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Article

Women’s Perspectives on Black Infant Mortality in the United States

by
Cecilia S. Obeng
1,*,
Tyler M. Nolting
2,
Frederica Jackson
1,
Barnabas Obeng-Gyasi
3,
Dakota Brandenburg
1,
Kourtney Byrd
1 and
Emmanuel Obeng-Gyasi
4,5
1
Department of Applied Health Sciences, School of Public Health, Indiana University, Bloomington, IN 47405, USA
2
Department of Health and Human Performance, Austin Peay State University, Clarksville, TN 37044, USA
3
School of Medicine, Indiana University, Indianapolis, IN 46202, USA
4
Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
5
Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
*
Author to whom correspondence should be addressed.
Women 2024, 4(4), 514-528; https://doi.org/10.3390/women4040038
Submission received: 20 October 2024 / Revised: 16 November 2024 / Accepted: 2 December 2024 / Published: 6 December 2024
Browse Figures
Versions Notes

Abstract

:
Although global neonatal mortality rates have significantly decreased, Black infant mortality in the US continues to be a major issue. This study identifies, assesses, and illustrates women’s views on infant mortality and the resources needed to address the problem. Women of diverse demographic backgrounds were recruited via purposive sampling, with 91 participating. Seventy percent of participants were aged 18 to 39 (n = 64), and forty three percent lived in Indiana (n = 39). Access to care, sleeping issues, supporting breastfeeding, awareness, affordability challenges, healthcare provider factors, and creating sustainable programs and policies to address infant mortality emerged as prominent themes in the data. This study highlights the importance of cultural congruency in addressing maternal and child health issues, emphasizing the need for stakeholder involvement to ensure interventions are acceptable, practical, and sustainable.

1. Introduction

Infant mortality, concerning the period before 12 months of life, is a critical indicator of a society’s overall health and survival [1,2]. Despite the US having the highest healthcare spending per capita of all countries [3,4] it ranks 55th out of 227 countries and territories for infant mortality rate (IMR) at 5.1 deaths per 1000 live births [5] and 33rd out of the 38 Organisation for Economic Co-operation and Development (OECD) countries [6].
Currently, in the US the IMR of the Black population (10.52) is nearly 2.4 and 3.1 times greater than White (4.42) and Asian (3.4) populations, respectively [7]. Although IMRs have declined for all major racial and ethnic groups in the US for more than the last century, these declines have been slower for the Black population, resulting in increased racial disparities [8]. These disparities remain even when considering education levels, where the IMR for infants born to Black women across all levels of education is higher compared to White women with a high school education or less [9].
Black infant mortality is further impacted by the intersection of racism, sexism, unsupportive reproductive healthcare policies, and other structural inequalities, which have more deleterious effects on Black maternal health outcomes than their White counterparts, such as accelerated aging, which increases maternal and infant morbidity and mortality [10]. Intersectionality also explains increased stress and worse mental health outcomes, as seen in Black perinatal women living in the South [11]. The top five leading causes of Black infant mortality in the US are low birthweight, congenital malformations, sudden infant death syndrome (SIDS), accidental/unintentional injuries, and maternal complications [12]. Some additional risk factors related to the mothers for increased IMR are obesity, smoking, not receiving Women, Infants, and Children (WIC) benefits, receiving late or no postnatal care, and having Medicaid compared to private insurance [7].
The factors mentioned above are well documented as major contributors to the higher Black IMR in the United States. However, structural and systemic racism add an additional burden and serve as significant contributing factors for many Black women. For instance, Black women who report emotional distress due to experiences of racism in the year prior to delivery are more likely to experience preterm births [13]. Postnatally, premature Black infants exposed to structural racism have worse health outcomes, such as more frequent doctor’s visits, hospital readmissions, and death upon discharge from hospitalization [14]. Considering socioeconomic status and geographic location, racial disparities and inequities in education levels, occupational status, and homeownership significantly impact Black IMRs in small, medium, and large metropolitan areas [15].
The experiences of racism, discrimination, segregation, and lack of quality care given—“weathering”—certainly influence maternal and infant health [16]. Infant mortality risk is highest among dual Black parents [17] and older Black women who give birth [18]. Black infant health and mortality are significantly influenced by structural racism and implicit bias, which manifest in factors such as lower-quality neonatal intensive care unit (NICU) care, residential segregation, and increased adverse birthing outcomes due to environmental and healthcare accessibility challenges [19]. Thus, the weathering framework helps explain Black IMRs by understanding racism’s stressful impact as a determinant of Black maternal health outcomes [20]. Other factors influencing infant mortality in the US include air pollution [21] and rurality in relation to geographic limitations regarding health services [22,23,24].
Research must seek to listen to, assess, and understand the experiences of Black mothers to decrease IMR racial disparities and improve overall health outcomes for the Black population. One study analyzed a panel of providers and community members about their birthing experiences, with one participant saying, “No matter how early you went to see your doctor, even though that’s something you need to do, no matter how on top of things you were, you could still come out dead, regardless of age, social economic status. It is because you are Black in America” [25]. To eliminate racial disparities for IMRs in the US, the nation must involve Black mothers and birthing people in shaping these solutions by first listening to and believing their experiences [26,27].

Aim

This study aimed to identify, evaluate, and articulate women’s views on infant morbidity and mortality in the US and the kind of resources the women thought could help address such issues.

2. Results

The first part of the results reports participant(s) demographics, including age, geographic location (state of residence), parental status, and race (Table 1). Illustrations of participant demographics are provided below (Figure 1, Figure 2, Figure 3 and Figure 4).
Next, we report the qualitative findings of this study. Below is a presentation and elucidation of the themes identified in this study.

2.1. Qualitative Analysis of Results

The following themes came from our study data: access to care (Section 2.1.1); sleeping issues (Section 2.1.2); supporting breastfeeding (Section 2.1.3); awareness (Section 2.1.4); affordability challenges and healthcare provider factors (Section 2.1.5); and creating sustainable programs and policies to address infant mortality (Section 2.1.6). Each of the above-identified themes is described in further detail below.

2.1.1. Access to Care

Participants in this group emphasized issues and strategies related to healthcare accessibility, economic challenges (poverty), the associated unaffordability of healthcare costs (a situation that had brought health disparities), systemic racism, and unavailability of adequate care due to obstetric (OB) deserts. The factors mentioned above, the participants noted, had contributed to high infant mortality (IM) in their communities. For example, two Indiana mothers noted
“Access to equitable healthcare; OB deserts.”
White, 30 y/o, Indiana.
“Lack of access to prenatal care, systemic racism, bias in the healthcare system.”
White, 47 y/o, Indiana.
Study participants recommended increased access to in-home care during the postpartum period, making healthcare affordable, developing legislation to address IM, eliminating healthcare access barriers, and increasing support for new mothers for at least the first three months after birth. Participants also indicated providing adequate housing and maternity/parental leave for new parents.
Participants advocated for supporting Black women by providing a trusting and comprehensive health program to boost the health of the infants of this population. Some participants favored creating free healthcare clinics that provide prenatal care for pregnant women. Three excerpts are cited for exemplification and explication.
“More support for mothers post-birth.”
Black, 19 y/o, Florida.
“Create more free, healthcare clinics for prenatal care and pregnancy for women.”
White, 50 y/o, Indiana.
“Legislation to address IM and accessibility to equitable healthcare.”
White, 30 y/o, Indiana.

2.1.2. Sleeping Issues

Several participants cited unsafe sleep conditions, which sometimes resulted in the suffocation of babies, as one of the causes of infant deaths. Parents’ poor understanding of the risks of unsafe sleeping arrangements for newborns could contribute to infant deaths. Complications during birth and premature factors were also noted as contributing factors to sudden unexplained infant deaths during sleep. Two Indiana women noted
“Unintentional suffocation in unsafe sleep environments.”
Biracial or Multiracial, 46 y/o, Indiana.
“SIDS, congenital defects, preterm birth.”
White, 23 y/o, Indiana.
An overwhelming number of respondents suggested educating mothers and birthing people about the significance of a safe sleep environment for babies and what constitutes optimal sleeping care during pregnancy and postpartum. Three excerpts are cited for exemplification and explication.
“Follow the ABCs of safe sleep: Alone, Back, Crib.”
White, 24 y/o, Indiana.
“Educating Black women more and providing more resources for postpartum professional and childcare support. Especially for low-income and working-class Black women and families.”
Black, 31 y/o, New Jersey.
“Education on safe sleep and explaining that even if it generational to sleep with your infant, it is a risk every time that the baby goes to sleep.”
White, 33 y/o, Indiana.

2.1.3. Supporting Breastfeeding

Participants recommended increased support services for prenatal and postnatal breastfeeding care. They called on healthcare employees and community members to encourage mothers to find breastfeeding support, receive counseling on the importance of breastfeeding, and try to breastfeed for as long as possible. Study participants also recommended encouraging mothers to read the current information on breastfeeding and to focus on using breastmilk instead of infant formula to avoid malnutrition in infants. Some participants recommended encouraging mothers to breastfeed, as lack of breastfeeding could lead to infant morbidity and mortality. One Indiana and one Mississippi woman opined
“Breastfeed and find breastfeeding support to try to reduce risk for premature death.”
White, 47 y/o, Indiana.
“Try to breastfeed for as long as possible and read up on the information that’s currently available.”
Black, 29 y/o, Mississippi.

2.1.4. Awareness

The participants expressed a lack of awareness or minimal awareness about pregnancy and postpartum, a lack of infant care information provided to parents, and a lack of infant health training for parents. Participants recognized the deleterious impacts on infant health created by these deficiencies in awareness. Additionally, participants expressed a need for postnatal support when caring for themselves and their infant. They therefore advocated for making resources and support systems available to mothers.
Participants also identified that infant mortality rates increase when mothers and their infants do not have access to resources and strong financial support. They further noted that the pressure on mothers to return to work and the lack of culturally competent support networks also contribute to the increased infant mortality rates in their communities. Excerpts from two participants are cited below for exemplification and explication.
“Lack of awareness and emphasis on protecting and educating mothers.”
White, 28 y/o, Indiana.
“Education of mothers about pregnancy and expectations.”
Black, 43 y/o, Indiana.

2.1.5. Affordability Challenges and Healthcare Provider Factors

Another common theme called for more affordable healthcare. They believed that making healthcare affordable would increase accessibility and address health disparities affecting infant mortality. Closely associated with affordability are provider factors such as health professionals’ negligence of Black mothers’ health concerns and provider implicit bias, which, according to the participants, have the potential to cause infant mortality. Specifically, the chiasmas and interlacing effects of affordability and bias against Black mothers lead to negligence of their maternal and infant needs, and these subsequently negatively affect their well-being and survivability. The following extracts are cited in support of the assertions mentioned above.
A 24-year-old respondent from New York wrote
“Lack of urgency in assisting mothers due to implicit bias.”
Black, 24 y/o, New York.
Another respondent, a 31-year-old from Texas, noted
“Negligence of [sick ‘by’] medical staff.”
Black, 3 y/o, Texas.
A thirty-five-year-old respondent from California wrote
“Access to quality healthcare, awareness and education of resources, change socioeconomic status, change affordability.”
Black, 35 y/o, California.
The final theme, creating sustainable programs and policies to tackle infant mortality among Blacks, is exemplified below.

2.1.6. Creating Sustainable Programs and Policies to Address Infant Mortality

Participants advocated for trusting and inclusive health programs to support Black/African women and their infants with a view to boosting their health outcomes. The participants also called for advocacy in making and/or ensuring that resources are made available to Black/African American families (mothers and their infants). Three excerpts are cited below to exemplify and help explicate the above assertions.
In the first excerpt, a 28-year-old Indiana resident recorded
“Programs or services to address the environments these infants live in as well as increased education for not only parents but the support system/family members of the infant.”
Black, 28 y/o, Indiana.
Another Indiana resident, a forty-seven-year-old, in the excerpt below wrote:
“Policies, training, advocacy.”
White, 47 y/o, Indiana.
A Tennessee resident noted
“Advocate, advocate. Speak up. Listen to your intuition and ask about resources. Demand the best for your baby starting at conception until adulthood.”
Black, 45 y/o, Tennessee.

3. Discussion

Infant mortality in the US is a problem, especially among Black children, since it disproportionately affects them. To move from the present skyrocketing numbers of infants dying in the US, a study was designed using the transtheoretical model (TTM), also known as the stages of change model [28], to help make changes in infant deaths. Study participants indicated making changes in healthcare access, addressing sudden infant death syndrome (SIDS) and other sleeping-related issues, increasing breastfeeding support, improving affordability and healthcare provider factors, as well as creating programs and policies that are sustainable and interact with each other. Therefore, in addressing maternal and infant mortality, all the above-mentioned factors must be taken into consideration.
As observed in the Access to Care Section, respondents mentioned healthcare access and equity concerns, demonstrating disparities in healthcare availability and distribution based on race, bias, and affordability, resulting in worse Black infant health outcomes. These findings reflect studies by Yearby [29] and Copeland [30] regarding disparities in healthcare access and its impact on the health status among Black mothers and their children. The findings also point to the need to educate Black mothers and other stakeholders on the extent of the problem mentioned above and the urgency in coming up with mitigating strategies to avoid an even greater healthcare problem among Black mothers and their infants.
Participants’ narratives on sleeping issues point to the need to provide health education to Black mothers regarding SIDS and how to mitigate and/or avoid it. Also of importance is the need to provide resources, including professional maternal and infant care support, to Black mothers to help mitigate SIDS in their communities. The recommendation by the participants regarding sleep safety align with and bolster studies carried out by Ajao et al. [31] and Willinger et al. [32], which call for increased educational support to Black mothers with disproportionate rates of SIDS. Also important is the need to consider cultural awareness in the care of mothers and infants, especially when safe sleep and breastfeeding habits are being examined. A study by Williams and Mohammed [33] revealed that systemic racism results in disparities in health education and resources, leading to higher rates of SIDS among Black infants. This stresses the importance of tailored educational interventions for Black mothers.
Also of healthcare importance is the discovery from the recommendations provided by the participants on sleep safety and the need to educate Black mothers at risk of losing their infants due to SIDS, especially as it relates to the dangers of sticking with ‘traditions’ on infant sleep. As noted, a change in parental perceptions and practices regarding infant sleeping arrangements will help lower SIDS. Indeed, as noted in the previous section, Ajao et al. [31] and Willinger et al.’s [32] identification of SIDS among minority populations and the above authors’ call for the need to educate such groups about SIDS causes and dangers will help avert more infant deaths among minority populations.
Regarding supporting breastfeeding, participants’ support for breastfeeding, given its nutritional value and healthful benefits, supports the findings and recommendations by Brahm and Valdés [34] and Kornides and Kitsantas [35]. Research by the above-mentioned authors calls for interventions to help bolster prenatal breastfeeding education. The authors also ask clinicians and other stakeholders to offer more breastfeeding support.
The participants acknowledged low breastfeeding rates among the Black population and expressed support for increasing these rates to enhance infant and child health. Most importantly, knowledge of the high content of nutrients in breast milk will potentially encourage its use among Black populations and result in improved infant health outcomes. The current study’s findings also reinforce those of Obeng et al. [36], Brahm and Valdés [34], and Kornides and Kitsantas [35] regarding requests for stakeholders to develop interventions to improve Black mothers’ knowledge of breastfeeding benefits, thereby creating awareness about infant-breastfeeding to decrease Black infant morbidity and mortality. Note also that the findings in this current study bolster those of Gribble et al. [37], Lupton [38], and Lauritzen [39] on the importance of parental education and the protection of mothers and their children and the creation of healthcare awareness among mothers to ensure their optimal health.
There is no doubt that the respondents were aware of and understood issues of healthcare affordability and the associated implicit bias that leads to poor maternal and child healthcare access and outcomes for Black mothers and their infants. The call by the research participants for better maternal and infant care via the provision of awareness, increased pecuniary support to aid affordability, and provider education to mitigate various forms of bias against Black mothers is in the right direction. It supports the findings by Glover [40], Saluja and Bryant [41], and Pathak [42], which discovered physician and healthcare system bias as contributing to bad health outcomes for Black women and their infants.
An important issue that occurs in some excerpts and others scrutinized in the data is the need for advocacy to ensure equitable healthcare resource allocation, healthcare access by Black mothers and their infants, policies, and programs aimed at enhancing accessibility and its associated and resultant optimal health.
It is paramount that healthcare practice cultural congruence to decrease Black infant mortality rate disparities. Implicit bias among healthcare providers significantly affects vulnerable populations and their healthcare quality [43,44]. Research shows that unconscious biases can result in unequal treatment and increase health inequities [45,46]. Black mothers encounter considerable obstacles to receiving quality care due to systemic racism in healthcare systems [43,47,48,49,50,51,52,53].
Cultural congruence is intertwined with factors such as access to healthcare and affordability. Addressing implicit bias within the healthcare system requires more than just individual provider training; it necessitates the creation of a culturally congruent healthcare environment that acknowledges the unique needs of Black families, particularly those of Black mothers [43,47,48,50,51,54,55,56,57,58]. By targeting both the symptoms of health disparities and the underlying biases and systemic barriers, we can enhance health outcomes and rebuild trust within historically marginalized communities [38,39,43,44].
Also mentioned is the need for education for mothers and healthcare providers to ensure improved healthcare for Black mothers and their children. An important observation of all the above themes is how they interlace and blend. Thus, we observe an intertwining of issues related to affordability, healthcare access, advocacy, awareness, parental and health provider education, and program creation to support breastfeeding or deal with sleeping issues (especially SIDS). It is impossible to mention one without another, with each being felt or seen as an essential facet of the others. This points to attention being paid to them holistically to ensure an efficacious healthcare delivery.

3.1. Limitations

This study adhered to ethical research standards and employed a purposive sampling approach to ensure diverse representation across demographics, mitigating selection bias. However, the participant pool included a significant proportion of Indiana residents (48.4%), which may limit the broad applicability of the findings. Future research should aim to recruit participants from a wide range of locations to enhance generalizability and provide a more representative view of the U.S. context.
While self-reported data was a limitation [38], thematic coding and group validation processes helped enhance the reliability and depth of the qualitative findings. Nonetheless, self-reported data introduces potential social desirability and recall biases, which may have influenced the responses. Additionally, the sample size, while sufficient to reach data saturation, may not fully capture the diversity of experiences across all demographic groups.
The recruitment method, which included a snowballing approach where known participants invited others, did not yield as many participants as anticipated and may have introduced recruitment bias, as participants were likely to recruit friends and family members. This limitation highlights the need for future studies to employ more diverse and targeted recruitment strategies to reduce bias and improve representation. Future research should also prioritize obtaining data from a broader range of mothers, especially Black mothers, and ensure a more even geographic distribution to enhance the generalizability of findings.
Although the results from this study are not generalizable to the entire U.S. population, they remain significant because the analytical claims are grounded in the actual words of the participants, making the findings authentic and realistic rather than hypothetical. Finally, this study underscores the critical need to advocate for equitable healthcare resource allocation, as well as for healthcare policies and programs that support Black mothers and infants, to improve infant health outcomes. It also emphasizes the importance of cultural congruency in support systems designed to help mothers and their infants address infant mortality effectively.

3.2. Policy Solutions

Addressing Black infant mortality requires targeted interventions across key thematic areas identified in this study. In terms of access to care, providing incentives for physicians to practice in OB deserts is crucial. Such incentives could include medical school loan forgiveness, high sign-on bonuses, and other financial benefits to attract healthcare professionals to underserved areas [58]. This could be financed through Medicaid or federal grants targeted at health equity. Additionally, deploying culturally competent [59] health navigation teams in hospitals that serve predominantly Black communities can assist patients in accessing care and scheduling appointments, ensuring more equitable healthcare delivery.
For sleeping issues, hospitals in high-IMR areas should be required to distribute safe sleep kits, including a safe crib with firm mattress, no gaps, secure slats, no loose parts, upon discharge to underserved mothers. These materials will promote safe sleep practices for infants [60]. Furthermore, hospitals should recommend safe sleep workshops for parents before discharge, led by trained nurses using standardized materials, to reinforce education about safe sleep practices.
Supporting breastfeeding is another critical theme. Hiring lactation consultants in WIC offices in counties with high Black infant mortality rates will provide direct support to new mothers [61]. These consultants can offer weekly breastfeeding classes and one-on-one guidance. Additionally, in-home postpartum visits within the first 30 days for underserved mothers should focus on breastfeeding support and infant care education, ensuring mothers receive the guidance they need during this critical period.
To enhance awareness, monthly town halls should be organized in high-IMR neighborhoods through partnerships with local community-based organizations [62,63]. These events can share resources and provide education on safe sleep, breastfeeding, and postpartum care.
To tackle implicit bias, hospitals with over 20% Black underserved patient populations should implement a patient-facing implicit bias reporting system, reviewed by a third-party agency. This system, which will have an online component [64], will enable continuous assessment and improvement of care. Finally, mandatory implicit bias training for healthcare providers, tied to professional licensing renewals, would improve health outcomes for at-risk populations.
Finally, for creating sustainable programs and policies to address infant mortality, state-funded programs should support in-home postpartum nurse visits to assist with breastfeeding, postpartum depression screening, and infant care education [65]. To ensure ongoing accountability, hospital-based infant mortality data dashboards should be established to make data publicly available. These dashboards will track progress, identify persistent disparities, and sustain efforts to reduce Black infant mortality rates effectively.
These targeted recommendations align directly with this study’s findings and provide actionable steps to address the multifaceted challenges of Black infant mortality.

4. Materials and Methods

4.1. Study Design and Participants

Approval from the institutional review board (IRB) was obtained so that participants could consent before the study began. We also assured them of their confidentiality before proceeding with the research. A purposive sampling approach [66] was used to recruit women into this study. This approach helped us gather rich data that could help address the issue of infant mortality affecting the U.S.
The authors sent an email to women known to them and recruited additional participants through social media. Bias was controlled by inviting women from all demographic backgrounds (age, race, mothers, and from different states) to participate in this study anonymously. The diverse representation ensured wide-ranging views on Black infant mortality in the US.

4.2. Research Questions

The writing of the research questions benefitted from the TTM [28]. The TTM could guide societies/communities to change infant mortality to improve children’s health. We used constructs from the TTM to ask about what could be carried out to make changes to save infant lives. The TTM has five stages: pre-contemplation, contemplation, preparation, action, and maintenance.
  • Precontemplation: At the pre-contemplation stage (the initial stage), people do not anticipate taking serious action regarding changing their behavior.
  • Contemplation: It is at the contemplation stage that people consider a change.
  • Preparation: People see their behavior as problematic at the preparation stage and commit to a change.
  • Action: At this stage, action is made, and people plan to keep their actions.
  • Maintenance: Finally, people try to avoid returning to their previous behavior/situation at the maintenance stage.
By using the TTM, we propose to change infant mortality, which is affecting children. The research questionnaire is part of a larger study about Black maternal and infant mortality in the US collected by the authors.
Ethical approval for this research was received from the authors’ ethical institution committee, and data were collected from January 2023 to June 2023. All participants consented before taking part in this study.

4.3. Study Design

This study included both open-ended and closed-ended questions designed to gather information from women regarding Black infant mortality. This method was used to help the researchers thoroughly describe the phenomenon being studied. The questionnaire development was informed by prior research examining views on Black infant mortality [67,68,69]. The lead researcher’s past research on infant and maternal mortality and her expertise in children’s health issues also helped create the research questions.

4.4. Instrument

The study questionnaire asked about participants’ background/demographic information.
The main questions asked participants to share their views on infant mortality in the US and the kind of resources that could help address the issue. Qualtrics software was used to design the research questionnaire and to create an anonymous link for easy distribution.

4.5. Eligibility and Participants

The qualifications for this study were living in the US, being at least 18 years or older, and identifying as a woman/female. We targeted women of diverse races and ages and women from different US states to ensure representation of all women’s views in the US adult population. Our exclusion criteria included women who do not reside in the US, as this study focuses solely on women in the US, and the participation of women outside the US could compromise the validity of the research results.

4.6. Recruitment

The research team used a purposive sampling approach to recruit participants for this study. Social media platforms were used to collect responses from women of all races and ethnicities. By including the perspectives of all adult women, we demonstrated unanimity in recognizing Black infant mortality as a real public health issue requiring combined efforts and input from all women. Data saturation was reached after the researchers saw that information submitted by participants began to show similar responses with no new information [70].

4.7. Data Coding and Analysis

4.7.1. Closed-Ended Items (Quantitative Data Analysis)

One hundred and forty (140) participants met the eligibility criteria, and one hundred and twenty-one consented to participate in this study. We retained a final sample of 91 participants who consented and completed all the questions in this study. Frequencies and proportions are reported in Table 1 in the Results Section. All descriptive analysis was conducted using R programming software in R Studio Version 2024.04.2+764.

4.7.2. Open-Ended Items (Qualitative Data Analysis)

We used qualitative content analysis to describe women’s perspectives on what should happen to curtail Black infant mortality. With this method, we categorized and condensed the data and developed broad themes to understand participants’ perspectives on combating Black infant mortality.
The coding and analysis were completed by four of the authors. It is important to note that individual coders moved from specific to general to capture all necessary information before analyzing the data to ensure timely and comprehensive results. Our data dictated the categories and reflected a bottom-up analysis. We used open coding to annotate emergent headings during our data analysis. Open coding categories were developed in an ongoing procedure, typically descriptive and high order, through inductive techniques and analytic interpretation. Categorical interpretation and development are reflected within our data to ensure their grounding within the results. Internal validity was used in the content analysis to assess quality and agreement among the researchers. Both the data coding and theme derivation were completed by the authors individually. A subsequent review was carried out in a group meeting of the authors to verify themes.

5. Conclusions

The findings of this study reinforce the persistent racial disparities in maternal and child health, with high infant mortality and morbidity rates disproportionately affecting Black populations. While previous research has attributed these outcomes to systemic issues such as limited access to healthcare, implicit bias, and affordability, this study highlights the critical need for culturally congruent healthcare solutions. Addressing these disparities requires a multifaceted approach that prioritizes the voices of affected mothers, ensuring their insights guide interventions.
This study emphasizes the importance of actionable policies and practices to mitigate Black infant mortality. Key recommendations include incentivizing physicians to practice in OB deserts through loan forgiveness and financial benefits, deploying culturally competent health navigation teams to improve access to care, and mandating implicit bias training for healthcare providers. Additionally, distributing safe sleep kits, offering breastfeeding support through WIC lactation consultants and in-home nurse visits, and organizing community town halls can address immediate barriers while fostering trust and education within underserved communities.
Sustainable solutions must also involve robust state-funded programs, such as postpartum nurse visits and publicly available hospital-based infant mortality data dashboards, to ensure accountability and track progress. Interventions aimed at improving Black maternal and infant health require collaboration among all stakeholders, ensuring they are culturally relevant, practical, and scalable. By integrating these recommendations into systemic change efforts, healthcare systems can take significant steps toward eliminating racial disparities in maternal and child health outcomes.

Author Contributions

Conceptualization, C.S.O.; methodology, C.S.O.; software, C.S.O.; validation, C.S.O. and E.O.-G.; formal analysis, C.S.O., F.J., D.B. and K.B.; investigation. C.S.O., F.J., D.B. and K.B.; resources, C.S.O.; data curation, C.S.O.; writing—original draft preparation, C.S.O., T.M.N. and B.O.-G.; writing—review and editing, C.S.O., T.M.N., F.J., B.O.-G., K.B. and E.O.-G.; visualization, C.S.O. and E.O.-G.; supervision, C.S.O.; project administration, C.S.O. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Indiana University Institutional Review Board (Protocol #17663, Date 12 May 2022).

Informed Consent Statement

Informed consent was obtained from all subjects involved in this study. The authors affirm that human research participants provided informed consent for publication.

Data Availability Statement

The data from this study are available upon reasonable request and approval by the IRB of the author’s institution.

Conflicts of Interest

The authors declare no conflicts of interest.

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Women 04 00038 g001
Figure 1. Age distribution of participants.
Figure 1. Age distribution of participants.
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Figure 2. Parental status of participants.
Figure 2. Parental status of participants.
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Figure 3. Race/ethnicity distribution of study participants.
Figure 3. Race/ethnicity distribution of study participants.
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Figure 4. Distribution of study participants by US state of residence.
Figure 4. Distribution of study participants by US state of residence.
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Table 1. Descriptive statistics of the study sample (n = 91).
Table 1. Descriptive statistics of the study sample (n = 91).
Overall n (%)
Age
18–2935 (38.4)
30–3927(29.7)
40–4917 (18.7)
50 and older12 (13.2)
Race
Black/African American54 (59.3)
White/Caucasian 29 (31.9)
Hispanic/Latino4 (4.4)
Asian/Pacific Islander2 (2.2)
Biracial or multiracial2 (2.2)
Parental Status (mother)
Yes41 (45.1)
No50 (54.9)
US State
Colorado1 (1.1)
California3 (3.3)
Florida5 (5.5)
Georgia12 (13.2)
Indiana44 (48.4)
Louisiana2 (2.2)
Maryland3 (3.3)
Michigan2 (2.2)
Mississippi1 (1.1)
New Jersey1 (1.1)
New York3 (3.3)
North Carolina3 (3.3)
Ohio1 (1.1)
Pennsylvania1 (1.1)
South Carolina1 (1.1)
Tennessee3 (3.3)
Texas3 (3.3)
Utah1 (1.1)
Virginia1 (1.1)
Abbreviations: % Percent.
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MDPI and ACS Style

Obeng, C.S.; Nolting, T.M.; Jackson, F.; Obeng-Gyasi, B.; Brandenburg, D.; Byrd, K.; Obeng-Gyasi, E. Women’s Perspectives on Black Infant Mortality in the United States. Women 2024, 4, 514-528. https://doi.org/10.3390/women4040038

AMA Style

Obeng CS, Nolting TM, Jackson F, Obeng-Gyasi B, Brandenburg D, Byrd K, Obeng-Gyasi E. Women’s Perspectives on Black Infant Mortality in the United States. Women. 2024; 4(4):514-528. https://doi.org/10.3390/women4040038

Chicago/Turabian Style

Obeng, Cecilia S., Tyler M. Nolting, Frederica Jackson, Barnabas Obeng-Gyasi, Dakota Brandenburg, Kourtney Byrd, and Emmanuel Obeng-Gyasi. 2024. "Women’s Perspectives on Black Infant Mortality in the United States" Women 4, no. 4: 514-528. https://doi.org/10.3390/women4040038

APA Style

Obeng, C. S., Nolting, T. M., Jackson, F., Obeng-Gyasi, B., Brandenburg, D., Byrd, K., & Obeng-Gyasi, E. (2024). Women’s Perspectives on Black Infant Mortality in the United States. Women, 4(4), 514-528. https://doi.org/10.3390/women4040038

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