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AIrican-American Low Birth Weight Rates: An American Disparity

Statement of the Problem
For the majority oI mothers, the birth oI a child is considered a joyous culminating event
oI nine months anticipation. The ability to hold one`s child and marvel at the amazing result oI
hours, maybe days oI painIul labor is one oI a mother`s most precious liIe experiences. There is a
group oI mothers, however, whose joy is dampened by sorrow, concern and worry. Every year
13-17 oI all AIrican-American mothers` give birth to a low birth weight (LBW) baby. This
baby, instead oI being held and celebrated will be removed Irom their mother`s arms to a
Neonatal Intensive Care Unit (NICU) unit Ior special care.
AIrican-American women born and raised in the United States give birth to inIants with
LBW at 2.2 times the rate oI Euro-American women (USDH, 2010). In addition, the number oI
AIrican-American inIants born with LBW constitutes 33-38 oI all inIants born with LBW
(JaIIe & PerloII, 2000; USDA 2010). These high rates put low birth weight AIrican Americans
inIants at a disproportionate risk oI severe disability or even death Irom Iailure to thrive,
respitory distress syndrome and retinopathy. There are additional long term health consequences
Ior AIrican -Americans born with low birth weight that include asthma, cognitive delay, ADHD,
depression, academic diIIiculties, hypertension, heart disease and adult onset diabetes (Borders,
2007).
Despite extensive research into the causal Iactors Ior the higher AIrican-American LBW
rates it remains unexplained. Research and theories in the 1970-1990`s Iocused on biological,
social-economic causal Iactors. Current evaluation oI the evidence Ior biosocial causal Iactors,
however, by Mustillo et al. (2004) concluded that ' Extent research indicates that this . gap is
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only partially explained by major identiIied determinants oI the adverse birth outcomes such as
tobacco alcohol and drug use; use oI prenatal care; genetics; and social economic position". A
growing Iield oI literature supports the hypothesis that biological eIIects Irom chronic
psychological stress attributed to perceived racism is the previously unidentiIied Iactorial cause
in high AIrican -American LBW rates. Dominguez, T., Dunkel-Schetter, C., Glynn, L., Hobel, C.
& Sandman, C. (2008) contributed empirical evidence Ior this hypothesis through a study that
Iound AIrican-American women whom reported high levels oI racial discrimination had Iive
times the number oI LBW births than women who reported no racial discrimination. In addition,
the study Iound that the impact oI vicarious childhood racism experienced through the caretaker
was the only racial stress predictor Ior LBW that could be isolated Irom socio-economic status.
Presuming that a child`s sense oI security and emotional stability is inextricably linked to their
parents' well-being Irom an attachment perspective, Dominguez et al. (2008) concluded that
there is a critical need to examine the developmental context within which racism is experienced
Irom an attachment perspective.
This Iinding along with research Irom Amani et al (2008) that qualiIied vicarious childhood
experiences oI racism as '.particularly salient and to have especially enduring eIIects on
AIrican -American women, especially through their role as mothers, suggested to this author a
need to explore racism through the conceptual Iramework oI developmental theory. To this
author`s knowledge, no literature has explored the aspect oI how developmental theories may
intersect with childhood experiences oI vicarious racism when examining the problem oI high
LBW rates in the AIrican-American community. Nor have racial stress level outcomes Ior
AIrican- American women with LBW pregnancy outcomes been examined through a
developmental liIe course context.
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%heoretical Framework
Spencer`s Phenomenological Variant oI Ecological Systems Theory (PVEST) an identity-
Iocused, cultural ecological development liIe course model provides a culturally sensitive
conceptual Iramework to design a study involving AIrican-American liIe course development
(Lerner, Damon & Spencer, 2006). According to Lerner, Damon & Spencer (2006) PVEST`s
Iive components oI: (1.) net vulnerability level, (2.) net stress engagement, (3.) reactive coping
skills, (4.) emergent identities, (5.) liIe stage coping outcome, promote improved comprehension
oI how '. individuals experience racism and cultural socialization, and highlight developmental
processes through which they cultivate stable strategies Ior coping with these challenges (p.864).
Statement of Purpose
The purpose oI this study was to provide inIormation on relationships between
vicariously experienced childhood racism and racial stress level outcomes in AIrican-American
women with LBW pregnancy outcomes. SpeciIically, this author was interested in the
perceptions oI the mothers on the impact their childhood experiences had on developmental liIe
course events such as pregnancy. Through analysis oI inIormation gathered using critical
incident interviewing and results Irom the Index oI Race Relations modiIied to identiIy speciIic
developmental age ranges the Iollowing three research questions will be addressed:
1. Were there correlations between the ages at which AIrican-American mothers with LBW
pregnancies Iirst experienced vicarious racism, their perceptions oI the experience and
racial stress level outcomes?
The purpose oI the Iirst question is to determine iI certain developmental stages are more
sensitized to the impact oI racism. A correlation between early childhood developmental
stages, perceptions oI experiences and higher stress levels would support the hypothesis
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oI Dominguez (2008) that attachment issues during early childhood developmental stages
may lead to higher chronic racial stress outcomes as an adult.
2. Did AIrican-American mothers with LBW pregnancies who experienced vicarious
childhood racism perceive themselves as having experienced heighted racial stress levels
aIter learning oI their own pregnancy?
The purpose oI the second question is to explore iI racism experienced vicariously as a
child maybe a predictive Iactor in pregnancy related racial stress experienced by AIrican-
American women with LBW pregnancy outcomes as indicated by the Iindings oI
Dominguez et al. (2008) and Amani et al. (2009).
3. Would congruent themes emerge in regard to development, vicariously experienced
racism and racial stress Irom interviews and surveys conducted with AIrican American
women with LBW pregnancy outcomes?
The purpose oI the third question is to explore emerging themes to ascertain possible
protective Iactors, net stress, reactive coping skills, emergent identities and liIe stage
coping outcomes as presented in the PVEST Iramework.
Significance of Study
AIrican-American low birth weight rates have not been improved by decades oI programs
like Healthy People 2010 that Iocus on redressing structural and individual barriers as identiIied
through research on biosocial causal Iactors (JaIIee & PerloII, 2009). As a result it appears oI
importance to this author that social workers develop an understanding oI the connection
between racial stress and AIrican-American LBW rates in order to design, implement, evaluate
and advocate Ior successIul prevention and intervention programs. This study may contribute to
the social work proIession a richer understanding oI the impact oI vicarious racism experienced
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in childhood by AIrican-American women. The signiIicance oI this study resides in its ability to
provide a voice Ior AIrican-American mothers oI LBW inIants to contribute their own
perceptions regarding the developmental impacts oI vicariously experienced racism Iirsthand to
the Iield oI social work through narrative interviews. Social workers should, Iurthermore, Iind
the interviews relevant Ior the purposes oI developing social work proIessional core
competencies, including that oI 1.05 Cultural Competency and Social Diversity (NASW, 2011).
In addition, the author`s analysis oI emergent themes to ascertain protective Iactors, net stress,
coping skills, emergent identities and liIe stage coping outcomes may provide social workers
inIormation to assist in the development, implementation and evaluation oI developmentally
appropriate methods Ior empowerment and resilience when engaged in direct practice with this
client population. Finally, this study educates social workers to evaluate policy Ior its ability to
address the social problem oI disproportionate AIrican-American low birth weight rates through
a developmentally competent biopsychosocial perspective that acknowledges the role oI racism
as a stressor in the lives oI AIrican-American women.
efinition of %erms
This section contains terms in relation to this paper primarily taken Irom USDH 2010:
O A Low Birth Weight (LBW) inIant is an inIant born 5.8 lbs or under. The statistics
used in this paper were only Ior inIants born 5.8 lbs or under at Iull term and excluded
statistics Ior LBW rates due to pre-mature delivery and statistics Ior Extremely Low
Birth Weight InIants (ELBW) which is an inIant born under 2.3 lbs.
O Racial stress is used to reIer to race-related stress.


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ReIerences
Amani, N., & Dominguez, T., Hammond, W., Leu, J., SkaII,M., Egerter, S., Jones, C. &
Braveman,P. (2008). 'It`s the skin you`re in: AIrican-American women talk about their
experiences oI racism. An exploratory study to develop measures oI racism Ior birth
outcome studies. Maternal Child Health Journal, 10, 1-12. Retrieved 3/08/2011 Irom
EBSCOhost.
Borders, A., Grobman, W., Amsden, L., & Holl, L. (2007). Chronic stress and low birth weight
neonates in a low-income population oI women. %he American College of Obstetricians
and Gynecologists.109, 331-338. Retrieved 2/22/2011 Irom Google Scholar.
Dominguez, T., Dunkel-Schetter, C., Glynn, L., Hobel, C. & Sandman, C. (2008). Racial
diIIerences in birth outcomes: The role oI general pregnancy, and racism stress. Health
Psychology, 27 (2), 194-203. Retrieved 2/22/2011 Irom EBSCOhost.
JaIIee, K. D., & PerloII, J. D. (2003). An ecological analysis oI racial diIIerence in low birth
weight: Implications Ior maternal and child health social work. Health & Social Work,
28(1), 9. Retrieved 2/22/2011 Irom EBSCOhost.
Lerner, R. (Ed.). Damon,W., & Spencer, M. (2006). Phenomenology and ecological systems
theory: Development oI diverse groups. Handbook of Child Psychology (6th Ed.). Jol 1,
%heoretical Models of Human Development, (pp.829-893), NY,NY: Wiley. Retrieved
4/24 Irom GoogleE-books.
Mustillo, S. , Krieger, N., Gunderson, E., Sidney, S., McCreath, H., & KieIe, C., (2004) SelI-
reported experiences oI racial discrimination and blackwhite diIIerences in preterm and
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low-birth weight deliveries: The CARDIA study. American Journal of Public Health.
94(12):2125-2131. Retrieved 2/22/2011 Irom EBSCOhost.
National Association oI Social Workers. 2011. Code oI ethics. Retrieved 2/22/2011 Irom
http://www.naswdc.org/pubs/code/code.asp
United States Department oI Health. 2010 Child Health Report.Retrieved 2/20/2011 Irom
http://www.mchb.hrsa.gov/chusa10/hstat/hsi/pages/202lbw.htm