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While medicine has advanced over the last few decades, racial disparities remain throughout healthcare, particularly among infant and childbirth outcomes. For some populations, rates of infant mortality are almost double the national average.
As caregivers and health providers, nurses must provide equitable care for all patients. By understanding why these disparities occur, nurses can take steps to improve and advocate for equity in patient care.
This guide includes a breakdown of infant mortality rates, along with best practices nurses can use to address these gaps.
Facts About the Infant Mortality Gap
The rate of infant mortality among Black patients is 2.3 times that of white patients.
14.4% of Black infant births are preterm compared to 9.3% among white births.
Black women are more than twice as likely to receive late or no prenatal care when compared to white women.
Infant mortality rates are highest among southern states. The states with the highest rates are Mississippi, Louisiana, and Alabama.
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The State of Infant Mortality
Over the last few years, the birth rate within the U.S. has reached an all-time low. According to the National Vital Statistics System (NVSS), there were approximately 3.6 million births in 2020, which is a 4% decrease compared to 2019. In fact, the birth rate has declined for the last six years, with a 2% average yearly decrease since 2014.
With the decline in birth rates, there has also been a decrease in infant mortality rates. There were over 800 less infant deaths from 2017-2018, a 4% decrease. Since 1995, the infant mortality rate has also decreased, with a 17% reduction since 2005.
Disparities in Infant Mortality
Despite the steady decline in infant mortality rates, significant disparities among various racial groups still exist. According to the NVSS, the rate of infant mortality among Black patients is 10.75 deaths per 1,000 live births, more than double the rate among white patients (4.63) and three times the rate among patients of Asian descent (2.67).
Not only do Black infants suffer higher mortality rates, but so do women, with maternal mortality rates at 37.3% compared to white women at 14.9% and Hispanic women at 11.8%. Overall, these percentages indicate a correlation between race and infant/maternal mortality rates.
Infant Mortality Rate, by Race
Disparities in Birth Outcomes
Disparities also affect a variety of birth outcomes which differ among racial groups. These outcomes include preterm births, low birth weight, and/or late or no prenatal care.
While white infants are the least impacted, Black infants have the highest rate of preterm births and low birth weights. Native Hawaiian or other Pacific Islanders have the highest rate for late or no prenatal care.
|Race||Preterm Births||Low Birth Weight||Late or No Prenatal Care|
|American Indian or Alaska Native||11.6%||8%||13%|
|Native Hawaiian or Other Pacific Islander||11.2%||7.8%||20.5%|
According to the Office of Disease Prevention and Health Promotion, birth outcomes can be impacted by a variety of personal, social, and economic issues. An individual's physical surroundings, literacy levels, discrimination/racism, and legislative policies can all play a role. These factors can have significant influences on one's access to:
Affordable/reliable public transportation
Culturally sensitive healthcare providers
Clean water/unpolluted air
What Can Nurses Do?
To help reduce racial disparities, nurses can practice cultural competence in nursing, advocate for a more diverse nursing staff, support improving access to care, and/or pursue additional training and education in perinatal nursing.
Practice Cultural Competence
Cultural nuances can impact the standard of care for pregnancy and childbirth. To help decrease the infant mortality rate, nurses can develop their understanding of people from various cultures to help with more positive and beneficial interactions.
Nurses must recognize the patients' needs and communicate with them in a culturally appropriate way that makes them feel comfortable. Below are four important cultural aspects nurses should consider:
1. Family Dynamics
A patient's cultural background can impact matters on gender and sex. For instance, some cultures view men as the head of the household, while others differ with their view on pregnancy and birth.
A culturally competent provider maintains an open mind and can meet the needs of patients from a variety of backgrounds.
2. Provider Gender
Some patients feel more comfortable when their healthcare provider is a certain gender, especially for childbirth. If a provider of the preferred gender cannot meet a patient's care, nurses can help set the patient at ease.
3. Religious and Cultural Beliefs
Some cultures and religions do not accept certain medical procedures. Patients might seek culturally traditional remedies and treatments instead.
It is important for nurses not only to recognize those beliefs, but also to explain why the patient may benefit from various courses of action that may not align with their traditions.
4. Communication and Linguistic Barriers
Because of cultural beliefs, patients may find it unnecessary or impolite to ask questions about their treatment. Nurses must ask the right questions to ensure patients understand their treatment.
Advocate for More Nurses and Midwives of Color
Advocating for more racially and culturally diverse nurses and midwives can help address the disparity in infant mortality rates. According to the U.S. Department of Health and Human Services, women who can connect culturally or racially to a midwife often find they receive better interpersonal care.
The American Midwifery Certification Board states 85% of certified nurse midwives (CNMs)/certified midwives (CMs) are white, while Black CNMs and CMs make up only 7% of the total. Overall, less than 15% of CNMs/CMs are people of color.
Increasing cultural and racial representation among midwives can help diminish the infant mortality rates and provide increased access to care for people of color.
Support Improved Access to Care
By increasing access to care, the health services industry can help lower infant mortality rates. Providing women with improved access can positively affect their pregnancy and childbirth experiences.
Areas with a higher number of CNMs/CMs have significantly higher birth outcomes. These outcomes include successful vaginal deliveries after cesarean sections and lower rates of preterm births, low birth weight, and neonatal death.
However, according to the March of Dimes, over five million women live in "maternity care deserts," areas where access to maternity healthcare is limited or nonexistent. These areas impact more diverse communities. Women who identify as Black, Hispanic, or Asian Pacific Islander are less likely to be attended by a midwife compared to white and Native American women.
Unfortunately, there are many barriers within the United States that reduce the availability of high-quality care, especially in rural and underserved communities. For example, North Carolina nurse midwives must practice under a supervisory agreement with a doctor, according to the American College of Nurse-Midwives. These types of regulations can reduce accessibility.
To improve access to care, various legislative policies seek to increase accessibility. Overall, beneficial changes can be made by funding midwifery education programs and diversifying the maternity care workforce. Other changes include enhancing public health programs and eliminating disparities within maternal healthcare access.
Pursue Perinatal Nursing Education and Training
Nurses can help reduce the disparities in infant mortality by pursuing perinatal education and training. There are various resources nurses can use to complete continuing nursing education units on pre and postdelivery care.
March of Dimes provides the following resources:
- Implicit Bias Training: offers strategies to limit racial bias in maternity care
- Genetics Education: details screening methods for certain birth defects
- Prenatal Care Resource Guide: identifies resources to increase access to prenatal care
- Safer Cultures Toolkit: helps healthcare professionals build a culture that promotes patient safety
The Association of Women's Health, Obstetric and Neonatal Nurses also provides nurses with information that can help improve prenatal care:
- SBAR for Inclusive and Equitable Patient Care: The Situation Background Assessment Recommendations (SBAR) technique helps nurses address racial and social inequities when interacting with their patients. The goal is to develop a relationship of respect between patient and caregiver.
While infant mortality rates have decreased over the last decade with the advancement of technology and medical techniques, a disparity still exists among different races. Nurses can play a large part in closing the gap on racial inequities.
To accomplish this goal, nurses can focus on developing their cultural competence, advocate for a more diverse workforce, campaign for improved care, and educate themselves on the best ways to interact with their patients. By taking even one small step toward change, nurses have the power to diminish these disparities for the benefit of all patients.
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