Jennifer Hickes Lundquist University of Massachusetts, Amherst
A continuing indicator of racial inequality in the United States is infant mortality rates. African American babies are more than twice as likely to die as white babies. The primary cause of higher mortality is low birth weight, with black children twice as likely as white children to be born underweight. Despite many studies investigating why low birth weights and infant mortality are so much higher among African American infants than white infants, the causes are not well understood. Group differences in social class and access to healthcare fail to fully explain the racial disparity, which has, in turn, led to a focus on biological explanations. Using a new, uniquely created dataset that allows for a detailed comparison of births across the military and civilian environments, this research evaluates racial disparities in birth outcomes in a way that has not been done before. As an alternative to the biological approach, the study evaluates birth outcomes in the U.S. military, a natural experiment setting that will provide insight into structural causes of racial disparities in infant health outcomes. The military is one of the only locations in U.S. society where African Americans not only have equal access to high-quality healthcare, but also where economic, social, and racial inequality is substantially lessened. Previous research has found that many other racial disparities common among the civilian population disappear or even reverse themselves in the military environment. The research examines the hypothesis that in a setting where conditions of racial inequality are considerably lessened, the race gap in poor infant health outcomes will also be considerably lessened, or even disappear. The study uses a natural experiment design which evaluates racial differences among civilian births compared to military births using data from the Pregnancy Risk Assessment Monitoring System (PRAMS). Using multivariate analyses, the project evaluates whether there are racial disparities in infant mortality, low birth weight, and the incidence of pre-term birth among military mothers as there are among civilian mothers. The project then studies whether and how the characteristics associated with such birth outcomes vary by race in the civilian context versus the military context. A methodological innovation of the research design is the use of propensity score matching analyses to account for selection effects of individuals into military service.
Research findings have the potential to inform biological theories on race difference in poor infant health outcomes. If the gap in low birth weight diminishes, as is likely given findings from studies that employ less comprehensive data, any role played by genetics will lessen in relevance, encouraging renewed focus on structural reform. Findings will also be of immediate relevance to the military and medical community more generally. by shaping the public and professional debate over structural versus genetic factors behind high African American infant mortality and low birth weight. In addition, the medical health of military families is of immediate relevance given that the Pentagon is the largest employer in the U.S., particularly of African Americans. The project will also contribute a unique dataset to the academic and professional community, providing an important resource for other researchers seeking to examine institutionalized populations.
