Race matters in health outcomes

By Jeremy Rhodes

Throughout our nation, and throughout its history, we have seen drastic health disparities in different racial and ethnic groups. Some of the most severe disparities surround maternal and infant health.

The graph below shows the percentage of McLennan County newborns who are classified as having either a “low” birthweight or a “very low” birthweight, along with comparisons to Texas and to our peer counties. In 2020, 8.7% of babies born in McLennan County had a low or very low birthweight, and this percentage has seen a modest increase in the last 10 years. McLennan County’s most recent numbers are worse than our state or peer county averages.

The next chart shows these same figures broken down by the three largest racial/ethnic groups in the county. For this chart, the data only go up to 2019, as Texas has not released the 2020 data broken down by race/ethnicity. At 6.6%, our county’s White residents have fewer low-birthweight babies than the county average in 2019. Our Hispanic residents, at 8.7%, are close to the county level of 9.1%. However, an astonishing 16.4% of babies born to Black mothers are born with low or very low birthweight. This is more than 2 1/2 times the percentage for White residents of McLennan County! Our county is not exceptional; you would find a similarly high incidence of low-birthweight babies born to Black mothers throughout our state and nation.

The percentage of babies born with low birthweight is hardly the only example of Black mothers and their babies suffering from disproportionately dangerous healthcare risks and outcomes. For example, Black mothers are much more likely than other mothers to die in childbirth, to suffer other pregnancy-related deaths, to give birth pre-term, and to lose their babies in childbirth.

Why are Black mothers so exceptionally likely to give birth to babies with low and very low birthweight? Several factors are at play here, but experts generally agree on a few causes:

  • Women of color are more likely to lack health insurance, and consequently, they are more likely to lack the pregnancy-related care that can prevent many complications.

  • Black women are more likely to lack resources associated with what are called social determinants of health. For example, Black mothers are less likely to have stable housing, high-paying jobs, reliable transportation, and to receive high-quality education.

  • Women of color, especially Black women, commonly suffer from racism and discrimination, which can play a major role in health outcomes. This racism can have many tangible effects on health outcomes, such as chronic stress, or the tendency for health providers to minimize or dismiss the claims of Black women. One recent study of hospital births in Florida found that there were significant improvements in mortality for Black newborns who were cared for by Black physicians, pointing to the importance of culturally competent care.

Jeremy Rhodes, Ph.D., is director of research and community impact with Prosper Waco.