Page 3 of 6
- Photo by Drew Costley
- Kiko Malin said it's important to consider the "social factors that might be driving" the disparities between racial groups apparent in the health department's data.
She worries, too, about the babies. "Extremely premature infants often will have disabilities in their life — developmental, hearing, vision, speech," she said. These struggles, "coupled with a challenging socioeconomic situation in the family, can lead to a very challenging life for both the growing child and its parents."
Dr. Bryant said it would be very difficult to point to a specific cause for any particular preterm birth because there are so many factors involved in each case. There are, however, things that make preterm birth statistically more likely: if the mother has an infection, for instance, or if she smokes.
Other risk factors, according to Bryant, are "maternal diseases, fetal abnormalities, multiple gestations [carrying twins or triplets], and uterine abnormalities." All of these things, and more, she said, "are statistically associated with an increased risk of preterm birth, but are not necessarily" the cause.
Christina "Kiko" Malin, family health services director at the Alameda County Public Health Department, said it's important to consider the "social factors that might be driving" the disparities between racial groups apparent in the health department's data.
Malin said African Americans are more likely to live in low-income neighborhoods. She also pointed to the issue of "fragmentation of care," meaning women not getting continuous care because something changes with their provider or their insurance, or they lose their coverage altogether. This is most likely to happen to a low-income family, in which the parents may not have steady insurance through an employer. In these cases, a woman might not get the regular care she needs, or her providers might not be able to communicate effectively about her care.
Some women who are "increasingly marginalized" and "very stressed" may have a hard time keeping appointments, Malin said. "For folks who have to choose between putting food on the table or getting kids to school, a medical appointment might not seem as high of a priority, so the care is not as coordinated, as thorough, as it probably could be."
For low-income women, part of the problem starts long before pregnancy. "We spend a ton of money on medical care and relatively less on social programs," said Bryant.
The poor health outcomes for women of color, Bryant said, are partly due to what she called "the social determinants of health" or the hardships they suffer outside of the medical system, and which might hinder them from getting the care they need. "Do they have transportation issues? Do they have issues with childcare? Do they have food and security? Do they have housing issues? Do they have issues with the legal system?" Bryant said. "We care for our patients for a small slice of their life, and so it's a little crazy that we think everyone's health outcomes are so dependent on the care that they receive, when really so much of their health outcomes have to do with the milieu in which they live and work."
These struggles aren't unique to African Americans, but, Bryant said, they disproportionately affect her patients of color, who bring all of those issues "with them in terms of their health and healthcare."
According to the Child Health USA 2013 report, produced by the U.S. Health Resources & Services Administration (HRSA), nearly 20 percent of mothers between 2009 and 2010 reporting from 30 U.S. states weren't able to access prenatal care as early in their pregnancies as they wanted to. Nearly 23 percent of non-Hispanic Black mothers reported delayed access to care, as compared with 14.7 percent of white mothers.
"Common barriers to getting prenatal care as early as desired [or at all]," according to the report, include a lack of money or insurance to pay for visits, issues with transportation, and "not knowing that one is pregnant."
While African Americans face the widest gap in infant health outcomes, other groups in Alameda County face similar disparities. For instance, from 2012 to 2014, while the Hispanic and Latino population experienced the lowest percentage of premature births, they represented more than a quarter of the infant deaths in that period.
Angelica Foreman, a Berkeley resident who identifies as Latina and whose husband is African American, went into premature labor with two of her three children. She went into labor with her first son when she was around 7 months pregnant, and her doctor placed her on bed rest. She carried him to term and was able to "deliver naturally," she said.
Her next pregnancy was more eventful. Foreman went into labor at 30 weeks and was immediately admitted to Kaiser Oakland. Her medical providers wanted her to stay so they could observe her, and so that she would be there should her labor progress. When she went into active labor in her 32nd week, her baby's blood pressure dipped. Before long, her blood pressure was dropping, too. When her son's heartbeat was no longer registering on the monitor, hospital staff told Foreman they had to deliver him.
"I was flooded by, like, 15 doctors," Foreman recalled. "They came in the room, they lifted me up, put me on the gurney, and they were, like, shooting me down the hallway so fast."
Her son was delivered via C-section. Foreman said she had adverse reactions to medications during the surgery and an infection afterward. Much of the experience was "terrifying," she remembered.