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Understanding Trends in the Concentration of Infant Mortality Among Disadvantaged White and Black Mothers in the United States, 1983–2013: A Decomposition Analysis

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Demography

Abstract

The United States compares unfavorably with other high-income countries in infant mortality, which recent literature has attributed to the poor birth outcomes among disadvantaged (i.e., unmarried and less-educated) mothers. Describing and decomposing the trend of the concentration of infant mortality among disadvantaged mothers thus provides important clues for improving birth outcomes. We develop the infant mortality disadvantage index (IMDI) to measure such concentration. Using the 1983–2013 Birth Cohort Linked Birth and Infant Death data, we show that although the IMDI—as a measure of mortality inequality—was persistently higher for Blacks than Whites, the trends were different between the two groups. The IMDI declined for Black women; for White women, however, it increased in the 1980s, then plateaued until the early 2000s, and declined thereafter. We then use Das Gupta’s decomposition method to assess the contribution of five demographic/social factors (age, education, marriage, fertility, and infant mortality) to the IMDI trend. Nonmarital fertility among women with less than 12 years of education contributed most to Whites’ changing IMDI; for Blacks, a shrinking proportion of the less-educated group and declines in infant mortality among disadvantaged mothers contributed to their declining IMDI. These findings explicate links between population-level compositional changes and infant mortality inequality.

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Data Availability

The IPUMS-CPS data are available from https://cps.ipums.org/cps/, and the National Center for Health Statistics (NCHS) Birth Cohort Linked Birth and Infant Death data are available from http://data.nber.org/data/linked-birth-infant-death-data-vital-statistics-data.html.

Notes

  1. We conducted a separate set of analysis for non-Hispanic Whites, non-Hispanic Blacks, and Hispanics, drawing on the 1995–2013 data. Results, shown in section C of the online appendix, suggest that the trends in the IMDI are similar between non-Hispanic Whites and Hispanics (i.e., more or less stable throughout the late 1990s and declining since 2006), even as the IMDI is persistently higher among Hispanic women than either non-Hispanic White women or non-Hispanic Black women. The decomposition analysis further shows that two factors played the largest role in Hispanic women’s decreasing IMDI following 2006: declines in the share of women with less than 12 years of education and decreasing fertility among unmarried Hispanic women with less than 12 years of education.

  2. We note one exception. For Black women, when the 15–19 age group was removed, nonmarital fertility rates among those with less than 12 years of education played a larger role in driving up the IMDI (143%; Table D1, online appendix), compared with the result when this age group was included (21%; Table 3). This finding seems to suggest that over time, nonmarital fertility increases at a faster rate (or declines at a slower rate) for Black women older (as opposed to younger) than 19. Or perhaps nonmarital fertility poses a greater threat for Black women older (as opposed to younger) than 19; this possibility is consistent with the weathering hypothesis, which suggests that the health of Black women begins to deteriorate in early adulthood as a result of their cumulative exposure to socioeconomic disadvantage (Geronimus 1992). As age increases, therefore, nonmarital birth may lead to particularly poor birth outcomes for Black women. We advise more future research to better understand this finding.

  3. One caveat is that in the Birth Cohort Linked Birth and Infant Death data, maternal education was not available in all states in early years (1983–1991). We conducted a sensitivity analysis excluding the four states with incomplete or no reporting of maternal education (California, New York, Texas, and Washington); results were substantively similar to our main findings (see section E of the online appendix).

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Acknowledgments

An earlier version of this article was presented at the Population Association of America Conference in Chicago in 2017. The authors thank the organizer of the session, Saifuddin Ahmed, their discussant, Ndola Prata, and participants in the session for comments on the earlier version. They are also grateful for the helpful suggestions of three anonymous reviewers.

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Authors and Affiliations

  1. Department of Sociology, Boston College, Chestnut Hill, MA, 02467, USA

    Wen Fan

  2. Department of Sociology and Criminology, The Pennsylvania State University, University Park, PA, 16802, USA

    Liying Luo

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  1. Wen Fan
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Both authors conceived of the research idea, performed the analysis independently (to make sure the calculations are correct), and discussed the results. W.F. wrote the manuscript, and L.L. provided comments, revisions, and feedback that helped shape the research and manuscript.

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Correspondence to Wen Fan.

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Fan, W., Luo, L. Understanding Trends in the Concentration of Infant Mortality Among Disadvantaged White and Black Mothers in the United States, 1983–2013: A Decomposition Analysis. Demography 57, 979–1005 (2020). https://doi.org/10.1007/s13524-020-00878-4

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