POPULATION BRIEF The University of Mississippi Center for Population Studies & State Data Center of Mississippi Exploring Trends and Disparities in Preterm Births in Mississippi John J. Green, PhD; Sarah Gayden Harris, BA; Molly Phillips, MPH, MSW The University of Mississippi Center for Population Studies & Sannie Snell, LMSW, MPH Project Director of the Right! from the Start Project September 212 Overview Birth outcomes are important indicators for the health and wellbeing of a population. Poor birth outcomes such as preterm birth, low-weight birth, and infant death are of particular concern in this regard. Preterm birth (<37 weeks of gestation) is a risk factor for other problematic health outcomes 1 and is therefore the primary focus of this report. Research literature demonstrates that, preterm birth is a multifactorial disease caused by genetic, social, and environmental factors, which most likely interact to increase risk. 2 With expansion of health care facilities and improvements in medical technology, it is often assumed that health problems should be decreasing along with a corresponding shrinkage in socioeconomic and racial disparities. However, as the technical side of health care advances, we are likely to witness an increase in the importance of social inequality in determining some health outcomes. 3 As shown in this report, vital records data from Mississippi demonstrate a complex trajectory for preterm birth. While infant mortality rates decreased over the past several decades (but have leveled off in recent years), preterm birth rates increased (see Trends and Disparities section below). The patterns may be due to increased medical technology and services to help babies born preterm remain viable. Unfortunately, racial disparities between whites and blacks remain fairly continuous, and these patterns are evident even when controlling for age in analysis of preterm births. Additional data were obtained from recent participatory dialogue sessions conducted as part of the Right! from the Start Project, led through the Community Foundation of Northwest Mississippi. Findings suggest that in addition to improving health care services and access to technology, it will be necessary to enhance awareness and understanding of preterm birth among health and social service workers, administrators, and policy leaders. Furthermore, scholars should help provide research-based education on factors influencing these birth outcomes and strategies for addressing them. Training for frontline service providers to be empathetic and supportive of mothers and fathers in vulnerable families appears to be particularly warranted. 1 Williamson, Dhelia M., Karon Abe, Christopher Bean, Cynthia Ferré, Zsakeba Henderson, and Eve Lackritz. 28. Current Research in Preterm Birth. Journal of Women s Health 17(): 14-149. 2 Ibid, quoted from page 14. 3 Link, Bruce. 28. Epidemiological Sociology and the Social Shaping of Population Health. Journal of Health and Social Behavior 49(4): 367-384.
Mississippi Data It is important to monitor birth outcomes for the State of Mississippi. Data for this analysis were obtained from the Mississippi Department of Health through its Vital Records and Mississippi Statistically Automated Health Resource System (http://mstahrs.msdh.ms.gov/). The University of Mississippi Center for Population Studies analyzed the data. The primary areas of focus for analysis in this report concerned patterns in state-level aggregate data. County-level and regional analyses will be addressed in separate Population Briefs. Additional qualitative data were obtained from a series of participatory dialogue sessions held in three locations throughout the Delta region of northwest Mississippi during spring 212. Meeting participants included nurses, social workers, nutritionists, early childhood educators, program administrators, policy leaders, and others likely to work with mothers at risk of having poor birth outcomes or having had preterm births. Forty people participated in these discussions held across three different venues in the Mississippi Delta region. Extensive notes were taken based on the content of discussions from these dialogue sessions, and the data were later analyzed for theme and content. Trends and Disparities To begin, quantitative analysis was focused on exploring longitudinal patterns in infant mortality rates between the years 198 and 211. Infant deaths (per 1, live births) decreased substantially from 198 to the mid 199s, and then the trend tapered off (Figure 1). Comparatively, preterm birth rates (per live births) increased from198 through 2 (Figure 2). However, the trend stagnated and then dipped slightly in recent years. Figure 3 reiterates that overall preterm birth rates rose between 198 and the middle of the last decade, and then they slowly lowered again between 26 and 211. Additionally, this figure shows the corresponding patterns for births among white and black mothers separately. Preterm birth rates have been consistently higher for births from black mothers relative to whites, and these disparities persist. Infant Mortality Rate Per 1, Live Births Preterm (<37 Weeks) Birth Rate Per Live Births 2 2 1 Figure 1: Infant Mortality in Mississippi, 198 to 211 198 198 199 199 2 2 2 Figure 2: Preterm Birth Rates in Mississippi, 198 to 211 2 2 1 Page 2 198 198 199 199 2 2 2
Even when controlling for age, a factor well known for influencing birth outcomes, racial disparities are clearly apparent in preterm births (Figure 4). There are fluctuations by age, with younger and older women being at higher risk than those from about 18 to 29 years of age. Still, preterm birth rates for black mothers are consistently higher than those among whites, regardless of age group. Preterm (<37 Weeks) Birth Rate Per Live Births 2 2 1 Figure 3: Preterm Births in Mississippi by Race of Mother, 198 to 211 198 198 199 199 2 2 2 Qualitative Research Demonstrates that Training is Needed Findings from the series of participatory dialogue sessions held in three communities across the Mississippi Delta region were revealing. 4 Participants included health care workers, social service providers, educators, administrators, and policy leaders. They were presented with basic information about preterm births, and then asked to engage in facilitated dialogue sessions about the causes and consequences of preterm birth and strategies for addressing this problem in their communities. Documentation showed that participants were very worried about poor birth outcomes, including the complications associated with preterm delivery. However, there was a tendency for conversations to quickly move toward blaming mothers for their situation. Many, but not all, of the White Mothers Black Mothers Total Note: Total includes all racial groups, not only white and black Figure 4: Preterm Births by Race and Age, 27-211 Pooled Data - 14 years 1-17 years 18-19 years 2-24 years 2-29 years - 34 years 3-39 years 4 years + Preterm Births (<37 Weeks) Per Live Births 1 2 2 3 Note: Total includes all racial groups, not only white and black participants went from discussing preterm birth to focusing on sexually promiscuous teenagers and the high rates of teenage pregnancy. Furthermore, with but a few exceptions, the roles of fathers and men in general were largely discounted in these discussions. From the dialogue sessions, researchers and public health advocates were concerned by how the issue of preterm birth was being framed by these professionals working at the frontlines of White Black Total 4 The counties where these meetings were held are located in the northwest region of the state know as the Core Delta. Supplemental analysis found that these counties have preterm birth rates higher than the state as a whole, with notable racial disparities. Page 3
service delivery for women, children, and their families. This is particularly important when considering research showing the role that stress plays with birth outcomes. For instance, a specific syndrome related to stress and poor birth outcomes has been discerned and is known as pregnancy-related anxiety. This is thought to occur across racial, ethnic, and socioeconomic lines. The syndrome has been identified as having a strong enough association to predict spontaneous preterm birth and pertains to fear about the health and well being of one s baby, impending labor, hospital stay and experience, parenting, maternal role, and/or one s own health. It is noted that poor provider-patient interactions and communication may increase this syndrome. 6 Furthermore, a growing body of research is pointing toward a better understanding of stress, race, and disparities in birth outcomes. Of particular note are the patterns showing that beyond socioeconomic characteristics, including poverty and inequality, black mothers continue to have higher rates of negative birth outcomes, owing to the ways in which racism and stress are a part of our society, both institutionally and individually. 7 The weathering hypothesis suggests that social inequalities and associated stressors facilitate a faster decline in health among black women, thereby leading to disparities in health outcomes with increased age. This premature decline in health leads to poor birth outcomes, including preterm birth. 8,9 Given research findings about the importance of stress to birth outcomes and the existence of socioeconomic and racial disparities, it appears that more attention is needed to improve the awareness of health and social service providers, educators, administrators, and policy leaders pertaining to preterm birth. Additionally, the health care system might benefit from students, frontline workers, and people in leadership positions being trained in ways to serve as advocates for families and to provide a supportive social environment for those who are particularly vulnerable to broader inequalities and at risk of poor outcomes. Social service and health care organizations may not be able to control the broader structures influencing people s lives and leading to inequality, but they can intervene by providing caring and nurturing environments for the people most likely to suffer these stresses. Schetter, Christine Dunkel. 211. Psychological Science on Pregnancy: Stress Processes, Biopsychosocial Models, and Emerging Research Issues. Annual Review of Psychology 62: 31-8. 6 Ibid. 7 Rich-Edwards, Janet, Nancy Krieger, Joseph Majzoub, Sally Zierler, Ellis Lieberman, and Matthew Gillman. 21. Maternal Experiences of Racism and Violence as Predictors of Preterm Birth: Rationale and Study Design. Pediatric and Perinatal Epidemiology 1: 124-13. 8 Geronimus, Arlene T. (1992). The Weathering Hypothesis and the Health of African-American Women and Infants: Evidence and Speculations. Ethnic Disparities 2(3): 27-221. 9 Holzman, Claudia, Janet Eyster, Mary Kleyn, Lynne C. Messer, Jay S. Kaufman, Barbara A. Laraia, Patricia O Campo, Jessica G. Burke, Jennifer Culhane, and Irma T. Elo. 29. Maternal Weathering and Risk of Preterm Delivery. American Journal of Public Health 99(): 1864-1871. Page 4
This Population Brief was constructed in collaboration with the Community Foundation of Northwest Mississippi as part of its Right! from the Start Project led by Sannie Snell, with partial support from the W.K. Kellogg Foundation. The views expressed in this report do not necessarily represent these partner organizations. The University of Mississippi Center for Population Studies (CPS) educates, conducts research, and engages in public outreach concerning population issues in the State of Mississippi and beyond. This involves: assisting partners with training and technical assistance for accessing, managing, and analyzing secondary data; providing guidance on research design and methods for primary data collection; engaging students in applied research projects; and conducting original research on topics of relevance to community development, health, and wellbeing. The CPS works in collaboration with the Department of Sociology and Anthropology and numerous partners within the University of Mississippi (UM) system and other institutions, including colleges/universities, nonprofit organizations, and government agencies. Among its programmatic initiatives, the CPS is the lead agency of the State Data Center of Mississippi and the Institute for Community-Based Research. The State Data Center is a joint program of the U.S. Census Bureau and the State of Mississippi. In this capacity, the CPS distributes census and related data, provides instruction on data access and analysis, and serves as a liaison between the U.S. Census Bureau and data users. Originally started in the Mississippi Delta, the Institute for Community-Based Research is housed within the CPS, and it includes strong partnerships with other organizations across the state and southern region. The Institute is a consortium of individuals and organizations collaborating to inform social change and development through applied, participatory, and action-oriented research. The CPS houses the Editorial Office of Community Development, the official journal of the Community Development Society. This peer-reviewed publication addresses the cutting-edge of knowledge concerning community development research and practice. For more information on the Center for Population Studies, please contact: 4 Leavell Hall The University of Mississippi University, MS 38677 Tel. (662) 91-7288 Fax (662) 91-7736 Center for Population Studies: http://socanth.olemiss.edu/center-for-population-studies/ State Data Center of Mississippi: http://www.olemiss.edu/depts/sdc/ Institute for Community-Based Research: http://www.institutecbr.org Page