Black babies have a greater chance of survival when the hospital doctor in charge of their care is also black, according to a new study.
In the US, babies of colour face starkly worse clinical outcomes than white newborns.
Earlier research from the Centers for Disease Control and Prevention (CDC) published last year shows that black babies are more than twice as likely to die before reaching their first birthday than white babies, regardless of the mother’s income or education level.
While infant mortality has fallen overall in the past century thanks to improvements in hygiene, nutrition and healthcare, the black-white disparity has grown.
Multiple interrelated factors which contribute to these disparities include structural and societal racism, toxic stress and cumulative socioeconomic disadvantages.
The new study published in the Proceedings of the National Academy of Sciences suggests the race of the attending doctor also plays an important role.
Researchers reviewed 1.8m hospital birth records in Florida from 1992 to 2015, and established the race of the doctor in charge of each newborn’s care.
When cared for by white doctors, black babies are about three times more likely to die in the hospital than white newborns.
This disparity halves when black babies are cared for by a black doctor.
Strikingly, the biggest drop in deaths occurred in complex births and in hospitals that deliver relatively more black babies, suggesting institutional factors may play a role.
The study found no statistically significant link between the risk of maternal mortality – which is also much higher for black and brown women – and the race of the mother’s doctor.
Why race concordance is so important in black infant mortality requires further research, but it may enhance trust and communication between doctor and mother, and black doctors may be more attuned to social risk factors and cumulative disadvantages which can impact neonatal care, according to Brad Greenwood, lead author from George Mason University in Virginia.
Unconscious racism among white doctors towards black women and their babies may also be at play.
For white newborns, the race of their doctor makes little difference to their chances of survival.
Despite the stark findings, black women seeking a black doctor to minimize the risk to their babies will struggle as the medical workforce remains disproportionately white. Only 5% of doctors are black, according to the Association of American Medical Colleges.
The research underlines the urgent need for more diversity in the medical workforce, according to Greenwood.
“Inasmuch as research suggests stereotyping and implicit bias contribute to racial disparities in health outcomes, the work also highlights the need for hospitals and other care organizations to invest in efforts to reduce such biases and explore their connection to institutional racism,” he added.
The findings mirror clinical outcomes seen by Dr Arthur James, retired obstetrician/gynecologist and former head of the Ohio State University Kirwan Institute for the Study of Race and Ethnicity.
James was part of a group of black hospital obstetricians contracted to care for poor uninsured patients in eastern Michigan, where in 1980, black babies were dying at five times the rate of white babies. By the mid to late 1990s, the racial disparity had fallen to 1.4, despite a greater proportion of challenging births.
James said: “As black physicians we attended the same churches, barber shops, beauty salons, our children attended the same schools … this sense of community cultivates an entirely different level of relationship and accountability. The feeling that your provider genuinely cared for you is important … and, in my opinion, is more easily realized when racial concordance and genuine relationship is present.
“Kudos to the authors for raising an important and often overlooked potential contributor to improved birth outcomes,” added James.
Overall, US ranks 30th among the 33 OECD countries for infant mortality, with only Mexico, Turkey and Chile doing worse. A CDC report published last year found that over 22,000 American babies died before their first birthday in 2017. Black babies died at a rate of 10.97 per 1,000 births – more than twice the rate for white, Asian or Latin newborns.