By Rhonda Rogombe
West Virginia Center on Budget and Policy
Infants and birthing parents are dying at alarming rates in West Virginia. Infant and maternal mortality rates are an important statistic measuring overall societal health. The disparities in life outcomes between Black and white babies and mothers in particular raise questions about health equity and the ability of our health care system to meaningfully respond to both babies’ and mothers’ needs. There is much that we do not know, especially on the state level, which limits experts’ capacity to make policy recommendations that properly respond to this critical issue. In the meantime, West Virginians continue to die often preventable deaths. It is imperative that the state addresses the issues of infant and maternal mortality immediately, which includes producing nuanced data and implementing evidence-based policies. It is literally a matter of life or death.
Infant Mortality in West Virginia
The infant mortality rate measures the number of deaths in children under a year old per 1,000 live births. Between 2014 and 2017 (the most recent multiyear data available in the state), West Virginia’s infant mortality rate was 7.2 deaths per 1,000, outpacing the national rate of 5.9 deaths per 1,000. When controlling for race, we see that the state’s white infant mortality rate was only 6.8 deaths per 1,000 while the Black infant mortality rate was 13.7 deaths per 1,000 over the same period. Plainly stated, Black babies in the Mountain State were twice as likely as their white peers to die in their first year of life.
The infant mortality rate has decreased over the past several decades, but the racial disparities persisted despite health care advancements. Some of the leading causes of infant mortality include low birth weight, birth defects, maternal health complications, and sudden infant death syndrome (SIDS). High-quality pre- and post-natal care can play a key role in mitigating these and other factors contributing to infant death and improve outcomes significantly. However, a lack of access to health care is a pervasive issue for many West Virginians, especially for Black folks in rural parts of the state.
In 2019, the Black uninsured rate was 10.1 percent in West Virginia, two percentage points higher than that of their white counterparts. In several rural counties, the Black uninsured rate doubled to over 20 percent. Even with health insurance, many struggle to find adequate care within their communities. To provide just one example, West Virginia is facing an obstetrics care crisis: as of 2022, 37 of the 55 counties in the state did not have hospital birthing centers, requiring many to travel long distances to receive necessary care. Most of the state lacks both the workforce and infrastructure required to adequately care for infants and prevent complications that make their survival less likely.
Further, evidence shows that the doctor-patient relationship plays a significant role in life outcomes for Black infants. Racial bias and structural racism in the health care system shape how Black mothers and infants receive care. A study published in the Proceedings of the National Academy of Sciences found a positive correlation between having a Black doctor and Black infants’ survival rate. Though the data has limitations, this study found that being cared for by a Black doctor correlated with a nearly 50 percent decrease in Black newborns’ mortality rate. Existing health policy fails to challenge and address racial disparities despite ample evidence outlining the significant role it plays in the survival rate of Black babies.
Maternal Mortality in West Virginia
The maternal mortality rate measures the number of maternal deaths related to or aggravated by pregnancy per 100,000 live births. Between 2014 and 2019, the maternal mortality rate in the US was 17.3 deaths per 100,000. During that period, West Virginia reported 14 deaths per 100,000. While the state reports a figure slightly lower than the national average, a lot of relevant data is missing, making it impossible to fully understand how pervasive the issue is for various communities. Notably, there is no breakdown of this state data by race, so researchers must rely on inferences from national data and anecdotal state evidence.
Between 2017 and 2019, the US reported 14.1 white maternal deaths per 100,000. Black women faced a mortality rate nearly three times as high, with 39.9 Black maternal deaths per 100,000. This racial disparity has existed for decades. Even when controlling for educational attainment and income, Black mothers are still nearly three times more likely to die within a year of childbirth than their white peers. This severe gap is harrowing and indicative of deeply ingrained racial and structural problems that no level of access to care has addressed thus far.
There are many concerning unknowns in West Virginia, which makes it incredibly difficult to shape nuanced policy that is responsive to the needs of mothers across the state. National statistics collected during the COVID-19 pandemic indicate that the racial disparity in maternal mortality has only widened in recent years, illustrating the compound effects of long-standing health care inequity. While it is clear that the elevated uninsured rate among rural Black West Virginians and the state’s obstetrics care shortage impede access to necessary pre- and post-natal care, national data indicates these factors are not the only ones contributing to Black maternal mortality.
Without more detailed data, it is impossible to precisely understand what is happening in West Virginia and how significantly Black and other minority mothers in the state are harmed by the problem. While we are lacking some state-level data, the racial disparities in infant and maternal deaths in our state and around the country are undeniable. Eliminating racial inequities requires advocates, government leaders, and those most impacted to come together to demand an explanation for the missing data and put forth community-rooted ideas for solutions.
Would you like to learn more and share your experience?
Join our community conversation on July 21, 2023, at noon. All are welcome, particularly Black families and families of color who’ve experienced infant and maternal loss, inaccessible or biased health care, or are passionate about these issues.
We need your voices and expertise. Register here: bit.ly/IMMR-WV. We hope to see you soon!