Family Structure: How Does it Impact Black Infant Mortality?

By Courtney Wise

“Black babies died at a 4.5 times higher rate than white infants in Kalamazoo County over the last three years, up from 2 to 3 times higher rate about 20 years ago” (Mcmichael, 2015). How did this happen? Why does this rate keep on rising? In this section, the aspects of family structure and its impact on black infant mortality will be explored. This section includes structural violence, access to health care, single motherhood, poverty and the prison-industrial complex.

An Introduction to Family Structure and Structural Violence

Family structure refers to the combination of relatives that comprise a family (Statistics Canada, 2015). This includes parents, offspring and other relatives, such as grandparents, aunts and uncles. Being able to plan the structure of one’s family is an essential right to one’s humanity. The UN states that “Access to safe, voluntary family planning is a human right. Family planning is central to gender equality and women’s empowerment, and it is a key factor in reducing poverty” (UNFPA, 2015). Thus, it is crucial for women to be able to access health care, specifically reproductive health care in order to gain equality.

However, for women, specifically black women, accessing health care can be easier said than done. This is due to various structural hoops a black woman must jump through in order to gain access to what is her right as a human. These structural hoops are often referred to as “structural violence” which “describes social structures—economic, political, legal, religious, and cultural—that stop individuals, groups, and societies from reaching their full potential” (Farmer et al., 2006).

It is important to highlight structural violence in terms of family planning because throughout our interviewing process, there was a lot of blame that health care workers would place on women for getting pregnant. For instance, one health care worker said, “I wouldn’t say that they’re all unplanned but it’s the lack of responsibility on the person who is actually having sex because you can go and get condoms that’s for free, I mean they are right there for you to get. That is planned to me. If you don’t try and prevent it, it’s planned.” Having this perspective, especially as a health care worker, can have detrimental effects and can perpetuate harmful attitudes towards mothers who, due to structural violence, are limited in their ability to access the family planning resources that they need.


A Look at Kalamazoo County Families

“In Kalamazoo County, 37 percent of white babies are born to unmarried women compared to 26 percent nationwide. For blacks, the corresponding percentages are 60 percent locally and 68 percent nationally, according to the Census data” (Mack, 2013). Although these numbers do not take into account cohabitation and couples who chose to not get married, these statistics give us a hint of how black mothers are more often single than white mothers.

Single black mothers face unique challenges in combatting a variety of issues that may determine their infant’s health. “Being the head of a single-parent household with little or no father involvement, dealing with fragmented systems to get unfriendly family support services, living in neighborhoods where neighbors do not know or look after one another, and residing in communities with concentrated poverty, high crime rate, poor housing, no parks, limited bus services, and inadequate day care add to the daily wear and tear many African American mothers experience” (Lu et al., 2010). This echoes a comment made by a health care worker that was interviewed for our project: “It’s that some young moms, or not just young, but some single—it’s the single mom being the sole caregiver and responsibility for these children, besides going to school or working, or both, and taking care of a child: worrying about daycare, worrying about money, all of those social cofactors.”

“85 percent of black women giving birth in Kalamazoo County live in poverty; that percentage is 30 percent for white women” (Mcmichael, 2015). In addition, black mothers often work jobs that do not grant paid or unpaid maternity leave, so they are confronted with the “choice” of working away from home to financially provide for their children, or actually being able to stay home and take care of their children. This is also true in the case of prenatal care – a black mother in Kalamazoo County would have to have both reliable transportation and time off from work in order to make her appointments. “Expectant mothers who are black and poor in Kalamazoo County have a 3.7 times increased risk for birthing underweight babies” (Mcmichael, 2015). Thus, mothers who are single, black and poor are disproportionately affected by higher rates of infant mortality, because of the difficulty of reaching the resources out in Kalamazoo County aimed at helping her.

“Black women losing babies locally tend to grapple with inadequate nutrition and prenatal care as well as stress (“the stress of living poor, the stress of living black”)” (Mcmichael, 2015). This echoes a statement made in a focus group with community members: “[In response to why the hospital workers would send home an African American baby before it seemed ready to go home] “That’s because we’re African Americans. I’m sorry to say, it’s African Americans that they let go because we only receiving Medicaid.” This highlights an intersectionality between race and poverty – that not only are health officials discriminating against black mothers, but health care workers often do not spend enough time with Medicaid patients because they are seen as “lower-class citizens” (Mcmichael, 2015).

The prison industrial complex and the criminalization of black bodies has negatively impacted black people in Kalamazoo County, and thus has impacted the role in which a black parent can play in the lives of their children. An American Civil Liberties Union (ALCU) study on the marijuana possession arrest rate showed that Kalamazoo County had one of the highest rates of racial disparities in the arrest for marijuana possession – blacks in Kalamazoo are 8.5 times more likely to get arrest for possession vs. whites. In comparison, Wayne County, Michigan’s most populous county, the ACLU study found that blacks were 1.9 times more likely to be arrested than whites (ACLU, 2013).

These statistics lead one to believe that Kalamazoo County has an institutionally racist criminal justice system. One community member, when being interviewed, spoke about this in terms of black infant mortality: “[After being in the hospital and giving birth] “… another black person, black baby gone—Bye-bye. So we ain’t got to worry about that baby growing up, carrying no gun, or being a hoe on the corner. That’s just how I look at it. That’s my point.” This brings up how integral it is to not just focus on black babies, but to also focus on what happens when black babies grow up in Kalamazoo County – to focus on what happens to black females before they are mothers. Lu et al. have created a method to address this by creating a 12-point plan called the “life-course approach” that seeks to go “beyond individual-level interventions and move beyond the biomedical model to address the social and economic inequities that underlie much of health disparities” (Lu et al., 2010).


As I discussed in the introduction, providing resources and making those resources accessible to women to plan their families is a necessity. In terms of academia and other research done on black infant mortality, “further work is needed to ensure that racism measures in birth outcome studies adequately capture women’s childhood experiences, the potentially enduring impact of those experiences, perceptions of institutionalized racism and internalized negative stereotypes, women’s vicarious experiences specifically related to their children, and the pervasiveness and chronicity of African-American childbearing women’s racism experiences” (Lu et al., 2010).

Throughout our interviews, we found a consistent theme that health care workers were often unaware of the ways structural violence impacts a black mother’s life. Because of this, there appears to be a disconnect between what community members say and what health care workers say. I think this is attributed to a lack of grounding trust. As a community member put so poignantly: “I think people as far as workers, that do some of the things like home visits forget about building a rapport first because if someone doesn”t really trust you it”s very unlikely that they are going to do what you say or use your advice.” Perhaps if both health care workers and community members were to work more closely with the YWCA and develop a better understanding of how sexism, racism and poverty can negatively impact a black mother’s life, there would be a greater foundation of trust that could be built. Within the interviewing process, a community member made the remark that, “I honestly feel like it takes a village to raise a child. We need to come together as a community,” and that is only possible if we all take responsibility in wanting to understand the ways in which structural violence that makes the black infant mortality rate in Kalamazoo County so high.