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Open AccessArticle

“Look at the Whole Me”: A Mixed-Methods Examination of Black Infant Mortality in the US through Women’s Lived Experiences and Community Context

Mary Amelia Women’s Community Health Education Center, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Suite 2210, New Orleans, LA 70112, USA
National Birth Equity Collaborative, 4747 Earhart Blvd, Suite I, New Orleans, LA 70125, USA
Institute of Women and Ethnic Studies, 935 Gravier St., Suite 1140, New Orleans, LA 70112, USA
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2017, 14(7), 727;
Received: 17 April 2017 / Revised: 20 June 2017 / Accepted: 30 June 2017 / Published: 5 July 2017
(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)
In the US, the non-Hispanic Black infant mortality rate exceeds the rate among non-Hispanic Whites by more than two-fold. To explore factors underlying this persistent disparity, we employed a mixed methods approach with concurrent quantitative and qualitative data collection and analysis. Eighteen women participated in interviews about their experience of infant loss. Several common themes emerged across interviews, grouped by domain: individual experiences (trauma, grieving and counseling; criminalization); negative interactions with healthcare providers and the healthcare system; and broader contextual factors. Concurrently, we estimated the Black infant mortality rate (deaths per 1000 live births) using linked live birth-infant death records from 2010 to 2013 in every metropolitan statistical area in the US. Poisson regression examined how contextual indicators of population health, socioeconomic conditions of the Black population, and features of the communities in which they live were associated with Black infant mortality and inequity in Black–White infant mortality rates across 100 metropolitan statistical areas with the highest Black infant mortality rates. We used principal components analysis to create a Birth Equity Index in order to examine the collective impact of contextual indicators on Black infant mortality and racial inequity in mortality rates. The association between the Index and Black infant mortality was stronger than any single indicator alone: in metropolitan areas with the worst social, economic, and environmental conditions, Black infant mortality rates were on average 1.24 times higher than rates in areas where conditions were better (95% CI = 1.16, 1.32). The experiences of Black women in their homes, neighborhoods, and health care centers and the contexts in which they live may individually and collectively contribute to persistent racial inequity in infant mortality. View Full-Text
Keywords: infant mortality; race; health inequity; social determinants infant mortality; race; health inequity; social determinants
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Wallace, M.E.; Green, C.; Richardson, L.; Theall, K.; Crear-Perry, J. “Look at the Whole Me”: A Mixed-Methods Examination of Black Infant Mortality in the US through Women’s Lived Experiences and Community Context. Int. J. Environ. Res. Public Health 2017, 14, 727.

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