Improving infant mortality odds

An alumna's drive to end disparities

Nicole SmithMaster's-degree alumna Nicole Smith seeks to understand the motivating factors that contribute to infant mortality among African-American newborns.

African-American babies born in the United States are more than twice as likely as white infants to die within the first year. So, a recent alumna of the Betty Irene Moore School of Nursing at UC Davis dedicated her thesis work to bridging the divide.

“When I realized it was a national crisis, I thought, what can I do to help improve this?” said Nicole Smith, a public health nurse who recently earned her master’s degree in Nursing Science and Health-Care Leadership. “My desire for social justice drove me to investigate the issue further.”

Disparities in health care stem from a racial division that begins at birth and can have a significant effect on the future of infants. For her thesis, Smith interviewed health care providers to glean their knowledge of health disparities and discover if providers tailor care to those they serve. Across the board, the interviewees admitted they lacked current information and training on infant mortality, disparities and cultural competence. However, they used their knowledge base and experience to provide individualized care.

“What struck me was participants felt that social factors superseded biological factors as contributors to infant mortality,” Smith explained. “I didn't initially ask participants about how racism impacts infant mortality, but the providers I spoke with believe it plays a major role in why we’re seeing disparities that lead to negative outcomes.”

Smith said interviewees shared anecdotal stories of their experiences caring for black women and witnessing how others treated them in a clinical setting. They suggested the actions were not overt, rather based on biases and lack of understanding. Her research sparked two questions: How might racism contribute to biological reactions in a woman’s body during pregnancy, including increased stress? How might those hormones damage a woman’s organs and influence the growth of her baby?

“I hope that health care organizations will not ignore the elephant in the room and recognize that racism is an issue and needs to be addressed,” Smith said. “This study shows that while there are not universally accepted protocols right now, providers must promote more training in cultural competence.”

Smith continues her research and asking questions in her role as nurse manager for the Alameda County Public Health Department’s Nurse-Family Partnership Program. She hopes to improve birth and child development outcomes for low-income, first-time moms of all races. She argues improving the odds begins with awareness.

“In order to develop empathy for a group, you must work with them,” Smith explained. “When you understand a culture different than yours, it makes you a better and more effective health care provider.”