Academic journal article Federal Reserve Bank of Atlanta, Working Paper Series

A Decomposition of the Black-White Differential in Birth Outcomes

Academic journal article Federal Reserve Bank of Atlanta, Working Paper Series

A Decomposition of the Black-White Differential in Birth Outcomes

Article excerpt

Working Paper 2011-1 March 2011

Abstract: Substantial racial disparities continue to persist in the prevalence of preterm births and low-birth-weight births. Health policy aimed at reducing these disparities could be better targeted if the differences in birth outcomes are better understood. This study decomposes these racial disparities in birth outcomes to determine the extent to which the disparities are driven by differences in measurable characteristics of black mothers and white mothers as well as the extent to which the gap results from differences in the impact of these characteristics. The analysis is focused on three adverse birth outcomes: preterm, early preterm birth (less than 32 weeks gestation), and low birth weight. The results suggest that differences in covariates accounted for approximately 25 percent of the gap in the incidence of preterm births. The specific characteristics that matter the most are marriage rates, father's characteristics, and prenatal care. For gestation-adjusted birth weight, approximately 16 percent of the racial gap for first births is explained by covariates; for subsequent births this covariate explanation rises to 22 percent of the gap. Furthermore, differences in coefficients explain about another quarter of the gap in preterm birth outcomes but very little of the gap in birth weight.

JEL classification: I1

Key words: racial disparities, preterm birth, low birth weight

I. Introduction

The substantial racial disparities in birth outcomes between whites and blacks are well documented. In 2007, 18.3% of births to black mothers were preterm (less than 37 weeks gestation) compared to 11.5% of white mother births. (1) A similar pattern holds for low birth weight (less than 2500 grams); 13.8% of black infants were born low birth weight compared with 7.2% of white infants in 2007 (Hamilton et al. 2009). Low birth weight and preterm infants are at a higher risk for health problems and death relative to full-term and heavier infants. Infant deaths occur disproportionately among these infants, accounting for over two-thirds of infant deaths in 2005 while low birth weight infants accounted for about 8% of live births and preterm infants accounted for about 12% of live births (Matthews and MacDorman 2008).

Racial disparities in birth outcomes have been attributed to black mothers having, on average, lower socio-economic status (SES) than white mothers (Oliver and Shapiro 1995, Zeitlin et al 2002, Raatikainen et al. 2005); being less likely to receive adequate prenatal care than white mothers (IOM 2007); and, having different health behaviors and experiencing higher levels of stress than white mothers (Lu and Halfon 2003, Geronimus 1996, IOM 2007). Empirical evidence indicates that these disparities increase with maternal age. This has been attributed to weathering; or the physical consequences of social inequality that leads to "early health deterioration" among black mothers (Geronimus 1996; Raus et al. 2001; and Wildsmith 2002).

In spite of the volume of research on the topic, there is still much to be learned about how differences in characteristics across races impact birth outcomes. Specifically, health policy aimed at reducing disparities in birth outcomes could be better targeted if we understood whether differences in birth outcomes are driven by the variation in the characteristics of the two populations or whether it is the differences in the effects of those characteristics that matter. We use analytical methods from the labor economics literature that were originally used to decompose male/female differences in wages and apply these methods to decomposing racial disparities in birth outcomes. This decomposition allows us to measure the extent to which racial disparities in birth outcomes are driven by differences in measurable characteristics as well as the extent to which the gap results from differences in the impact of these characteristics on birth outcomes. …

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