Using Focus Groups to Understand Racial Disparities in Infant Mortality
Background Infant mortality in the United States is a significant public health problem. Approximately 23,440 infants died in the year 2013 in the U.S., at a rate of 6 deaths per 1,000 live births (Centers for Disease Control and Prevention, 2015). Moreover, the burden of infant mortality disproportionately impacts African American infants. Cradle Kalamazoo, is a community initiative designed to reduce racial disparities in Kalamazoo. As part of that initiative, we used a qualitative approach to understand the phenomena from the perspective of community stakeholders. Study Objectives Our objective was to collect information from community members about the causes of racial disparities in infant mortality in our community as well as ways to reduce these disparities. We conducted focus groups with: low-income at-risk women in the community, women whose infants died; and health and social services providers who work with families during the perinatal period. Methods A total of ten focus groups, with 59 individuals, were conducted: • Two focus groups (n = 12) recruited at-risk women from the YWCA and from local home visiting services. • Three focus groups consisted of community members who had experience with infant mortality (n =25) and • Five were health professionals (n = 22) of various racial/ethnic and gender identities. Participants drew upon their experiences to describe the scope and nature of the problem, including its determinants and consequences, and made recommendations for action. Results Women and family members who had lost infants identified contributing factors at both the individual level (maternal and family health behaviors, lack of knowledge, unsafe sleep practices, domestic abuse, behavioral and mental health issues) and at the system level (inadequate or culturally inappropriate health care systems, poverty, racism, lack of health care coverage, lack of funding for quality programs). Providers identified much the same issues, with more of an emphasis on the lack of sex education and contraception. Conclusion This research affirms the importance of involving the women, families and neighborhoods most affected by black infant mortality in shaping efforts to address it. Both parents and providers identified similar themes regarding the causes of racial disparities in infant mortality. Themes suggest that there are multiple levels on which to intervene to reduce racial disparities in infant mortality. One of the themes that may be most relevant to the issue of racial disparity is racism embedded within health care provision. This is an important area to address in our local community.