infant mortality – Anne Litwin

In a recent conversation, my dear niece, who is about to give birth to her second child, expressed some concern about how she is going to cope once the new baby is born. She has just started a new job as a contract worker and, consequently, is not eligible for paid leave. Her husband is a salaried employee in a new job but has not been employed long enough by his company to be eligible for paid family leave. They must both take leave without pay to care for the new baby, and they cannot afford to go without any income for very long. In addition, because she just started this new job and is a contract worker, she feels she will risk losing her job if she takes leave for more than a short time. And did I mention the high cost of day care for their two-year-old? No wonder she feels worried.

My niece’s situation is a common one for working parents and by itself makes the case for the need for extended parental leave for both parents. New research, however, adds to our understanding of the need for extended parental leave: a new mother’s health and the health of her new baby may depend on the father or other parent being available on a flexible basis to care for both the mother and baby. Claire Cain Miller of the New York Times reports on a new study by researchers Maya Rossin-Slater and Petra Persson, economists at Stanford. Miller notes, “The researchers . . . studied the effects of a 2012 Swedish law that allows fathers to take up to 30 days, as needed, in the year after a birth, while the mother is still on leave.” Miller explains that in the first couple of months after giving birth, often referred to as the fourth trimester, mothers are particularly vulnerable for multiple reasons:

Physical and mental recovery from pregnancy and delivery
Sleep deprivation
Exhaustion from round-the-clock care giving and possibly breast-feeding
Potential need to work to earn a living wage during this vulnerable period

The researchers found several positive effects when Sweden changed its law to allow fathers or other parents to take up to thirty paid days on a flexible basis:

A 26 percent drop in antianxiety prescriptions
A 14 percent reduction in hospitalizations or visits to specialists
An 11 percent decrease in antibiotic prescriptions

The key to these changes, according to the researchers, was that “the policy allowed fathers [or other parents] to take intermittent, unplanned days of paid leave” when the mother needed it to sleep, seek preventive care, or get antibiotics early in an infection. In fact, the typical father in Sweden took only an extra couple of days of time off, but his flexibility when it mattered most had a significantly positive impact on the physical and mental health of the mother.

Miller points out that the United States is the only industrialized nation that does not have mandated paid leave. Shamefully, this leads to some alarming statistics:

American maternal mortality—which includes childbirth-related deaths in the year after a birth—has increased 50 percent in a generation.
African American infant and maternal mortality is especially high due to the added stress of dealing with racism.
Other developed countries have much lower maternal mortality.
Sweden offers sixteen months of paid parental leave for parents to divide between them. In the United States, only seven states offer paid leave for between four and twelve weeks but often only for the mother.

We are actually moving backward in the United States. The United States Department of Labor is reviewing the Family and Medical Leave Act with a goal of reducing “the burden on employers” of being required to offer even unpaid leave. We can do better than this, but we will have to put pressure on our lawmakers at both the state and federal levels to pass laws requiring flexible paid leave for both parents for reasonable periods of time—more than four weeks and probably more than twelve weeks. Research such as this new study reported by Miller can go a long way to help make the case. We must all call and write our legislators and vote for candidates that support paid leave.

Photo by Kelly Sikkema on Unsplash

I often wonder why so many of my black women friends have died so early. Specifically, I have had the joy of being a member of a black and white women’s support group for more than twenty-five years. During these years in our group of seven to nine members, all of the original white members remained healthy and three of the black members passed away. As a white woman, I not only miss my friends, but I have been bewildered by these differences in our mortality. Let me be clear—our members have very few differences in our backgrounds and life experiences other than race. We are all middle-class professional women raised in middle-class professional two-parent households. We are all college educated and about the same age. Race is what differentiates us. Recent studies on infant and maternal mortality in the United States reported in the New York Times Magazine by Linda Villarosa opened my eyes and gave me some language to explain what may have caused the early deaths of my black women friends. While none of the three women in our group died from causes related to maternity or childbirth, the findings in these studies seem to explain a lot more about health disparities between African American and white women than just higher rates of infant and maternal mortality. Infant and maternal mortality rates are, however, both shocking and what led researchers to their broader conclusions about the impact of race on health. Villarosa reports on several examples from recent studies:

Black infants in America are now more than twice as likely to die as white infants—a racial disparity that is actually wider now than it was in 1850, fifteen years before the end of slavery.
Education and income offer little protection. A black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education.

Villarosa cites seminal research by Dr. Arline Geronimus, published in 1992, that first linked stress and black infant mortality in her theory of weathering. Villarosa explains that Dr. Geronimus “believed that a kind of toxic stress triggered the premature deterioration of the bodies of African-American women as a consequence of repeated exposure to a climate of discrimination and insults”—in other words, the lived experience of race in this country. In 1997 a team of female researchers from Boston and Howard Universities expanded on earlier studies showing the health effects of racism. Villarosa reports that their research concluded that “the bone-deep accumulation of traumatizing life experiences and persistent insults” results in the sustained, long term release of stress hormones, which can lead to wear and tear on the cardiovascular, metabolic, and immune systems, making the body vulnerable to illness and even early death. This wear and tear is the process mentioned previously called weathering by Dr. Geronimus. In 2006, Dr. Geronimus and her colleagues found that, even when controlling for income and education, African American women had the highest levels of stress-associated body chemicals—higher than both white women and black men. The researchers concluded that “persistent racial differences in health may be influenced by the stress of living in a race-conscious society. These effects may be felt particularly by black women because of [the] double jeopardy of gender and racial discrimination.” Deeply ingrained stereotypes about women and people of color are literally killing black women. I recently saw a sign that said “White Silence Is Violence.” As a white woman, I urge other whites to take action:

Become aware of the deeply ingrained stereotypes in our society about people of color.
Become aware of our own unconscious bias and white privilege and talk with other white people about what you are learning.
Watch for and speak out when you see discrimination or unfair treatment of a person in any minority group.

Change starts with each of us, and our society will change when we change. Photo courtesy of James Palinsad (CC BY-SA 2.0)]]>