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Understanding Mortality Rates for Black Newborns

Research published late this summer suggests that “newborn–physician racial concordance is associated with a significant improvement in mortality for Black infants,” i.e., when they received care from Black physicians.

Lead author Brad N. Greenwood, PhD, an associate professor at George Mason University School of Business, took time to answer questions about this research.

Did you determine why Black babies have a better chance of survival?

Greenwood: I want to emphasize how cautious we need to be about speculating about the “why” question because it is speculative. This is secondary data so nailing down the exact mechanism is difficult, even if we do see the effect get larger in some places — hospitals that deliver more Black newborns — and smaller in others — Black newborns without comorbidities. But there are several possible explanations:

  • We want to be careful not to pathologize Black newborns, but there is evidence that Black newborns can be more medically challenging to treat due to social risk factors and cumulative racial and socioeconomic disadvantages of Black pregnant women. As a result, it may be that Black physicians are more aware and attuned to these challenges than white physicians.
  • Issues of spontaneous racial bias, which research does suggest manifest towards both adults and children, could also be at play. As a result, it is conceivable that the newborns are treated differently.
  • There may also be challenges accessing preferred caretakers for Black mothers, or an inefficient process of allocating physicians at the hospital level.
  • There is evidence in the literature that racial concordance increases trust and communication between patients and providers. While the newborn obviously won’t be speaking to the pediatrician, the mother may be, and this might have an effect.

All of these are possible so we want to be very careful about the interpretation, since we cannot come down firmly on one mechanism or another. Likely, it is a mix of all these things and potentially more.

What we do know is that the effect is persistent under a lot of conditions and gets bigger when Black newborns are born in hospitals that deliver many Black babies, which suggests part of the explanation may be institutional.

Your findings state that it doesn’t matter if the birth mothers share the same race as the physician. So if a white mom gives birth to a Black baby, the chances of the baby surviving are increased here as well if the doctor is Black?

Greenwood: When we are investigating the mother, the physician changes from being the pediatrician to being the obstetrician (the two physicians are almost always different). There is no spillover examination where we look at the effect of the mother’s physician on the newborn.

Why the effect doesn’t manifest for mothers is also speculative. While absence of evidence is not evidence of absence, it could simply be that maternal mortality is an order of magnitude lower than newborn mortality. It is also possible that there is no effect of concordance in these situations.

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