PBS NEWSHOUR| In America, inequality begins in the womb by John Komolos

“What is the system that keeps people of color at the lower echelons of the socio-economic hierarchy? It begins at birth.”

The womb is a miraculous tiny organ prior to pregnancy — not greater than a medium-size orange; its sole purpose is to nurture and protect the fetus until it is expelled into the world. Though small, its impact is gigantic: the nature of its environment during the short period between conception and birth has lifelong consequences on the fetus. For instance, babies born prior to the 37 weeks of gestation or weighing less than 5.5 pounds will be disadvantaged for the rest of their lives in just about everything including their lifetime earnings. Fetuses exposed to toxins or infections will be irreparably damaged. The elephant in the room that we’ve been ignoring for the most part is that inequality — the big social issue of our time — begins amazingly during those 37 weeks.

Although it is obvious, we should nonetheless stress that the fetus has no agency; it did not choose the womb in which it finds itself. Yet it will soon enter the world and have to bear the consequences and responsibility of its experience in the womb. The tremendous variation in its fate depending on the zip code of its conception cannot be considered “just.” Luck ought not be the basis of justice, as the political philosopher John Rawls taught us. Yet, society has a tremendous stake in the fate of that fetus, because the future of the country depends on the fate of such fetuses.

The figure shows infant mortality rates, by race and Hispanic origin of mother in the United States during 2000, 2005, and 2010. The U.S. infant mortality rate plateaued during 2000-2005, then declined from 6.86 infant deaths per 1,000 live births in 2005 to 6.14 in 2010. Declines from 2005 to 2010 were largest for non-Hispanic black women (from 13.63 to 11.46), followed by non-Hispanic white (from 5.76 to 5.18) and Hispanic women (from 5.62 to 5.25). In 2000 and 2005, the non-Hispanic black infant mortality rates were 2.4 times the non-Hispanic white rates; however, the difference between the two rates has narrowed, and in 2010, the non-Hispanic black rate was 2.2 times the non-Hispanic white rate.

The data are stark and unmistakable: in every single metric that matters to long run health or earning capacity, African American babies are disadvantaged by the time they take their very first breath in the world. For instance, blacks have a much higher rate of preterm births than whites 20 percent vs. 12 percent. Low birth weight (LBW) is also a major setback: it is 8 percent among whites but 16 percent among blacks, a whopping four times as high as in Sweden or Finland. LBW, defined as a weight of less than 5.5 pounds, has harmful effects forever and is also a main cause of infant mortality. No wonder that the mortality rate among African American infants is 2.2 times that of whites.

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