Dobbs may exacerbate our racially disparate infant mortality rates

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Anti-abortion activists and lawmakers continue to celebrate Supreme Court ruling Dobbs v. Jackson Women’s Health Organization decision as a victory for American infants. Yet many states that have recently banned or severely restricted access to abortion have the highest infant mortality rates in the nation. Louisiana, for example, which now bans almost all abortions, has a rate of Child mortality rate over 66 countries – and a black infant mortality rate over 82 countries.

U.S. Sen. Bill Cassidy (R-La.) brought the issue to public attention last spring. “If you correct our population for race“, he claimed, “we are not as outliers as it would otherwise seem. “Although Louisiana has the second highest infant mortality rate and the fifth highest maternal mortality rate in the country, Cassidy seemed to say that somehow looking only at the deaths of white children and mothers is the “correct” view when it comes to health statistics .

Those like Cassidy — who profess to be pro-life but don’t seem to care about disproportionate black infant mortality rates — follow a long tradition. In many ways, Cassidy, who is white and a doctor by trade, resembles the public health officials, physicians and lawmakers who established America’s prenatal care system more than 100 years ago. These predominantly white men and women did so for the explicit purpose of saving white children. They also informed black families and other families of color that their children’s deaths were due to an inherent biological inferiority in their bodies – alleged deficiencies that could never be corrected.

These were not new ideas. Many of these biological narratives about black Americans were established to legitimize slavery. White slavers and doctors argued that the inherited physical nature of African Americans made them particularly suited to grueling manual labor. They claimed that black women had no natural sexual morality and “exceptional” fertility, justifying rape and forced pregnancy both morally and economically since, by law, children inherited slave status. of their mother. Slavers also argued that black women gave birth with little pain and needed no recovery time afterwards.

These ideas persisted after the end of slavery. Dr. George Engelmann, a white physician from St. Louis, wrote in 1881, for example, that black and native women in the United States were “primitive» people who experienced a « short and easy delivery, accompanied by few accidents and followed by little or no prostration ».

America’s racially biased prenatal care system was built on these ideas in the 1910s, when Americans learned two things this surprised them: more infants died in the United States than in most European countries, and the majority of those deaths occurred within the first month of life.

These findings created a storm of concern among politicians and doctors about the nation’s health and international power and prestige. Various groups, ranging from doctors and wealthy white club women to the U.S. Children’s Bureau — a newly created federal health agency — began researching why so many infants died and how medicine and public health measures could address the problem.

These groups strongly advocated a medical surveillance system for pregnant women, what we now call prenatal care. Their purported goal was to monitor a woman’s pregnancy from the start to ensure babies are born healthy and have a better chance of surviving into infancy. Doctors and public health agencies said this sustained scientific attention was needed, even though much of the advice under the new label of “prenatal care” appeared in countless health guides in the 19th century under the heading “hygiene of the pregnancy”. In addition to repeating traditional advice on diet, exercise and clothing, proponents of prenatal care argued that only male doctors could properly analyze a woman’s urine for signs. of preeclampsia, a newly developed tool to combat a very old complication of pregnancy. But even doctors admitted that eclampsia accounted for a very small proportion of infant deaths, and that the real value of urinalysis and prenatal care brought women into doctors’ offices, where they could decide use them for childbirth assistance – as opposed to traditional women. midwives.

White leaders of this new prenatal care system produced study after study of infant mortality to build public confidence and interest in prenatal care – and to compel state and federal agencies to provide funding. Yet their conclusions reflected their own racial biases.

J. Whitridge Williams, for example, was a white physician who investigated infant mortality in Baltimore and published his findings in 1914. He examined 705 infant deaths in a population he estimated to be 46% Black. Reporting his findings that syphilis accounted for the majority of black infant deaths, he found a way to not consider this a cause for concern because it accounted for “only” 14% of white infant deaths. He argued that black Baltimoreans lacked intelligence and proper care to prevent syphilis, and that these shortcomings were ones that “so often characterize[d] this course. According to him, biological inferiority caused syphilis in black Americans, which no funding or treatment could change.

Similarly, after reviewing the death of every child in Detroit in 1919, the Detroit Health Department also concluded that public funds for prenatal care should be directed primarily to preventing the deaths of white infants. The survey found the highest rates of respiratory disease were among black and Italian infants, which the authors attributed to “climatic influence” as both groups were “accustomed to hot climates”. Based on the association of black Americans of African descent (regardless of the length of their life in Detroit or elsewhere in the United States, which generally corresponds to their entire life), the Department of Health determined that their bodies were genetically unsuited to the cold Detroit winters and therefore the black dead could not be helped.

Thanks to advances in medicine over the next 100 years, the infant mortality rate in the United States declined for both black and white infants, but the racial disparity has actually increased. Black Americans won more legal rights and the establishment of Medicare and the Civil Rights Act of 1964 desegregated medicine. Yet these great advances have done little to change racial gaps in medical care or increase concern for black women and their children.

Throughout the civil rights era of the 1950s and 1960s, black women were still disproportionately subjected to sterilization by white medical providers. And until the 1990s, several states, including Louisiana, created legislation that tied social benefits to the use of the long-acting contraceptive Norplant in hopes of stemming black reproduction, especially among young black women. As a lawyer Dorothee Roberts illustrated, Norplant was promoted in predominantly black, low-income schools in cities, even though nationally teenage mothers were more likely to be white.

In other words, the American prenatal health care system was established with the health of white mothers and infants in mind first – a story that has repercussions today.

By celebrating the Dobbs v. decision, Cassidy likewise proclaimed: “Being pro-life means being pro-mothers, pro-babies and pro-healthy future.” While we can criticize anti-abortion politicians like the Louisiana senator for their callous and hypocritical words and actions, we cannot forget the role of medicine and public health in building a society that devalues black lives.

Since black Americans rely on abortion more than any other racial group, Black women will be forced to give birth at disproportionate rates. And with racial disparities in prenatal care still prevalent in America, a disproportionate number of these women will also be forced to suffer the deaths of the babies they deliver.

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