title: Closing the Black-White gap in birth outcomes: a life-course approach.
abstract: In the United States, Black infants have significantly worse birth outcomes than White infants. Over the past decades, public health efforts to address these disparities have focused primarily on increasing access to prenatal care, however, this has not led to closing the gap in birth outcomes. We propose a 12-point plan to reduce Black-White disparities in birth outcomes using a life-course approach. The first four points (increase access to interconception care, preconception care, quality prenatal care, and healthcare throughout the life course) address the needs of African American women for quality healthcare across the lifespan. The next four points (strengthen father involvement, systems integration, reproductive social capital, and community building) go beyond individual-level interventions to address enhancing family and community systems that may influence the health of pregnant women, families, and communities. The last four points (close the education gap, reduce poverty, support working mothers, and undo racism) move beyond the biomedical model to address the social and economic inequities that underlie much of health disparities. Closing the Black-White gap in birth outcomes requires a life course approach which addresses both early life disadvantages and cumulative allostatic load over the life course.
authors.affiliation: Departments of Obstetrics and Gynecology, David Ceffen School of Medicine at UCLA, Los Angeles, CA, USA. mclu@ucla.edu
authors.forename: Michael C
authors.initials: MC
authors.lastname: Lu
authors.forename: Milton
authors.initials: M
authors.lastname: Kotelchuck
authors.forename: Vijaya
authors.initials: V
authors.lastname: Hogan
authors.forename: Loretta
authors.initials: L
authors.lastname: Jones
authors.forename: Kynna
authors.initials: K
authors.lastname: Wright
authors.forename: Neal
authors.initials: N
authors.lastname: Halfon
mesh_terms: D001741:Black or African American; D003266:Continuity of Patient Care; D054521:Cultural Competency; D004522:Educational Status; D005190:Family / Q000208:ethnology*; D005192:Family Health / Q000208:ethnology*; D005260:Female; D006266:Health Education; D054625:Healthcare Disparities; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011203:Poverty / Q000517:prevention & control; D011247:Pregnancy; D047928:Premature Birth / Q000208:ethnology*; D012931:Social Environment; D014481:United States