Race and Pregnancy Outcomes in the Twentieth Century: A Long-Term Comparison

Differentials between blacks and whites in birth weights and prematurity and stillbirth rates have been persistent over the entire twentieth century. Differences in prematurity rates explain a large proportion of the black-white gap in birth weights both among babies attended by Johns Hopkins physicians in the early twentieth century and babies in the 1988 National Maternal and Infant Health Survey. In the early twentieth century untreated syphilis was the primary observable explaining differences in black-white prematurity and stillbirth rates. Today the primary observable explaining differences in prematurity rates is the low marriage rate of black women. Maternal birth weight accounts for 5-8 percent of the gap in black-white birth weights in the recent data, suggesting a role for intergenerational factors. The Johns Hopkins data also illustrate the value of breast-feeding in the early twentieth century -- black babies fared better than white babies in terms of mortality and weight gain during the first ten days of life spent in the hospital largely because they were more likely to be breast-fed.