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Topics in Minority Health Ethnic Variation and Maternal Risk Characteristics Among Blacks --- Massachusetts, 1987 and 1988
Blacks are the largest minority group in the United States. For black women the prevalence of risk characteristics associated with adverse birth outcomes is higher than it is for women of other races (1,2). Although risk characteristics for black mothers vary by place of ancestry/ethnicity, the relation between these characteristics and ethnicity among black mothers is not well defined (3). This report describes an assessment of the relation between risk characteristics and ethnicity among black women who resided and gave birth in Massachusetts during 1987 and 1988.
To assess this relation, the Massachusetts Department of Public Health (MDPH) used birth certificates for infants of women who were residents of Massachusetts and delivered during 1987 and 1988. The parent questionnaire contains questions on both race and ancestry/ethnicity. A total of 12,066 mothers identified their race as black. Based on MDPH classifications, these women further self-identified their ancestry/ethnicity into one of six mutually exclusive groups: American (7473 (61.9%)), Haitian(1626 (13.5%)), West Indian (1079 (8.9%)), Cape Verdean (574 (4.8%)), Hispanic (420 (3.5%)), and other ancestries (894 (7.4%)). Variables examined by MDPH included maternal age at delivery, maternal marital status, maternal education, and adequacy of prenatal care.*
Risk characteristics of black mothers varied by ethnic group. The percentage of births to teenagers (i.e., births to women aged less than or equal to 19 years) was highest for American mothers (21.7%), approximately eight times that for Haitians, 2.6 times that for West Indians, and 1.2--1.4 times that for Hispanics and Cape Verdeans (Table 1). Births to unmarried women were also most prevalent for American mothers (70.5%)---more than twice that for Haitians (32.4%) and 1.6 times that for West Indians (44.4%). However, the percentage of women with less than 8 years of education was highest for Cape Verdean (18.6%) and Haitian mothers (10.2%) and lowest for American mothers (1.3%).
The proportion of mothers who received adequate prenatal care varied less by ethnicity and was 62.0% in West Indian, 61.6% in other ancestry, 56.4% in Haitian, 54.6% in American, 53.8% in Hispanic, and 45.1% in Cape Verdean mothers. Mothers least likely to be foreign-born were American (3.0%) and the most likely, Haitian (99.2%) (Table 2). Within ethnic groups, maternal birth place was related to risk characteristics (Table 2). For all ethnic groups, mothers born on the U.S. mainland were more likely to be teenagers and unmarried. Conversely, for all ethnic groups, higher proportions of mothers who were not born on the U.S. mainland had less than 8 years of education. Reported by: DJ Friedman, PhD, BB Cohen, PhD, VH Dunn, MD, RI Lederman, MPH, C Mahan, PhD, HR Spivak, MD, EB Trudeau, Massachusetts Dept of Public Health. Div of Reproductive Health, Center for Chronic Disease Prevention and Health Promotion, CDC.
Previous reports have described variations in maternal risk characteristics and infant outcomes among Hispanic mothers in relation to national ancestries (4,5) and maternal place of birth, as well as the association between levels of acculturation and health behaviors (6--8). These reports indicate that Hispanics are heterogeneous in terms of maternal risk characteristics, health behaviors, and infant outcomes and that these factors vary by ethnic group, place of birth, and acculturation.
In contrast to methods used to study Hispanics, classification schema and research efforts that focus on blacks have generally assumed ethnic homogeneity. However, the findings in this report indicate substantial ethnic heterogeneity among black mothers in Massachusetts and variations between ethnic heterogeneity and maternal risk characteristics. This report also documented that, within specific ethnic groups, the relation between maternal place of birth and risk characteristics varied. Finally, the MDPH findings suggest that current classification schema for assessing health status among blacks in the United States may be incomplete and that ethnic identification and national ancestry among blacks may be important variables affecting maternal risk characteristics. These findings are consistent with other reports indicating that health behaviors may vary by ethnicity: for example, foreign-born women have reported lower rates of smoking and other substance misuse during pregnancy than U.S.-born women (3). In addition, national data have demonstrated that outcomes are better for infants of foreign-born black mothers than for infants of U.S.-born black women: low birth weight is 36% lower, and infant mortality is 28% lower (9).
Neither race nor ethnicity has been adequately characterized for use in public health (10). Even though the use of race and ethnicity for self-reported data, such as birth certificates, may overlap, these variables have distinct implications for identifying maternal risk. Improved understanding of these terms should assist in clarifying the relation between maternal risk characteristics and infant outcome, as well as other public health problems.
2. NCHS. Advance report of final natality statistics, 1988. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1990; DHHS publication no. (PHS)90-1120. (Monthly vital statistics report; vol 39, no. 4, suppl).
3. Cabral H, Fried LE, Levenson S, Amaro H, Zuckerman B. Foreign-born and US-born black women: differences in health behaviors and birth outcomes. Am J Public Health 1990;80:70--2.
4. Ventura SJ, Taffel SM. Childbearing characteristics of U.S.- and foreign-born Hispanic mothers. Public Health Rep 1985;100:647--52.
5. Becerra JE, Hogue CJR, Atrash HK, Perez N. Infant mortality among Hispanics: a portrait of heterogeneity. JAMA 1991;265:217--21.
6. CDC. Childbearing patterns among Puerto Rican Hispanics in New York City and Puerto Rico. MMWR 1987;36:34,39--41.
7. Ventura SJ, NCHS. Births of Hispanic parentage, 1985. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1988; DHHS publication no. (PHS)88-1120. (Monthly vital statistics report; vol 36, no. 11, suppl).
8. Scribner R, Dwyer JH. Acculturation and low birthweight among Latinos in the Hispanic HANES. Am J Public Health 1989;79:1263--7.
9. Kleinman JC, Fingerhut LA, Prager K. Differences in infant mortality by race, nativity status, and other maternal characteristics. Am J Dis Child 1991;145:194--9. 10. Crews DE, Bindon JR. Ethnicity as a taxonomic tool in biomedical and biosocial research. Ethnicity and Disease 1991;1:42--9.
*Adequacy of prenatal care was defined through the Kessner Index; adequate care refers to women with nine or more prenatal care visits, with those visits beginning during the first trimester.
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