Black babies more likely to survive if they have Black doctors: study
'The reasons are really complex,' says co-author Dr. Rachel Hardeman
For Black babies, the race of their first doctors can be a matter of life and death.
Black newborns are significantly more likely to survive if they have a Black doctor, according to a U.S. study published Monday in the Proceedings of the National Academy of Science.
The researchers looked at 1.8 million hospital birth records in Florida between 1992 and 2015, and found Black babies were three times more likely to die in hospital than white babies.
But when Black infants received care from a Black doctor, that disparity was cut by 39 to 58 per cent — whether the doctor was providing care before, during or after childbirth.
The same was not true in reverse. A doctor's race has little to no impact on the health of a white infant, the study found.
"I think that the reasons are really complex," co-author Dr. Rachel Hardeman told As It Happens guest host Helen Mann. "It's a constellation of different issues that are showing up."
Trust, bias, and a history of racism
Hardeman studies reproductive health equity at the University of Minnesota's School of Public Health. While this specific study doesn't look at root causes of racial disparity in infant mortality, she has some ideas about why this is the case.
"Based on my research and many other scholars, we know that implicit racial bias or unconscious or automatic bias happens in the clinical encounter where a physician is drawing on the ways that they've been taught, both implicitly and explicitly, to think about race," she said.
"It can have an impact on clinical decision making. It can have an impact on how a provider unintentionally treats a patient."
For example, a white doctor might make incorrect assumptions about a pregnant Black patient based on negative stereotypes.
"We've heard stories about women feeling disrespected or not heard by their provider," Hardeman said. "We've heard stories around women saying ... 'I had a toxicology screen run on me for no reason, and I don't use drugs.'"
Another factor, she says, is trust between the doctor and the patient. If you've experienced anti-Black racism your whole life, it might be harder to trust a white doctor.
"The health-care system in the United States has to grapple with a lot of issues throughout our history related to racism that have had an impact on the trust that people have when they're interacting with the health-care system," she said.
Racial health disparities in Canada
Black babies across the U.S. are more than twice as likely as other infants to die before reaching their first birthday, according to 2017 data published last year by the U.S. Centers For Disease Control.
Comparable stats don't exist in Canada because the Canadian government doesn't collect race-based health data.
But a 2015 McGill University study found that Black women in Canada have higher rates of premature births than white women, with 8.9 per cent for Black women, compared with 5.9 per cent for white women.
And according to Statistics Canada, infant mortality rates are 2.3 times higher in areas with large populations of First Nations people, and 3.9 times higher in places where Inuit people live.
An alternative approach
Hardeman is currently researching health outcomes at Roots, an African-American-owned birthing centre in Minneapolis where she says infant mortality rates "are not reflecting the disparities that we see in the rest of the state and across the country."
"What we see is that people who received care from a Black midwife in this particular research study were more likely to report being satisfied with that care, feeling like they were a partner in that care, feeling respected, feeling heard," she said.
"There's something about, you know, sharing a lived experience that can be incredibly important, again, during a time in someone's life where they're feeling maybe out of control or feeling very vulnerable."
Still, Hardeman says her advice isn't as simple as telling Black expectant parents to find a Black health-care provider.
First of all, that's not always an option. Only five per cent of U.S. doctors are Black, according to the Association of American Medical Colleges.
"I think we certainly have to start by thinking about and doubling down on our efforts here in the United States around diversifying our physician workforce," Hardeman said.
Medical schools should also be teaching doctors of all races how to practice their trade more equitably, she said.
"I definitely think we need to be considering medical education and what our curriculum looks like and how we're training physicians to both understand the history of racism in our country and the fact that health-care systems and health-care delivery is not immune from that," she said.
Her advice for patients is to not be afraid to ask questions and advocate for themselves. Her advice for doctors is to listen to their patients.
"Part of that is also considering and listening to Black birthing people and hearing — really hearing — what they need and what they want, and centering that and allowing that to be what drives any of these efforts in any of this work forward," Hardeman said.
For more stories about the experiences of Black Canadians — from anti-Black racism to success stories within the Black community — check out Being Black in Canada, a CBC project Black Canadians can be proud of. You can read more stories here.
Written by Sheena Goodyear. Interview with Dr. Rachel Hardeman produced by Kate Cornick.
- An earlier version of this story mistakenly reported that Black babies are twice as likely to survive if they have a Black doctor. In fact, the study reports that being cared for by a Black doctor cuts the mortality rate of Black infants by 39 to 58 per cent.Aug 19, 2020 10:20 AM ET