Low Birth Weight Racial Disparity in United States

United States

Low birth weight infants (infants weighing less than 2,500 grams at birth) are at increased risk of several short- and long-term complications. Low birth weight and preterm birth are both leading causes of infant mortality. 

Significant and persistent racial and ethnic disparities exist in birth outcomes such as low birth weight, preterm birth and infant mortality. Socioeconomic status does not solely explain racial disparities in low birth weight, as rates are higher among Black women even after controlling for socioeconomic status. Research has revealed that genetics do not play a role in this disparity, since Black infants born in Africa have much lower rates of low birth weight than those born in the United States.

Research has shown that higher lifetime exposure to chronic stressors, such as interpersonal and institutional racism, increases the risk for poor pregnancy outcomes among Black women. Racial discrimination may reduce access to protective clinical and social resources such as adequate prenatal care, employment ,educational opportunities and stable housing. Experiencing a lack of social support, psychosocial stress, or unsafe and unhealthy environments at any time in a woman’s life, especially in the period leading up to pregnancy, may independently or collectively contribute to adverse birth outcomes.

According to America’s Health Rankings analysis, the percentage of infants born with low birth weight is two times higher among non-Hispanic Black women compared with non-Hispanic white women.

Health professionals can implement initiatives to reduce the racial disparity in premature births, such as prenatal care groups located in neighborhood clinics, which aim to provide primary health care and social support for Black pregnant women. Other programs, like the Health Resources and Services Administration's Healthy Start Initiative, focus broadly on providing education, emotional support, access to high-quality health services and comprehensive care during pregnancy and the postpartum period tailored to the unique needs of Black women. 

Expanding doula services through Medicaid or state programs can improve delivery outcomes by shortening labor, reducing complications, increasing breastfeeding initiation and reducing the rate of low birth weight. 

Supporting a diverse health care workforce builds trust and improves birth outcomes by providing care that includes patients' cultural backgrounds and needs. 

Various federal programs exist to support women's needs outside of doctors’ offices like financial, housing and nutrition assistance. Participation in WIC — a supplemental nutrition program for women, infants and children — is associated with higher birth weight and higher breastfeeding rates.

Healthy People 2030 has several objectives related to pregnancy and childbirth, including reducing preterm births and reducing infant mortality.

Alhusen, Jeanne L., Kelly M. Bower, Elizabeth Epstein, and Phyllis Sharps. “Racial Discrimination and Adverse Birth Outcomes: An Integrative Review.” Journal of Midwifery & Women’s Health 61, no. 6 (November 2016): 707–20. https://doi.org/10.1111/jmwh.12490.

David, Richard J., and James W. Collins. “Differing Birth Weight among Infants of U.S.-Born Blacks, African-Born Blacks, and U.S.-Born Whites.” New England Journal of Medicine 337, no. 17 (October 23, 1997): 1209–14. https://doi.org/10.1056/NEJM199710233371706.

Hill, Latoya, Samantha Artiga, and Usha Ranji. “Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them.” Issue Brief. KFF, November 1, 2022. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/.