contribute to racial disparities in health outcomes, the work also highlights the need for hospitals and other healthcare organizations to invest in efforts to reduce such benefits and explore their link with institutional racism,” he added.
The findings reflect clinical outcomes seen by Dr. Arthur James, retired obstetrician / gynecologist and former head of the Ohio State University Kirwan Institute for the Study of Race and Ethnicity.
James was part of a group of black midwives in the hospital who were contracted to care for poor uninsured patients in eastern Michigan, where in 1980 black babies died at five times the rate of white babies. By mid to late 1990s, the racial gap had dropped to 1.4, despite a larger proportion of challenging births.
James said: ‘As black doctors, we attended the same churches, barber shops, beauty salons, our children wanted to attend the same schools … this sense of community cultivates a completely different level of relationship and responsibility. The feeling that your supplier really cares about you is important … and, in my opinion, it is more easily realized when racial concordance and real relationship is present.
“Kudos to the authors for raising a significant and often overshadowing potential participant in improved birth outcomes,” James added.
Overall, US ranks 30th among the 33 OECD countries for infant mortality, with only Mexico, Turkey and Chile doing less. A CDC report published last year found that more than 22,000 American babies died before their first birthday in 2017. Black babies died at a rate of 10.97 per 1,000 births – more than twice the rate for white, Asian or Latin newborns .
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