Infants die at a higher rate in Washington, D.C., than in any other capital city in the developed world, according to a new report by the international charity Save the Children. The findings, released this week as part of the group’s annual “State of the World’s Mothers” report, highlight the failure of the world’s wealthiest country to prevent high rates of child deaths among its poorest and most vulnerable citizens.
Of 25 high-income capital cities, Washington, D.C., has by far the highest infant mortality rate, with 7.9 deaths under the age of one per 1,000 live births in 2012, the report found. In Stockholm, Prague, and Oslo, the rate is under 2. But the aggregate figure for Washington masks huge disparities that the report links to vast economic- and racial inequalities: According to the analysis, infants born in poor and mostly black areas of D.C. die at a rate more than 10 times higher than those born in wealthier, whiter areas of the city.
“Our new report reveals a devastating child survival divide between the haves and have-nots,” Carolyn Miles, chief executive of Save the Children USA, said in a statement. “It’s survival of the richest.”
With a rate of 14.9 per 1,000, infant mortality in D.C.’s poorest area — the largely black Ward Eight, located just four miles from the White House — is “on par with the capitals of El Salvador and Cambodia,” the Washington Post points out. The wealthiest area of the city, Ward Three, has a rate of just 1.2 per 1,000, “on par with the lowest infant mortality rates worldwide seen in cities such as Tokyo and Stockholm.”
Washington hardly stands alone. According to data from the Annie E. Casey Foundation’s Kids Count project, which the report used in creating its rankings, 18 major American cities have infant mortality rates equal to or higher than the District, as of 2011. D.C.’s rate that year was 7.5 deaths per 1,000 births, a substantial decline from its rate of 13.1 just four years earlier. Chicago’s was 7.9. Atlanta’s was 9.3. Philadelphia’s was 9.3. Baltimore’s was 10.8. Detroit’s was 12.4. Cleveland’s was 14.1.
Like D.C., these cities are plagued by inequalities that are reflected in strikingly disparate rates of infant death. “In some U.S. cities, urban child survival gaps between rich and poor are greater than those found in developing countries,” the report says.
As a key marker of population health, infant mortality rates are reflective of broader social and economic conditions, including poverty, poor educational opportunities, concentrated exposure to pollutants, and unequal access to health care. “Race is also a factor,” the report states, noting that black mothers in many U.S. cities “are losing their babies at much higher rates than the U.S. average of 6.1 deaths per 1,000 live births.”
In D.C., the infant mortality rate among black women is 14.6 — about six times higher than the rate among white women (2.6). On the other side of the country, the situation is nearly identical. “In San Francisco,” the report says, “an African American mother is six times as likely as a white mother to lose her baby before her child’s first birthday.”
These disparities persist across age categories, income and education levels, and marital and employment statuses, and they are not explained by differences in medical or genetic risk factors. Most tellingly, research shows that babies born in the U.S. to African-born mothers are similar to those of babies born to white American mothers – and both are significantly higher than those born to black American women. In other words, being black is not a risk factor for infant mortality — but the experience of being black in America is.
“It’s important to think about how we use language. It is very common for people to say ‘race plays a factor,’ and in fact it’s not race so much as racism and the experience of being a black women or a person of color in this society,” Linda Goler Blount, president and CEO of the Washington-based Black Women’s Health Imperative, told Newsweek.
“Race implies there’s some kind of biologic determinant and there isn’t,” said Blount. “There’s nothing unique about black women that would cause them to have higher infant mortality rates or maternal mortality rates.”
Rather, research points to the cumulative effects of social disadvantage as the culprit in these disparities, with racism and discrimination playing a key role. As a chronic, “toxic” stressor, racism has been shown to trigger a pattern of psychological and physiological vulnerability to stress that, over time, leads to worse physical health, poorer overall wellbeing, and even less supportive social relationships. The result of this cumulative disadvantage is that black women have more severe physiological reactions to stressful experiences — including racism — during pregnancy, which has been directly linked with negative consequences for fetal and child development.
And that’s what makes these new figures so tragic: Babies are dying — not because of incurable diseases or birth defects, but because racism has marked their lives as less valuable before they are even born.