Monday, June 01, 2015

Inequality in the womb

22% of African American families and 38% of children and youth living in poverty.

The nature of the fetus’ environment during the short period between conception and birth has lifelong consequences on it, including birth defects and chronic conditions such as coronary heart disease, stroke, type II diabetes, and hypertension. Babies born prior to the 37 weeks of gestation or weighing less than 5.5 pounds will be disadvantaged for the rest of their lives in just about everything—their height, cognitive abilities, educational attainment, employment, and their lifetime earnings. Those exposed to toxins or infections in the womb will be irreparably damaged. Maternal mortality is high in the United States: 1 in 1800 pregnancies, which is about 6-7 times as high as in Western Europe where mothers have free medical care.

The environment of a fetus in midtown Manhattan, where the annual income is $2.9 million, is coddled: absolutely no toxins or infections, certainly no shortage of micronutrients, and a stupendous team of doctors will make sure that it sees the light of day with optimal weight under optimal circumstances. A few miles away, the fetus in the Melrose-Morrisania neighborhood of the South Bronx, where in some housing projects half the households have less than $9,000, the fetus faces a very different environment. The environment matters greatly. There are numerous of well-known negative effects if a fetus experiences stress, anxiety, abuse, poor nutrition, infrequent doctor’s visits, or no visits at all until the time of delivery because of lack of money and lack of health insurance. Inadequate micronutrients, insufficient vitamin B, or infections lead to all sorts of complications and suboptimal outcomes including birth defects, stillbirths, pre-term delivery, and low birthweight followed by high infant mortality. The emotional stress that invariably accompanies such poverty all too often makes things much worse as it leads to drug use or alcohol abuse.

African American babies are disadvantaged by the time they take their very first breath. Blacks have a much higher rate of preterm births than whites (20% vs. 12%). Low birth weight (LBW) is also a major setback (it is 8% among whites but 16% among blacks). Low birth weight, defined as a weight of less than 5.5 pounds, has harmful effects that last forever, such as stunted educational achievement and lower lifetime earnings, and is also a main cause of infant mortality. No wonder that the mortality rate among African American infants is more than twice that of whites and higher than that of 60 countries in the world in a league with Russia, Serbia, Thailand, and Sri Lanka. (Actually, those of Russia and Serbia are slightly better.)

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