America’s Birthweight Crisis

Americans are increasingly at risk of having lower incomes, poorer health, and a worse shot at opportunity even before they are born. More babies are now born with low birthweights than in the last 30 years. This has caused growing inequalities that can persist if not properly addressed. In certain parts of the country, that risk may be ten-times greater.

Underweight newborns are at an increased risk of long term health challenges, lower IQ scores, and developmental delays. New data shows that the frequency of this problem is rising with more than 300,000 newborns now experiencing low birthweight. This public health and equity issue is increasingly common in low-income communities, communities with poor access to healthy foods, and homes that are near high-polluting sites. 

Emily Oster, a professor of economics at Brown University and author of Expecting Better writes, “Babies that are born in this group are much more likely to have complications. These include difficulty breathing, difficulty regulating blood sugar, and abnormal neurological signs… Some studies suggest that babies who are born SGA [Small for their Gestational Age] have more long-term issues, including a higher risk for diabetes and lower cognitive skills.”

Lower birth weight can also predict career trajectory and earning power. In a paper published in the American Journal of Epidemiology, researchers looked at thousands of government officials in England and found that even after controlling for other factors like parental education that people born with low birthweight tended to have lower wages and lower ranking roles.

Our team at American Inequality wanted to see how pervasive the issue of low birthweight is not just nationally but within specific communities. We found 29 counties, largely in the South and Midwest, where babies are twice as likely to be born with lower birthweights than the national average.

Pollution during pregnancy

A new report from Human Rights Watch found that babies in Louisiana’s “Cancer Alley” are three times more likely to experience low birthweight. This 85-mile stretch that runs along the Mississippi River between New Orleans and Baton Rouge contains over 200 fossil fuel and petrochemical plants—reportedly the highest density in the Western Hemisphere. Americans living in the area are exposed to higher concentrations of harmful substances. This current generation is paying the price.

The role of food deserts

Low birthweight is a product of many compounding factors including inadequate nutrition. In the 29 counties we looked at, all had elevated levels of obesity and were considered food deserts. Many Americans who don’t have access to healthy foods often turn to fast food as an alternative. In two of the counties, 50% of residents were food insecure, with some residents sharing that when the only grocery store in town closed, they would have to drive 130-miles round-trip to find the next nearest place to purchase food for their family.

I spoke with Dr. Gillian Goddard at ParentData who shared this, “Low birth weight infants are at increased risk of developing insulin resistance in adulthood, which can progress to type 2 diabetes. This results in varying health challenges, which aren’t always diagnosed promptly.”

Low incomes and poor healthcare

In the 29 counties we looked at, median household income was $35,830 and 1 in 3 families lived in poverty. Healthcare is deeply connected to income in America, meaning low income communities often had poor health outcomes and inadequate care.

No place struggles with low birthweight more than Issaquena County in Mississippi. This rural county of 1,100 people has no hospitals, one of the highest poverty rates in the country, and 1 in 4 babies is born weighing less than 5 pounds 8 ounces. Taneria Williams has lived in Issaquena for years, and has given birth to three children with low birthweight, despite her best efforts to avoid it. “As a mother you try to nourish your body as much as you can when you are pregnant. You try to do all the necessary things you have to do to have a healthy baby and I felt because I don’t have the proper health care, I am not able to do that.”

Black families routinely receive worse healthcare in America, and this impacts Black babies too. Black babies are twice as likely to be born with low birthweight as white babies. Babies born to college-educated Black women are more likely to have low birthweight than are babies born to white women who dropped out of high school. This indicates that race seems to be a much stronger factor than education in contributing to this social issue.

Economists from the National Bureau of Economic Research found that the U.S. spends more than $5 billion each year addressing challenges emerging from low birthweights.

The trend is getting worse

The preterm birth rate is now at its highest point since 2014. One of the main drivers of this is that food insecurity in America has also risen to its highest point over that same period. 

In 2022, 1 in 12 babies in America was born with a low birthweight. This rate puts the U.S. in a similar ranking with Hungary, Turkey, and Brazil. Nordic countries, on the other hand, have half the rate of low birthweights as is seen in the U.S., largely due to strong healthcare systems, low pollution, healthier foods, and higher incomes.

Preterm babies account for the vast majority of low birthweight babies. 1 in 10 babies is born preterm (born before 37 weeks of the typical 40 week gestational period), which can often come with its own set of health and developmental challenges. The World Health Organization explains that most preterm births happen spontaneously. But, increasingly, health issues for parents like diabetes, pre-eclampsia or heart disease (which are far more common in low-income communities) are driving more preterm births.

Stopping the low birthweight epidemic 

Regular doctor visits are the best method for warning pregnant women about low birthweights, but some lesser known factors can also make a difference. Safer environments and better nutrition can address the low birthweight challenges that the nation is facing. Specifically, this can be done by reducing the exposure pregnant women have to pollution, while also increasing the adoption of the Supplemental Nutrition Program for Women, Infants, and Children (WIC), which is far too low in certain states.

Promoting healthy habits through WIC: WIC is eligible to low-income women who are pregnant all the way up until their infant’s first birthday, but most women don’t know about it. Women who enrolled in WIC saw an 11% reduction in babies born with low birthweight, and this number could rise to 65% if they enrolled early in pregnancy. Children whose mothers participated in WIC while pregnant scored higher on mental development assessments. However, in California, 65% of families that are eligible for WIC participate in the program, whereas in 8 states (Louisiana, South Carolina, Tennessee, Illinois, Montana, Utah, and Arkansas) the participation rate is only half that figure. Encouraging more parents to make use of the service in these low uptake states is a data-driven way to ensure that children face fewer challenges throughout their lives. 

Reducing exposure to hazardous environments: A study of 32 million births in the U.S. found that high exposure to pollution is a direct cause of low birthweight. In Cancer Alley, expansion is underway with at least 19 new fossil fuel and petrochemical plants in regions with the highest poverty rates and highest percent of Black residents. Reducing just 5 micrograms per cubic meter (µg/m3) of fine particle pollution can decrease the risk of low birthweight by 15%. Polluting factors should not be developed near vulnerable communities, and in the meantime, pregnant women would benefit from staying away from polluting sites (like downwind of highways) as much as possible. The EPA has a free app to help monitor this, and you can buy some in-home devices too.

The next generation deserves basic nutrition and clean air; and expectant parents deserve the same. We just have to determine how best to ensure they are actually receiving these key factors for success.

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