Edited by McKoi Alaia Brown
The term reproductive rights encompasses so much in U.S. history, from the right to an abortion to the right to have children. All women, no matter their race or socioeconomic status, have these rights. Yet many women in Connecticut, despite living in one of the healthiest states in the nation, experience this human right being challenged by forces within and outside their control.
Many of these women give birth to children with low or very low birth weight (LBW). A LBW birth is defined as an infant weighing less than 2,500 grams (5 pounds, 8 ounces) at birth. The rate of LBW births is closely associated with infant mortality rate. If the children survive past their first year of life, then LBW puts them at a higher risk for certain diseases as they grow up, like cerebral palsy, deafness, blindness, epilepsy, learning disabilities and ADHD. The risk for disease increases the lower the child’s weight at birth.
The burden of LBW births is disproportionately suffered by Black and brown women all over the US, including in Connecticut. From 1990 to 2006, the CT Department of Public Health tracked the percentage of LBW births among Black, Latina, and White women. Consistently, Black women had the highest rates of LBW births, Latina women experienced the second highest, and White women the lowest. In this 16-year time period, while the racial disparity between Black and White women has narrowed, this is mostly due to the increasing rate of LBW births among White women. The number of LBW cases for women in general varied by location as well. In 2008, the city of Bridgeport had 53 more cases than expected, New Haven had 55, and Hartford had a staggering 83.
As previously mentioned, higher rates of LBW births is correlated with higher rates of fetal death. Out of 1000 births, from 1990 to 2006 in CT, White women had a rate of 1.40 fetal deaths, Latina women had a rate of 1.82, and Black women had a rate of 2.90. The rate of fetal death for Black mothers is more than two times higher than for White mothers. CT public health and policy interventions must address this pressing human rights issue.
There are many upstream factors (as opposed to downstream or immediate factors) that affect a woman’s likelihood of having a LBW birth. Some of these factors include: late or no prenatal care, maternal age at pregnancy, and chronic or pregnancy-induced hypertension. Travel even further upstream, there are factors like medical racism, housing segregation, community violence, lack of quality education and low income, which are all a result of the racism and violence built into and sustained in US institutions and systems. Consequently, even when access to care is provided to low-income communities, or when the mother of color is well-educated and of higher-income, the racial disparities in rates of LBW births still persist.
Many of these factors are social determinants of reproductive health. They can be organized along the lines of an obstetric life-course theory. At the top or beginning of a woman’s life, we find the disadvantaged environment that white supremacy and structural racism created and enforces. This encompasses housing segregation, poverty, mass incarceration, insufficiently-funded schools, and the strained relationship between the medical community and the Black and Latinx communities. Deprived environments lead to lack of access to quality care, higher rates of teen pregnancy, chronic hypertension, obesity, mental illness, and chronic stress. Finally, the accumulation of insults on the body and spirit that she has endured often results in preterm birth, LBW birth, and poor health outcomes for her child. Those outcomes will affect the children’s children, too, and the cycle continues.
In order to break this cycle, we need to stop treating poor health outcomes like they are primarily caused by “individual behaviors and attitudes”, and put much more focus on the structural determinants of health. We need to financially and mentally invest in community health centers, in anti-racism training for health care professionals and of course, in the communities themselves. We need to stop the criminalization of Black and brown people and the violence that the prison industrial complex does to families.
Black and brown mothers’ and their babies’ lives matter. Their health matters. Their flourishing matters. Listen up, Connecticut.
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(This blog piece is an abridged version of a longer academic paper on maternal health disparities in Connecticut. For the entire paper, references and relevant data, shoot us an email and we’ll send them your way.)
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