Food for Thought : Food Insecurity and Infant Mortality

This is a decline of 4% from 2017 (22,341). The infant mortality rate declined to 5.67 deaths per 1,000 live births in 2018, down 2% from the 2017 rate of 5.79, making the 2018 infant mortality rate the lowest reported in U.S. history.

Overall, the infant mortality rate (IMR) has decreased drastically in recent years.

And yet, Black babies are dying at disproportionately higher rates than White babies.

The Black-White rate ratio for infant deaths per 1,000 live births was ~1.8 in 1915, and increased to ~2.2 in 2017, in which 4.67 White infants died per 1,000 live births as opposed to 10.97 Black infants.

To sum this up, in a 1988 Boston Globe newspaper, an article revealed that Massachusetts was ranked among the top 10 states with the lowest overall infant mortality rates in the year 1985. And yet, the state had the 7th worst mortality rate among Black infants in the nation (approximately 2.5 times higher than the White infant mortality rate).

So while the absolute numbers are decreasing, underneath the surface, the racial gap is widening.

The Food and Agriculture Organization of the United Nations writes that a person is considered food insecure when they lack regular access to enough safe and nutritious food for normal growth and development and an active and healthy life. Food insecurity may be due to unavailability of food and/or the lack of resources to obtain sufficient amounts of food. Food insecurity can also be experienced at different levels of severity.

According to Feeding America, in 2019, just before the COVID-19 pandemic, 10.9% of the US population experienced food insecurity. Of these 35 million people, 1 in 11 were White, non-Hispanic individuals, while 1 in 5 were Black individuals. Below are more statistics showing the inequality in who experiences food insecurity and the subsequent harmful effects.

Though some may point to racial genetic differences to account for health disparities resulting from food insecurity, with the advancement of technology, the racial-genetic explanation is untenable for explaining broad population differences in this case (Dressler 2005).

Here are just 3 quantitative and 3 qualitative factors that actually contribute to the disparity:

While these are all important factors that contribute to the disparity, one of the fundamental causes is residential segregation.

Morello-Frosch and Lopez (2006) argue that communities of color who are segregated in neighborhoods with higher levels of poverty and material deprivation are disproportionately exposed to a physical environment that adversely affects health and well-being. This environment may have fewer supermarkets and nutritious, fresh produce options, for example.

Their conceptual framework connects a spatial form of social inequality (racial segregation) to community-level conditions that unevenly expose communities of color to environmental hazards and various stressors.

Take the city of Chicago, for example.

"Today, more than half the Black population in Chicago lives in only 20 of the city's 77 residential communities." - Natalie Moore, 2016

In Natalie Moore's book, The South Side: A Portrait of Chicago and American Segregation (2016), she writes that today, more than half the Black population in Chicago lives in only 20 of the city's 77 residential communities. This statistic in residential segregation corresponds directly to areas of economic hardship and food insecurity, as seen below, revealing a link between these three factors. Unfortunately, this connection between race, socioeconomic status, and food is not unique to Chicago.

According to the Impact of Food Insecurity and Hunger on Global Health: Issues for Congress, indirect consequences of high food prices and food insecurity include, but are not limited to: deeper poverty, declines in agricultural productivity, increases in rural to urban migration, and declines in school attendance. They also lead to declines in future learning and earning capacity, which can lower cognitive capacity, increase the risk of adult poverty, create poorer nutritional conditions for the next generation, and thus, perpetuate the cycle of hunger.

There is also an economic impact. According to Dr. Mark Hyman, the cost of food insecurity is estimated to be $160 billion annually, not including the $70 billion spent yearly on SNAP, a type of supplemental nutrition program.

However, food insecurity also has significant impacts on pregnancy outcomes, such as infant health and mortality. Since food insecurity disproportionately affects Black Americans, this also has a disproportionately larger affect on Black pregnant women and mothers.

Food insecurity leads to pregnancy complications which can lead to infant mortality.

Inadequate nutrition, stemming from a lack of access and education, can lead to adverse pregnancy outcomes. For example, maternal diabetes can lead to congenital anomalies in the infant; poor dietary control of blood sugar during organogenesis can lead to birth defects; nutritional deficiencies can cause anemia; obesity is a precursor to preeclampsia; and low-BMI in the mother can result in fetal growth reduction.

These adverse health outcomes can lead to infant mortality. In the US, three of the five leading causes of infant mortality are birth defects, low birth weight, and sudden infant death syndrome (SIDS), all of which are impacted by maternal nutritional status.

Based on multiple experimental animal studies and observational human studies, maternal nutritional deficiencies are most influential to fetal growth and birth outcomes at the very earliest embryonic stages.

One way to prevent this is through federally-funded supplemental nutrition programs.

"Data shows preterm labor and infant mortality decrease if we provide housing and food to pregnant mothers, and this reduces overall health care costs." -Dr. Mark Hyman, Food Fix (2020)

Established in 1972 and funded by the USDA, WIC helps low-income pregnant and post-partum women, infants, and children up to age 5 who are nutritionally at-risk. They do this by providing health education, breastfeeding support, peer counseling, phone hotlines, doctor referrals, as well as a monthly prescription of nutritious foods.

Eligible mothers must live in the state in which they apply, have an income at or below an income level set by the stage agency, and be assessed by a health professional who determines the individual is at nutritional risk. This can be done in the WIC clinic at no cost to the applicant.

Studies show that the WIC program, which focuses on aspects of nutritional health, reduces conditions associated with infant mortality such as low birth weight.

WIC benefits have also been shown to have a greater effect on Black participants, which is especially notable when debating strategies to close the racial health gap.

Though not enough to fully overcome the negative effects of low socioeconomic status on diet quality, WIC has still shown to reduce the risks of preterm birth and LBW, particularly among women in the highest risk groups.

Click below to learn about other factors maintaining the racial health disparity in infant mortality in the US.

These sources were used to develop the content on this page

1. https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf 
2. “South Side: Moore, Natalie Y: 9781250118332: Amazon.Com: Books,” accessed November 28, 2021,  https://www.amazon.com/South-Side-Portrait-American-Segregation/dp/1250118336/ref=sr_1_1?keywords=natalie+moore+south+side&qid=1638160167&qsid=130-7141124-7164615&s=books&sr=1-1&sres=1250118336%2CB01K0TTMO0%2C1642596515%2C148383123X .
3.  https://www.fao.org/hunger/en/ 
4.  https://www.everycrsreport.com/reports/R40127.html#_Toc222631531 
5. https://academic.oup.com/epirev/article/32/1/5/492553 
6. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm 
7. https://www.fns.usda.gov/wic/wic-eligibility-requirements 
8.  https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf 
9. https://www.annualreviews.org/doi/pdf/10.1146/annurev.anthro.34.081804.120505 
10. Sally Jacobs, Globe Staff. "Infant Deaths Hit Low, but Racial Disparities Still seen." Boston Globe (1960-), Mar 04, 1988. http://proxy.uchicago.edu/login?url=https://www.proquest.com/historical-newspapers/infant-deaths-hit-low-racial-disparities-still/docview/2227914803/se-2?accountid=14657.
11. Dr Mark Hyman MD, Food Fix: How to Save Our Health, Our Economy, Our Communities, and Our Planet--One Bite at a Time, Illustrated edition (New York: Little, Brown Spark, 2020).
12.  https://www.aucd.org/docs/resources/im-maternalnutrition.lu.pdf 
13.  https://www.nwica.org/overview-and-history 
14.  https://s3.amazonaws.com/aws.upl/nwica.org/wics-role-reducing-infant-mortality.pdf 
15.  https://www.chicagosfoodbank.org/blog/the-1-in-5-a-mothers-story/