Maternal and Infant Mortality: How we are Failing Black Women and Children

The United States continues to have the highest rates of maternal and infant mortality among developed countries.[1] However, maternal and infant mortality rates do not impact all racial and ethnic groups equally.[2] In fact, maternal and infant mortality rates for Black women and children are significantly higher compared to other racial or ethnic groups.[3]

While global rates of maternal mortality have steadily decreased since the 1990s, maternal mortality in the United States has increased, impacting all mothers but especially Black mothers.[4] For example, in New York “between 2006 and 2010 black women were 12 times more likely than white women to die from pregnancy-related causes,” an increase “from seven times more likely between 2001 and 2005.”[5]

In 2020, 861 women in the United States died due to maternal causes, an increase from 754 women in 2019 and 658 women in 2018.[6] This means that 23.8 women died per 100,000 live births in 2020.[7] When broken down by race, 55.3 Black women died per 100,000 live births compared to 18.2 Hispanic women and 19.1 White women per 100,000 live births during the same year.[8]

Although infant mortality rates have decreased since the 1800s, “the disparity between Black and White infant deaths today is actually greater than it was under antebellum slavery.”[9] In 1850, enslaved Black infants were estimated to die “at a rate 1.6 times higher than that of White infants.”[10] Yet, Black infant mortality rates in 2017 were more than 2.3 times higher than White infant mortality rates.[11]

In 2017, the overall infant mortality rate in the United States was 5.79 deaths per 1,000 live births.[12] However, infant mortality rates for Black children was 10.97 deaths per 1,000 live births, more than double the infant mortality rates for Hispanic (5.1 deaths per 1,000 live births) and White (4.67 deaths per 1,000 live births) infants.[13] Of the Black infants who died in 2017, approximately two-thirds died within the first 28 days of their life (neonatal deaths) and one-third died between 28 and 364 days after birth (post neonatal).[14]

Public health officials, medical experts, and social scientists have long pointed to social determinants of health as the cause for racial disparity in maternal and infant mortality rates. However, social determinants by themselves do not fully explain why Black women and children die at such higher rates than their White counterparts in the United States.[15] Instead, unconscious biases embedded in medical institutions amplify the problems involving social determinants of health, impacting the quality of medical care Black women and children receive.[16]

Research has shown that racism is one of the root causes of unequal health outcomes for people of color, “not simply the conditions in which people are born, grow, live, work, play, and age.”[17] In fact, researchers who study the infant mortality difference between Black and White babies have discovered “that controlling for maternal background factors” does not completely explain the racial disparity in infant mortality.[18] Additionally, racial disparities in maternal deaths for Black women persist “regardless of seemingly protective factors,” such as education.[19] Black, college educated women “are more likely to die from pregnancy-related causes than pregnant white, Hispanic, and Asian/Pacific islander women without high school diplomas.”[20] Unfortunately, “Black women, regardless of social or economic status,” have higher rates of maternal mortality.[21]

Every day in the United States Black women and children die because medical providers and institutions fail to listen to Black mothers and do not intervene to save Black women and children’s lives.[22] Cori Bush, a United States Congresswoman, explained how she and her two children almost became maternal and infant mortality statistics.[23] Bush alerted doctors to medical issues she was experiencing during her first pregnancy, but doctors ignored her, instead telling her to go home.[24] A week later, Bush went into preterm labor and delivered her son at 23 weeks gestation.[25] When Bush began going into preterm labor during her second pregnancy, a doctor told her “the baby was going to abort.”[26] Bush pleaded with the doctor to save her baby.[27] The doctor told her “‘Just go home. Let it abort. You can get pregnant again because that’s what you people do,’” clearly referring to Bush’s identity as a Black woman.[28] Fortunately, Bush and her children survived, but their stories stand as a testament to how racism continues to kill Black people.[29] Bush explained in her own words: “Every day, Black women are subjected to harsh and racist treatment during pregnancy and childbirth. Every day, Black women die because the system denies our humanity.”[30] Black women and children deserve better; Black women and children deserve to live.


[1] Jamila Taylor, Katie Hamm, Cristina Novoa & Shilpa Phadke, Eliminating Racial Disparities in Maternal and Infant Mortality: A Comprehensive Policy Blueprint1 (Ctr. for Am. Progress ed., 2019).; Jamila K. Taylor, Structural Racism and Maternal Health Among Black Women, 48 J. of L., Med. & Ethics 506 (2020).

[2] Evelyn J. Patterson, Andréa Becker & Darwin A. Baluran, Gendered Racism on the Body: An Intersectional Approach to Maternal Mortality in the United States, Population Rsch. & Pol’y Rev. 1, 2 (2022).; Reproductive Health: Infant Mortality, Ctr. for Disease Control & Prevention (Sept. 8, 2021), https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm#:~:text=Infant%20mortality%20is%20the%20death,for%20every%201%2C000%20live%20births.

[3] Taylor, supra note 11.;Rabah Kamal, Julie Hudman, & Daniel McDermott, What do we know about infant mortality in the U.S. and comparable countries? Peterson-KFF (Oct. 18, 2019), https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/.

[4] Patterson, Becker & Baluran, supra note 12.

[5] Robin Fields, New York City Launches Committee to Review Maternal Deaths, ProPublica (Nov. 15, 2017), https://www.propublica.org/article/new-york-city-launches-committee-to-review-maternal-deaths.

[6] Donna L. Hoyert, Maternal Mortality Rates in the United States, 2020, Nat’l Ctr. for Health Stat. (Feb. 2022), https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/E-stat-Maternal-Mortality-Rates-2022.pdf.

[7] Id.

[8] Id.

[9] Deirdre Cooper Owens & Sharla M. Fett, Black Maternal and Infant Health: Historical Legacies of Slavery, 109 Am. J. of Pub. Health 1342, 1343 (2019).

[10] Id.

[11] Kamal, Hudman, & McDermott, supra note 13.  

[12] Kamal, Hudman, & McDermott, supra note 13.  

[13] Id.

[14] Id.

[15] Kamal, Hudman, & McDermott, supra note 13.; Taylor, supra note 11 at 506, 511.

[16] Martin & Montagne, supra note 40.

[17] U.S. Dep’t of Health and Hum. Serv., supra note 26.  

[18] Kamal, Hudman, & McDermott, supra note 13.

[19] Keri Carvalho, Anna Kheyfets, Pegah Maleki, Brenna Miller, Siwaar Abouhala, Eimaan Anwar, & Ndidiamaka Amutah-Onukagha, A Systematic Policy Review of Black Maternal Health-Related Policies Proposed Federally and in Massachusetts: 2010—2020 9 Frontiers in Pub. Health 1, 2 (Oct. 2021).

[20] Id.

[21] Taylor, supra note 11 at 506, 511.

[22] Colleen Murphy, Congresswoman Cori Bush Shared Her Pregnancy Story — And It Highlights the Inequities of Birthing While Black, Health (May 7, 2021), https://www.health.com/condition/pregnancy/congresswoman-cori-bush-pregnancy.; Congresswoman Cori Bush (@RepCori), Twitter (May 6, 2021, 12:05 PM), https://twitter.com/RepCori/status/1390352127579594753?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1390352127579594753%7Ctwgr%5E%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.health.com%2Fcondition%2Fpregnancy%2Fcongresswoman-cori-bush-pregnancy.

[23] Congresswoman Cori Bush, supra note 2. 

[24] Id.

[25] Id.

[26] Id.

[27] Id.

[28] Id.

[29] Id.

[30] Id.

Effects of Social Media on Children

The children of today are growing up in a world that revolves around social media. Although there are benefits to being able to connect with others through the internet, there are also some risks to be aware of.

Dangers[1]:

  • Cyberbullying: This is bullying others through online means. Ramifications include low self-esteem and poor mental health. It is important to teach your children that people will say mean things, but that they should not pay them too much mind. It can be helpful to discuss the headspace of someone that might say something cruel to another, whether they are the victim or the bully.
  • Online Predators: Although it is hard to constantly monitor who your child may be talking to, it is important to discuss with them not to talk to strangers online. You can make them more aware by discussing certain things potential predators may say to them. This can include asking for personal information or asking to meet up. It can also be important to encourage your children to have private accounts, so that only those granted access to view their account can look at their pictures or other information they may post.
  • Sharing too much information: This is usually an issue because personal information is often shared in potentially harmful behavior. The ramifications of this include identity theft and predatory behavior. This is another important reason to encourage children to have private accounts on social media. Also, discuss with them what is and is not okay to post on their social media and why.
  • False marketing: This can be hard for children to gauge when something is fake marketing. It is important to research and explain to your children what to be aware of to avoid being tricked. A good rule of thumb is that if it seems too good to be true, then it probably is. It is important to again remind your child to not provide personal information without discussing it with you. Some false marketing are[2]:
    • Product Misrepresentation: This usually entails the product looking different or having different qualities than stated in the ad. The product’s color, size, and look are the things most often misrepresented.
    • Hidden Fees: These are any extra fees that are not stated in an ad or products that have falsely inflated prices so the seller can then advertise them as on sale.
    • Misuse of the Word “Free”: Most things are not free, and you will likely have to pay for something before receiving the product.
  • Dangerous viral trends: There is always some new trend that gets a lot of attention on social media and everyone wants to participate in it, but sometimes these trends can be dangerous. Also, most of these trends play directly into how adolescent brains are wired.[3] This is another area where it is important to talk with your child about what they are seeing on social media. It will give some insight into what the current trends may be and which ones they may be interested in participating in. You can also look into current trends yourself to stay up to date.

Although there are dangers that anyone using social media should be aware of, there can also be benefits to children using social media. They gain these benefits while also engaging in something they enjoy.

Benefits[4]:

  • Digital Media Literacy: This is the practice of interpreting digital media and discerning its accuracy and contextual implications. Skills learned include problem-solving, civic engagement, fact-checking, and research. The developmental benefits are language and literacy, cognitive development, and analytical thinking. Children learn to identify news and information distributed by reputable sources through social media. This can be a good way to discuss current events with children in the context of social media and to learn more about what they are being exposed to on social media platforms.
  • Collaborative Learning: This is any kind of learning done by joint effort. Skills learned include teamwork, emotional resilience, cooperation, empathy, and leadership. The developmental benefits are language and literacy and social skills. Studies have shown that the more children interact in collaborative learning online, the better their attitudes are towards technology.[5] This is especially important since technology is being engrained more into everyone’s daily life, whether through work or communication with others.
  • Creativity: This is using your imagination to make something, or develop an idea or concept. Skills learned include expanding understanding of the world around them, problem-solving, lateral thinking, self-expression, and communication. The developmental benefits are emotional regulation, cognitive perception, and strategic planning. Social media can play a huge role in a child’s creativity in the digital space. Some social media platforms (i.e., Tik Tok and Instagram) encourage children to create their own ideas in different ways that they enjoy, while also being able to share it with others.
  • Mental Health and Wellbeing:  This is a state when an individual realizes their own abilities, can cope with the normal stresses or life, and can work productively and contribute to their community. Social media is often viewed at as contributing negatively to children’s mental health and wellbeing. Unfortunately, that can be true for many children, but there are also some positive contributions to children’s mental health and wellbeing by using social media. It allows children to interact with likeminded people that can relate to their experiences. It can give children a more comforting way to engage with peers and discuss their thoughts and feelings.

Although most social media apps require users to be at least 13 years old, there are many children under the age of 13 that are on these social media platforms. But in a recent poll, parents shared that 50% of children 10 to 12 years old and 33% of children 7 to 9 years old use social media apps.[6] It is important to talk to children about what social media is and give them guidelines for how to use it.

If your child is old enough and social media is something they have expressed interest in, determine if you think your child is ready to be on social media platforms. Some ways to do this are by gauging their maturity level and how they interact with others such as friends at school.[7] If you are unsure, you can allow them to do a trial run on social media to see if it is something you think they would be able to handle. If you decide to allow your child to sign up for social media accounts, there are a few tips that have helped many parents limit the dangers of social media as much as possible.

Tips for Parents

Talk with your Child: It is important to be open and honest with your child about what social media is, what it is used for, and the dangers that come along with it. Determine why they are interested in having an account and what they would use it for. Also, continue to talk often once they do join social media platforms. Continuing to talk to your child allows them to feel like they can go to you and you also remain in the know about what they may be doing.

Be Aware and Monitor: Ensure that you are aware of what your child is doing on their phone and computer. There are a number of dangers on social media, as listed above, and you should do what you can to limit the chance of your child encountering those dangers. Especially, by ensuring that they are not speaking to strangers on the internet or giving out personal information. Having a conversation with your child about these things before allowing them to sign up for social media should reduce some of the actions they may engage in, but kids will be kids so being aware and checking for yourself what they are up to are still very important. There are apps that allow parents to monitor their child’s social media or you can simply scroll through the child’s tablet or phone to view their social media.

Limit Time: The American Academy of Pediatrics recommends limiting screen time to two hours a day for children.[8] There are apps that can limit the time spent on specific apps or the electronic device as a whole. These are great tools to give parents more control over their child’s social media presence. It is also important to understand what the screen time is taking time away from. For example, your child could be missing out on getting physical activity, face to face interactions, or learning time.

Go easy on yourself: Trying to figure out the best route to take when it comes to dealing with your child and social media is not easy. Talk with other parents to figure out what they do or ask for help if you’re struggling with what to do when it comes to navigating social media and keeping your child safe.[9] There are also podcasts and other websites that teach parents how to navigate social media with their children. In the end, do what you feel is best for you and your child.


[1] https://health.clevelandclinic.org/dangers-of-social-media-for-youth/

[2] brid.tv/false-advertising/

[3] https://cybersafetycop.com/how-to-talk-to-your-child-about-dangerous-social-media-challenges/

[4] https://www.whistleout.com.au/MobilePhones/Guides/Parenting-Dangers-and-Risks-of-Social-Media-for-Kids

[5] Noga Magen-Nagar & Miri Shonfeld, The impact of an online collaborative learning program on students’ attitude towards technology (2017).

[6] https://health.clevelandclinic.org/dangers-of-social-media-for-youth/

[7] https://health.clevelandclinic.org/dangers-of-social-media-for-youth/

[8] https://health.clevelandclinic.org/dangers-of-social-media-for-youth/

[9] https://health.clevelandclinic.org/dangers-of-social-media-for-youth/

Developing Resilience as a tool for Breaking the Cycle of Substance Use

Building Resilience & Reducing Harm, Sanford Inspirations, 2017

Developing Resilience as a tool for Breaking the Cycle of Substance Use

Children and youth with adverse childhood experiences include those that have experienced “all types of abuse and neglect, parental mental illness, substance use, incarceration, and domestic violence.”[1] These children and youth are at an increased risk of “developing both chronic diseases and substance use disorders.”[2] Recent studies reveal that 54% of youth age 12-17 used alcohol at least once and 41% had used marijuana while in care.[3] Additionally, youth currently in foster homes reported using drugs other than marijuana, including “hallucinogens (13.5%), stimulants (12.1%), non-street opiates (9.8%), and powder (5.5%) and crack cocaine (5.2%), all of which were higher than the comparison group.”[4] Additionally, youth in foster care “begin substance use at an earlier age than their peers who had not been in foster care,” placing them at an increased risk for developing substance dependence disorders.[5]

Many youth in the child welfare system turn to substance use as a way to cope with their past trauma experiences.[6] However, this coping mechanism has a detrimental and harmful effect on the lives of many youth who have been in the child welfare system. Substance usage not only puts youth at risk of developing substance disorders, but it also results in an increased risk of academic difficulties, difficulty building lasting relationships, and involvement with the juvenile justice system.[7]

Child welfare systems across the country have sought to address the issue of drug use among foster youth, but “no system has mastered the prevention of drug use among foster kids.”[8] Child welfare systems typically refer children and families to substance treatment programs ex post. Additionally, systems have began  (1) differentiating behaviors from underlying needs in order to better identify and address children’s needs, (2) collaborating with and integrating other systems, including the Department of Mental Health, and (3) placing children with the highest needs in group care with specially trained caregivers.[9] However, at a more granular level, resilience appears to be an underdeveloped tool that may help many youth break the cycle of substance abuse.

Resilience is “the ability to overcome obstacles, preserve through hardships, as well as the ability to balance negative experiences with positive factors that protect [a child’s] overall well-being.”[10] This skill allows youth to bounce back from difficulties and more easily adjust to change. Resiliencies have been grouped into seven categories: 

[1]Insight begins with a sense that life in the troubled family is strange. Such insight

can eventually protect the child from a tendency to internalize family troubles and feel

guilty.

[2] Independence is the child separating herself from the troubled family.

[3] Relationships fulfill needs that troubled families cannot meet.

[4] Initiative is the desire to overcome feelings of helplessness that a child can succumb

to in the troubled family.

[5] Creativity is the ability to take pain and transform it into something artistic and

worthwhile.

[6] Humor allows the child to make the tragic into something comic and laugh at his

emotional suffering.

[7] Morality is developing a set of principles that differentiates bad from good both

inside and outside the family.[11]

Resilience provides children and youth with adverse childhood experiences the ability “to fantasize about another time or place, [be] able to read and learn about a better time and place, realiz[e] that they are not responsible for the abuse directed at them, and hav[e] an adult in their life for a considerable period of time who sees them in a positive way.”[12] Furthermore, a 2012 article published in the Journal of Alcoholism: Clinicial and Experimental Research reported, “that relisiliency is related to lower levels of initial substance use, fewer problems with alcohol, and better working memory.”[13] Several characteristics of resilient youth (including high self-esteem, empathy, help-seeking, and self-awareness) overlap with “factors that deter children from engaging in harmful substances like tobacco, marijuana and alcohol.”[14] Thus, developing resilience in children in foster care could help some children break the cyle of substance dependence.

While resilience should not take the place of other court ordered services, supports, or treatment programs, it should be viewed as a vital skill that every child and youth in foster care is given the opportunity to develop. Furthermore, in seeking the best outcome for children in foster care, every individual (foster parents, attorneys, social workers etc.) in contact with the child should play an active role in helping the child build resilience by encouraging insight, independence, relationships, initiative, creativity, humor, and morality.


[1] Resilience Helps to Prevent Youth Substance Use (Feb. 24, 2020), https://accesshealthme.org/resiliency-helps-to-prevent-youth-substance-use/.

[2]  Id.

[3] Jordan M. Braciszewskia & Robert L. Stout, Substance Use Among Current and Former Foster Youth: A Systematic Review, Child Youth Serv Rev. (2012) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596821/.

[4] Id.

[5] Preventing, Identifying, and Treating Substance Use Among Youth in Foster Care (Oct. 2020), https://www.childwelfare.gov/pubPDFs/bulletins_youthsud.pdf.

[6] Understanding Substance Use Disorders—What Child Welfare Staff Need to Know, https://www.cffutures.org/files/nccan2019/web/usud/CWS_Practices_Tip_Guide%231_bg_cv.pdf.

[7] Consequences of Youth Substance Abuse (May 1998),  https://ojjdp.ojp.gov/sites/g/files/xyckuh176/files/pubs/drugid/ration-03.html.

[8] American Addiction Centers Editoria Staff, 3 Risk Factors for Foster Youth Drug Abuse (June 30, 2021), https://rehabs.com/blog/3-risk-factors-for-foster-youth-drug-abuse/.

[9]  Id.

[10] Resilience Helps to Prevent Youth Substance Use, supra note 1.

[11] Braciszewskia & Stout, supra note 3.

[12] Id.

[13] Resilience Helps to Prevent Youth Substance Use, supra note 1.

[14] Id.