While pregnancy loss is a devastating reality for many families, the topic remains taboo. Unfortunately, disparities in maternal mortality mirror those of infant loss. When compared to their white counterparts, Black expectant mothers and birthing people are nearly twice as likely to have a miscarriage. Statistics on stillbirth are equally as dismal, with Black expectant mothers and birthing people experiencing stillbirths at twice the rate of their white counterparts.
In addition to the right to not have children, the right to have children is central to reproductive justice. This calls on us to explore the barriers that render many Black women and birthing people unable to sustain pregnancies. As we honor Pregnancy and Infant Loss Awareness Month, we must consider the contribution of structural factors to the realities plaguing one of our nation’s most vulnerable populations.
In a 2013 study that examined Black and white birthing people in the southeastern United States, researchers found that Black birthing people experienced miscarriage at higher rates than white birthing people. Between gestational weeks 10 and 20, Black birthing people’s miscarriage rates were twice that of their white counterparts. The most significant aspect of the study was its control for alcohol use, age, and early pregnancy ultrasounds—which were no different between the races. Rather than accept these statistics as a matter of inherent racialized differences, we must investigate what makes Black women particularly more susceptible.
While medical professionals and researchers have yet to discover the specific cause of a miscarriage, there is growing knowledge on risk factors. Additionally, the contribution of factors outside of the birthing person’s control to maternal and infant mortality is unequivocal. Among the risk factors are pre-existing medical conditions such as diabetes in the patient, tobacco use, obesity, and low socioeconomic status—categories where Black women and birthing people are disproportionately present. These underlying risk factors are largely entangled with institutional and structural racism.
Unfortunately, the circumstances surrounding life-altering conditions look dismal for Black women. Heart disease and stroke are among the leading killers of Black women, with high blood pressure and diabetes increasing risk. There is a growing amount of research on the framework of accumulated stress, which posits that chronic stress, including that associated with prolonged racism, both interpersonal and structural, has implications for health. Because of weathering, Black birthing people and women come to pregnancy with a series of experiences that heighten their risk for complications, including infant loss.
This is one among many manifestations of structural racism. According to various studies, commercial tobacco use varies by race and ethnicity in the United States. This is partially tied to the industry’s predatory targeting of Black Americans and other vulnerable populations. In addition, 90% of Black smokers use menthol cigarettes, which are particularly addictive. In other words, the covert racism imbued within advertising practices creates the conditions that make Black birthing people more likely to engage in smoking in the first place—and once they do engage, they are more likely to remain dependent. When we couple this with surrounding societal conditions that heighten stress, we create even deadlier circumstances for Black people across all spheres of health, including maternal and reproductive health.
Additionally, the risk factor of low socioeconomic status means that Native American and Black women are particularly vulnerable. With poverty often comes a slew of stressful life events, which can be particularly troubling for pregnant people without the resources to manage them. Additionally, economic disparities unveil our nation’s failure to provide continuous care—the only form of care that can catch and manage risk factors early on—to poor expectant mothers.
While the contribution of structural racism to health outcomes is widely known, there is still work to be done to understand its unique manifestations for Black birthing people. As we work to raise awareness of the prevalence of pregnancy loss and infant death, we should honor tragic losses with additional research on the causes.