February 23, 2016

Despite Efforts, Black Women Deliver More Preterm Births

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Black women in Connecticut remain more likely than white or Hispanic women to deliver preterm babies, despite efforts to reduce the disparity, newly released data show.

In 2014, 12 percent of all births by black women in the state were preterm, meaning they occurred before 37 weeks gestation, according to data compiled by the Henry J. Kaiser Family Foundation. That compares with 9 percent of all births by white women and 10 percent of all births by Hispanic women that were preterm during the same year.

Connecticut reduced its preterm birth rate to 9.2 percent in 2014, but disparities persist.

Connecticut reduced its preterm birth rate to 9.2 percent in 2014, but disparities persist.

Nationally, the trend was similar with 13 percent of births by black women occurring preterm compared with 9 percent of white women’s births and 9 percent of Hispanic women’s births. In the vast majority of states, black women experience a higher rate of preterm births than whites or Hispanic women, according to the state-by-state comparison of the Kaiser data.

The trend has been evident for decades, said Dr. M. Natalie Achong, chair of the Health Equity Committee of the Connecticut State Medical Society.

“Black women, here in Connecticut and nationally, fare worse than white counterparts in just about every aspect of reproductive health,” said Achong, who is a fellow of the American Congress of Obstetrics and Gynecologists, an OB/GYN practicing in Waterbury and a faculty member in Yale School of Medicine’s OB/GYN department.

The racial differences persist even as Connecticut took steps to reduce overall preterm births and examine the causes of, and possible remedies for, the disparity.

In December 2012, Connecticut was one of four states chosen to take part in the National Governor’s Association Learning Network on Improving Birth Outcomes. As a result, the Connecticut Maternal and Child Health Coalition—formed by the state Department of Public Health, the March of Dimes Connecticut chapter and more than 100 members of stakeholder groups—developed the Connecticut Plan to Improve Birth Outcomes.

The plan identifies factors that contribute to preterm birth rate disparities and offers ways to address them, largely focused on increasing education efforts and access to health insurance.

And there have been signs of progress. In September, Connecticut received the March of Dimes Franklin Delano Roosevelt Prematurity Campaign Leadership Award and the March of Dimes Virginia Apgar Prematurity Campaign Leadership Award for reducing the state’s overall preterm birth rate to 9.2 percent in 2014, meeting a March of Dimes goal.

But the data show that “certain maternal risk factors” for preterm birth are more common among black women, Achong said. Obesity, chronic illnesses like diabetes, high blood pressure, smoking, being younger than 17 or older than 40, and using alcohol or drugs can all increase a woman’s risk of preterm delivery, she said.

For babies, being born prematurely can lead to long-term disabilities, both intellectual and developmental, according to advocacy group The March of Dimes. Preterm babies stand a better chance, health-wise, the later in pregnancy they are born.

Birth before 37 weeks gestation, according to the group, can lead to neurological disorders like cerebral palsy, autism, asthma and other lung problems, intestinal problems, infections such as pneumonia and meningitis, vision problems, hearing loss and dental problems.

In addition, preterm births can be emotionally and financially taxing for families, according to the National Center for Biotechnology Information, part of the National Institutes of Health.

Preterm labor and birth can be caused by various factors, according to the center, including: behavioral and psychosocial factors, environmental exposures, medical conditions, infertility treatments, biological factors and genetics. Often, multiple factors occur in combination, especially among lower-income women and racial and ethnic minorities, according to the center.

In addition to the toll they take on families, preterm births ultimately can be costly for states as preterm babies often require more social and behavioral services later in life, Achong said.

Work in Connecticut and beyond to understand the problem is helping but likely “will take years,” Achong said. Efforts to expand access to health insurance, and therefore prenatal care, for instance, could greatly improve health outcomes, she added.

But there are more deeply rooted problems to tackle too, she said, like poverty and other stressors.

“Health disparity is a mirror for societal disparities,” she said. Most babies born in Connecticut and the U.S. are healthy, she said, “but there are disparities that persist over decades, and certainly persist in our state.”

Kaiser’s state profiles on women’s health issues include statistics from the U.S. Centers for Disease Control and Prevention.

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