"Are you beginning to see a pattern here?" Family and medical discourses shape the story of black infant mortality

Journal of Sociology and Social Welfare, March, 2003 by Elaine R. Cleeton

Postmodern and poststructuralist theorizations of the interrelations of the particular and the universal have identified women's bodies to be the last frontier for scientific discovery leading to and satisfying the modern compulsion to stabilize and control life from birth to death. This institutional ethnography of one city's response to an elevated infant mortality rate among the babies of African American urban, impoverished women explores their discursive transformation from single mothers who cannot begin prenatal care before the second trimester because too few physicians will treat Medicaid patients, into sexually-immoral, illegal-drug-using women who deliberately harm their babies. The study locates an education campaign poster depicting these women as undisciplined, ignorant, irresponsible mothers who use drugs that kill their babies at the intersection of the family discourse of the "good mother/bad mother" dualism and the obstetrics discourse of the frail female body. At this site, the everyday experience of urban minority impoverished women doing the work of mothering is transformed into evidence of their "natural" maternal inadequacy.

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In 1986, the Congress of the United States legislated the creation of the National Commission to Prevent Infant Mortality. Ranking twenty-third among industrialized nations, the U.S. Congress and the Executive branch responded to the cry, "The nation must make the health and well-being of mothers and babies a top priority" (National Commission to Prevent Infant Mortality, 1988, p. 15). Crediting medical science with "dramatic improvements in the health and survival rates of very young children," the Commission focused on existing programs and policies promoting the health of "women of child-bearing age and their infants" in order to reduce the Infant Mortality Rate (IMR, deaths per thousand births), an international scandal (National Commission to Prevent Infant Mortality, 1988, p. 15). While the US IMR declined during the 1980s and 1990s, the black IMR increased from two to two-and-one-half times that of white babies (Associated Press, 2002, p. 2A). In a country where obstetrical medicine promises to save the lives of all women who receive prenatal care and deliver their babies in the hospital (Murphy-Lawless, 1998), deaths of black babies stand in for the elevated U.S. IMR, a critical indicator of the effectiveness of U.S. obstetric practices.

In the late 1980s, infant mortality among African American babies born in Eastern City (1) was three times that of white infants. In 1987, the black IMR was 30.1 in comparison with the white of 9.3 (County Health Department, 1992). While the county IMR reflected the national average of 10, Eastern City ranked first among 27 cities of comparable size with an IMR of 17.8. The difference was largely attributed to the black IMR (County Executive, 1990). Furthermore, long delays in beginning prenatal care among poor, black mothers, were attributed to a lack and inaccessibility of medical services and "maternal inadequacies"--ignorance of, or refusal to participate in, prenatal care, and use of illegal or harmful drugs (County Executive 1990). (2)

In response to the black IMR, Eastern City inaugurated an education campaign to "reduce ignorance and encourage responsibility" (County Health Department, 1989) with a poster depicting the outcome of maternal drug use during pregnancy (see figure A). Three black and white photographs of models posed as pregnant women using drugs are paired with one of a low-birth-weight baby fighting for life in a Neonatal Intensive Care Unit (NICU). Underneath the panel of photographs is printed the question, "Are you beginning to see a pattern here?" followed by a County Health Department telephone contact number. Read from left to right, the horizontal juxtaposition of six photographs tells a simple story: when single poor women get pregnant, they use drugs and kill their babies.

[FIGURE A OMITTED]

At present, the national African American IMR is two and one-half times that of the national white IMR, mirroring the incidence of low birth weight among black babies.

In 1990, I began an ethnographic study of Eastern City's response to the black IMR. Through visits with the targeted women, I learned of their daily struggles to safely house and adequately feed their families, find safe spaces for their children to play, access and maintain telephone service, transport their families to health services, and for some, deal with language barriers (Cleeton, 1994). While attending prenatal visits with them and assisting with their daily transportation needs, I saw no evidence that as a group, the target women were drug addicts avoiding prenatal care. Their mothering work (DeVault, 1992) contradicted the government-distributed poster story. This study examines the generalization of a story of drug-induced baby death to the struggles of black women producing family life in violent conditions of poverty (Freire, 1970; Kozol, 1988; Farmer, 1996; Wilson, 1987; Collins, 1999; Rawlings, 1998).