September is National Infant Mortality Awareness Month. Infant mortality is the number of babies under one year old that die from any cause.  Infant mortality rate (IMR) can be defined as the number of deaths during the first year of life per 1,000 live births in a given year or period. According to the National Center for Health Statistics (NCHS), the top 4 causes of infant deaths for 2010 (our most recent data) were birth defects, disorders related to preterm birth, and low birthweight, and sudden infant death syndrome, better known as SIDS. According to NCHS, the infant mortality rate for the US in 2010 was 6.15 deaths per 1,000 live births. While this may seem like a low number, the toll to the families who are affected is enormous. We recongize infant mortality each September to raise awarness and remember those children lost.  

At the Boston Public Health Commission, the Boston Healthy Start Initiative (BHSI) was one of fifteen original Healthy Start programs funded by the federal Health Resources and Services Administration (HRSA) in 1991, and has received funding ever since. Due to the persistently higher rates of infant deaths in Boston among Black infants, as compared to White infants, BHSI enrolls high-risk, low-income pregnant Black women into prenatal care and needed services in an effort to improve their birth outcomes.

In Boston, the infant mortality rate (IMR) for the years 2006-2010 was 5.9 deaths per 1,000 live births, according to the Health of Boston report. Looking at IMRs over the same period (2006-2010) for specific racial groups, the IMR for White infants was 3.4 while the Black IMR was 10.9. As you can see, the IMR for Black infants was more than 3 times higher than the IMR for White infants. Even though Black residents are only 22% of the Boston population, they bear a disproportionate burden of infant deaths.

In Boston, Black women have higher rates of preterm births and low birthweight births than White women, which contributes to their higher rates of infant death. Why are Black women more at risk for experiencing an infant death? Three common misconceptions about causes of infant deaths are examined below:

    1. Maternal education: Research shows that well educated Black women with college degrees still have worse birth outcomes than White women who have not graduated from high school.
    2. Maternal smoking: Research shows a higher percentage of White women than Black women smoke during their pregnancies, and Black women who do not smoke are still more likely to experience a poor birth outcome than White women who smoke.
    3. Lack of prenatal care: Lack of prenatal care is often blamed for poor birth outcomes. However, the majority of women, Black and White, who experience poor birth outcomes received good prenatal care, so this does not explain the difference in rates of poor birth outcomes.

If these things cannot explain why Black women have worse birth outcomes than White women, what does? Research shows stress due to experiences of discrimination and racism is related to poor birth outcomes. Stress from experiencing racism over a lifetime has a cumulative impact, and negatively affects the health of Black women and their infants.

In the next post from BHSI, there will be a discussion of initiatives BHSI has undertaken in partnership with the Boston Public Health Commission to help reduce stress levels in Black women in Boston, and to strengthen women’s health. Remember to look for our next post!


Aurelia Rus, MPH is an Intern for the Boston Healthy Start Initiative at the Boston Public Health Commission.