By: Brandi Givens, RD, IBCLC

The National Academy of Medicine defines healthcare disparities as “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.” While disparity problems show some signs of improving, studies continue to indicate that inequities in healthcare persist and may be worse than previously estimated. 

Health Disparity Statistics

Perhaps the most tragic cases are the racial disparities in neonatal care, where the mortality rates of helpless infants are unacceptably high. According to 2017 statistics from the U.S. Department of Health and Human Services Office of Minority Health:

• Black infant mortality rates were 11 per 1,000 live births compared to 4.7 per 1,000 white births and 5.1 per 1,000 LatinX births.  
• Low birthweight, the leading cause of infant death, was 3.8 times higher in Black infants and 1.3 times higher in LatinX infants compared to non-Hispanic white infants.
• The incidence rate of sudden infant death syndrome (SIDS) was two times higher for Black infants as for white infants.
• Black mothers were 2.3 times more likely and LatinX moms were 1.7 times more likely to receive late or no prenatal care compared to non-Hispanic whites.

While infant mortality rates for LatinX are statistically higher than for non-Hispanic whites, Black infant mortality rates are considerably higher than both.

Racial Disparities in the NICU

In several studies focused on perinatal care, statistics on NICU health disparities are alarming. One national retrospective study using nurse survey data concluded that hospitals with higher concentrations of Black babies had higher rates of nosocomial infections and lower rates of breast milk introduction, two issues that can have lifelong consequences for preterm infants.

Another large study involving observational analysis of 18,616 very low birth weight (<1500 grams) infants in 134 California NICUs found significant racial and ethnic variations in care quality. The study used a NICU quality indicator system called Baby-MONITOR, which evaluates nine indicators, including timely eye examinations to screen for retinopathy, steroid administration to mom to mature infant lungs before birth, and introduction of human milk before discharge. Results indicated that minority babies received lower quality care. 

Some research indicates there is racial segregation occurring when placing babies in NICUs. One study showed Black babies were more often sent to hospitals with lower NICU quality ratings compared to white and Asian babies.

Perhaps the most alarming statistics come from a study published in August 2020 by George Mason University. In a sample size of 1.8 million patients, researchers found the Black infant mortality rate to be  nearly three times higher than for white infants, or 289 per 100,000 white infant deaths vs. 784 per 100,000 Black infant deaths. However, the second part of the study revealed that when the attending physician was Black, the Black infant mortality rate was cut in half. This appeared to be especially true in more complicated medical cases.

Why Disparities Exist and What Can Be Done, According to Experts

In response to the concerning George Mason study, Areva Martin, award winning civil rights attorney and talk show host, interviewed several advocates working toward eliminating disparity. Dr. Brad Greenwood, who co-authored the George Mason study above, admits that one of the key limitations of his findings is understanding why these NICU health disparities exist. 

Greenwood only hypothesized that the inconsistencies may be based on lack of medical training or poor allocation of resources; he didn’t believe there was any malicious intent involved. He emphasized, “We can’t come to any hard conclusion at this point; more qualitative research is needed now.”

In the same interview, Dr. Brian Sims, an experienced Black Neonatologist and Professor at the University of Alabama at Birmingham, discussed what he thought about the significant difference in outcomes for Black babies with Black physician care. “I think we need to learn what the Black doctors did that was different…It’s not an indictment on the medical community, but it needs to make us want to be better.”

Rue Khosa, ARNP, FNP-BC, IBCLC is the founder of The Perfect Push Foundation, a nonprofit focused on addressing maternal and fetal mortality in underserved populations. Khosa believes the long-term solution to racial disparities depends on both unbiased medical staff training and patient-caregiver concordance. She believes the key to implementing both of these relies on increasing minority leadership in the hospital settings.

Khosa explained, “Implicit biases are so deeply ingrained in our medical training and culture…We need to level the playing field. When we start adding more people of color to positions of leadership, colleagues begin to see a different side of people instead of what the media seems to portray.” She believes this new understanding of people will then be passed on to patients in the form of better care.

A Call to Immediate Action 

While qualitative studies and diversity in hospital staff are important in the long term, more immediate action is needed to save babies right now. That’s where innovative technology can help.

Areva Martin also interviewed Tracy Warren, co-founder and CEO of Astarte Medical, the developer of NICUtrition® Equitable Care Intelligence, an EMR-integrated platform that enables unit-wide tracking of key metrics by race and ethnicity throughout the entire patient journey. The platform gives providers the tools and insights to understand where disparities exist to identify patients that require additional support or further assessment. 

The immediate feedback loop of the platform helps improve care while the patient is still in the hospital. The information is shared by the entire clinical care team and the hope is that its use will quickly identify and decrease NICU health disparities that may occur.

“As we’ve become sensitive to the level of data that we can liberate and provide to caregivers, I think it’s our role to empower them,” Warren continued. “Data is a great equalizer. Whether you have a lot of resources or few, you can use technology to bridge gaps and provide optimum care.”

For more information about recommended actions to reduce health disparities, see the Health and Human Services Action Plan to Reduce Racial and Ethnic Health Disparities.