The document summarizes a literature review analyzing the role of prenatal care (PNC) in racial disparities in infant mortality rates (IMRs) between Black and White populations. It finds that Black mothers are more likely to receive inadequate or no PNC compared to White mothers, and have a higher IMR. Studies examined the influence of PNC adequacy and timing of initiation on IMR outcomes. A specific PNC intervention program, the Special Supplemental Nutrition Program for Women, Infants, and Children, was found to effectively reduce the IMR racial disparity by improving outcomes for Black infants.

1. Infant mortality is defined as the death of an
infant before the first birthday. In 2018, the
Center of Disease and Control reported an IMR
of 10.8 for Black and an IMR of 4.6 for White.
Among the various racial groups, Black and
White have the most pronounced difference in
IMR outcomes.
The Influence of Prenatal Care Adequacy on Infant
Mortality Rate Disparities Among Black and White
Populations in the U.S.
Kristina Simon
Wayne State University
The articles included in this review are selected from
two different databases, including the WSU Summons
and PubMed. The search was refined by selecting for
sources that are scholarly, peer-reviewed, and journal
articles and that have been published between the years
of 2007 to 2022. The WSU Summons database resulted
in 80 articles whereas the PubMed database resulted in
10 sources. Therefore, the search terms were modified
for PubMed the search resulted in 63 articles. An
inclusion and exclusion criteria was used to select
relevant sources and filter out irrelevant sources.
PNC is assessed in terms of adequacy and trimester of initiation by using
two possible index measurements, the Kessner Index and the Adequate
Prenatal Care Utilization (APNCU) Kotelchuck Index. As a result,
adequacy values vary considerably depending on the index used. The
Kotelchuck Index is considered an improvement of the Kessner Index.
See Table 1 and 2.
Table 1. APNCU Index
Table 2. Kessner Index
Kessner Index of PNC Adequacy and General IMR Outcomes
• When PNC is initiated, White infants have more favorable IMR outcomes
than Black infants; when care is initiated in the first trimester, Black infants
have a 14.9% decline in IMR compared to 17.8% decline for White infants;
when care is initiated in the second trimester, Black infants have a 18.2 %
reduction in IMR compared to 21.1% for White; finally, when care is
initiated in the third trimester, Black have a 19.3 % decline in IMR
compared to a 22.4 % decline for White (Loggins & Andrade, 2014)
APNCU Index of PNC and IMR Outcomes Among Mothers and Infants with
High-Risk Medical Conditions
• Black women have more high-risk pregnancies are and more likely to either
receive no PNC or intensive PNC compared to White women who are more
likely to receive intermediate or adequate PNC (Chen et. al., 2007)
• Intensive PNC is associated with increased risk of infant mortality and this
inverse relationship is observed because intense PNC is received by
mothers with high-risk pregnancies
PNC Adequacy and IMR Outcomes Among Infants with Premature Birth
and Low Birth Weight (LBW)
• Dane County, Wisconsin experienced a 67% decline in Black IMR the
period 1990-2007 and according to Schlenker et al. (2012), this is
attributable to a 61% decline in extremely premature births during that
period due to better standard of PNC.
• Non-LBW Black infants have a greater postneonatal mortality rate (PNMR)
than White when PNC is adequate or adequate-plus (Collins et al., 2017)
• LBW Black infants have a lower neonatal mortality rate (NMR) than Black
infants when PNC is adequate (Collins et al., 2017)
References
Chen, K. X., Wen, W. S., Yang, Q., & Walker, C. M. (2007). Adequacy of prenatal care and
neonatal mortality in infants born to mothers with and without antenatal high-risk
conditions. Obstetrics & Gynecology, 47(2), 122-127. DOI: 10.1111/j.1479-
828X.2007.00697.x
Collins, J. W., Jr, Soskolne, G., Rankin, K. M., Ibrahim, A., & Matoba, N. (2017). African
American: White disparity in infant mortality due to congenital heart disease. The Journal of Pediatrics, 181, 131–136. DOI: 10.1016/j.jpeds.2016.10.023
Loggins, S. & Andrade, D. C. F. (2014). Despite an overall decline in U.S. infant mortality
rates, the black/white disparity persists: Recent trends and future projections. Journal of
Community Health, 39, 118-123. DOI: 10.1007/s10900-013-9747-0
Schlenker, T., Dresang, T. L., Ndiaye, M., Buckingham, R. W., & Leavitt, W. J. (2012). The effect of prenatal support on birth outcomes in an urban midwestern county. Wisconsin
Medical Journal, 111(6), 267-273. PMID: 23362703
Testa, A. & Jackson, D. B. (2021). Race, ethnicity, WIC participation, and infant health
disparities in the United States. Annals of Epidemiology, 58, 22-28. DOI: 10.1016/j.annepidem.2021.02.005
Introduction Methods of Research Results
Conclusion & Implications for
Public Health
Wayne State
University
College of Liberal
Arts and Sciences
Background of Problem
The infant mortality rate (IMR) of a nation
serves as an indicator of a population’s general
health status. Studies have proven that the IMR
differs between racial populations, and this
difference is amplified when comparing African
American (Black) and non-Hispanic White
populations. The literature review analyzes the
role of PNC in IMR racial disparities among
Black and White mothers to test the hypothesis
that Black mothers receive inadequate PNC and
consequently suffer greater IMR compared to
White. The research discussed addresses the
amount of PNC received by pregnant women
and the trimester of PNC initiation, if any at all.
This research explores the influence of PNC
adequacy in predicting general IMR disparities
among Black and White populations, IMR
disparities among Black and White infants with
high-risk medical conditions, including low birth
weight (LBW) and premature birth, and evaluates
the impact of the Special Supplemental Nutrition
Program (SSNP) for Women, Infants, and Children
(WIC) as a PNC intervention.
Objective
Specific PNC Intervention and
IMR Outcomes
Figure 2. SSNP for WIC Note. Black pregnant women have a significantly lower
probability of infant mortality if enrolled in SSNP for WIC. (Testa & Jackson, 2021)
The SSNP for WIC has been proven to be an effective
PNC intervention and contributes to the reduction of
IMR racial disparity among Black and White.
Figure 1. Phases of Review
PNC does influence the IMR disparity among Black and
White populations. The influence of PNC is heavily
dependent upon the adequacy and the index used for
measurement. Overall, Black pregnant women are more
likely to receive either inadequate or no PNC and have a
higher risk of IMR compared to White. A specific PNC
intervention such as the SSNP for WIC has proven to be
very effective in reducing the IMR disparity among Black
and White populations and results have indicated favorable
outcomes for Black infants. Future studies are encouraged
to further assess the quality of the SSNP for WIC and
increase promotion initiatives of the program.