memphis infant mortality

This is the sort of stuff that in my utopia, would be required reading for anyone holding any public office in Memphis…

From the first PDF that comes up under this google search:

Racism is a living legacy—a history that has become part of the lived experience, not only of African Americans, but of every American. We have developed a pattern of how we relate—or fail to relate—to one another. And it is most evident in tropes that we have invented for women of color. We make reference to them as Jezebels, Aunt Jemimas, welfare queens. These tropes are alive in public policy, manifesting as policies that fail to consider the lived experiences of women, particularly women of color.








To resist changing the social circumstances— the nature of relationships between us—we medicalize social problems, acting as if the problems are medical in nature and in need of a medical response. This has been part of the history of infant mortality rate analysis.

There is awareness that social relationships, the social environment, can be toxic to mothers and their infants. But we decide, consciously, that it is too hard to change that social environment, so we just try to educate women to adapt to the circumstances.



To develop effective policies, we must take relationality and women’s experiences in relationships into account. There is a difference between sending bread to a sister, and breaking bread with a sister. There is a difference between creating policy for women, and co-creating policy with women. And there is a difference between creating a policy that says, “Let’s educate women about prenatal care,” versus “What can we learn from women about their experiences before, during, and after pregnancy?”

What we are learning—or relearning— is not new. Throughout the history of reform efforts to prevent infant mortality, there has been a more or less explicit awareness that there are larger, more complex social forces adversely affecting the health of women and children. We have learned this from women long ago. That we have ignored it is problematic.


And a little bit later, about halfway down the PDF, there’s an interesting interview with Dr. Collins and Dr. David…

 …My colleagues and I found that African American women who delivered preterm, very low birthweight infants had approximately a two-fold greater lifelong exposure to racial discrimination than African American women who delivered term, normal birthweight infants.



















Dr. David: 

The take-home message  from our work over many years is that disparities in birth outcomes between African Americans and whites are just part of the story, but they tell us about deep-seated problems with American society. These problems lead to excess deaths for babies of both races. If African American infants had the same life chances as white infants, it would mean about 4,500 fewer African American infant deaths each year. But if white American babies had the same survival rate as infants born in other countries, 10,000 fewer white infants would die annually.











Dr. David: The high rate of prematurity and low birthweight among babies born to well-educated and welloff African American women was truly a surprising—and disappointing— finding when it was first demonstrated some decades ago. But it just tells us how pervasive and deep-rooted the effects of discrimination are. The idea that race is just a marker or indicator for socioeconomic status is false and simplistic. Race is part of a person’s  socioeconomic status if they live in a racialized society like ours. Because of racial divisions among the population at large, the condition of non-black women is driven down also. Lack of solidarity among middle- and lower incomepeople of various races makes it possible to prevent reforms favored by the vast majority, such as universal health care.








Our research has shown that African American infant girls whose parents live in poor neighborhoods grow up to have an increased risk of having a low birthweight baby themselves, even if they are no longer poor as adults. The beginning of the solution, I feel, is to forge social and political unity across racial lines so that the vast majority of people in this country, of all races, can be in a position to demand social justice—of which universal, high quality health care is only a small part.









In case no one has seen it before…,2845,MCA_25340_4757196,00.html

The babies are buried with a backhoe, as many as eight at a time, in homemade pine boxes.

Like a giant steel hand, the machine’s claw pats the soil as it covers the tiny coffins with dirt, tucking them in one last time.

Here at the Shelby County Public Cemetery, just outside the view of Memphis’s gleaming symbol of prosperity, Wolfchase Galleria, this 30-acre burial ground for the poor holds 14,000 bodies – most of them infants in graves marked only by numbers.

Caretaker Robert Savage, a gentle man with an unthinkable job, toils week after week with a modern-day plague.

Memphis has the highest infant mortality rate among the nation’s 60 largest cities. Babies here die at twice the rate of the national average.


Several Memphis ZIP codes have infant death rates higher than scores of Third World countries. North Memphis’ 38108, which includes the tattered communities of Douglass and Hollywood, is deadlier for babies than Vietnam, El Salvador and Iran.

Infant mortality is the barometer of a community’s ills: poverty, pollution, crime, lack of education, access to health care and safe, affordable housing.

In Memphis, the nation’s infant death capital for at least a decade, efforts to confront these problems have been small and splintered.

There has been no comprehensive effort to curb the problem.

Programs have come and gone as funding has come and gone.


Steve Cohen has been on it. We need a mayor dedicated to helping his efforts.

And for the record, it’s not “mothers behaving badly” (i.e. “crackheads” etc) causing it. It’s not “lack of access to healthcare”, either. (all of this was quite a shock to me)

From the full text of this:

(the footnote says:




*Address by Dr. Ronald David to Congressional Staffers of Congressman Steve Cohen, US House of Representatives, Washington, DC, USA, October 16, 2007. E-mail:







Mayor Caliguiri asked himself: How do we account for this paradox? Arguably, health care services in Pittsburgh were among the best in the nation and the world yet our infant mortality rates, especially for women of color, were abysmal. In response to the conundrum Mayor Caliguiri convened a consortium of civic leaders, including journalists, educators, social scientists, and labor and business executives. I was one of two physicians appointed to the consortium.

This is what we learned in Pittsburgh: The paradox was more apparent than real. Healthy pregnancy outcomes have little to do with access to health care. Moreover, the consortium found that contrary to conventional wisdom, poor pregnancy outcomes could not be attributed initially or primarily to ignorant, immoral, or irresponsible maternal behavior.

I want to repeat that slowly, deliberately, and succinctly: Poor pregnancy outcomes and infant mortality are not a consequence of poor prenatal care or mothers behaving badly.


He elaborates more later…




In summary, the Commission discerned three sturdy and interwoven strands of ideology running throughout the history of gathering and interpreting infant mortality data. The first strand that most explicitly continues to inform public policy today is the notion that pregnancy is a pathological condition, or so nearly so that it requires medical supervision.

The second strand lifted up for examination is distinctly misogynist and not so silently portrays women, especially women of color, as ignorant, immoral, and/or incompetent to the task of childbearing and childrearing. The third strand examined was the most subtle yet consistent and consistently ignored. That is, throughout the history of infant mortality studies an awareness is evident that toxic social relationships, social conditions, or both adversely affect maternal and child health.


In formulating a more comprehensive and complex perspective, the Commission turned to the concept of relationality. Relationality is a concept which asserts that human beings are by nature interdependent, relational beings. Anything that undermines the human experience of healthy relationships threatens growth and survival.

As one of the Commissioners poignantly summarized our understanding of infant mortality, babies are dying because their mothers are dying. Their mothers are in dead relationships.

Now, lest your minds race to images and fantasies of the dysfunctional black family let me hasten to clarify that the relationships about which the Commission speaks include, but greatly transcend, domestic relationships. Indeed, it is the Commission’s belief that domestic relationships are affected and infected by the culturally and socially toxic experiences of racism, misogyny and its attendant sexism, and income inequality that is itself a pale proxy for social inequalities more generally. These tears in the fabric of relationships are what make childbearing and child rearing such hazardous travails.




More can be read here.