City of Berkeley
Health Status Report, 2002
Low Birth Weight
Made Available by the City of Berkeley, Department of Health Services, Public Health Division
Health Status Report 2002 (PDF) (full report)
This Health Status Report focuses on the issue of low birth weight and health issues associated with decreased birth weight. A low birth weight baby is a baby that weighs less than 2,500 grams or 5 1/2 pounds at birth. A goal of the Berkeley Public Health Division is to eliminate racial and ethnic disparity in low birth weight rates. We are proud to report in this 2002 Health Status Report that the disparity in low birth weight between African American and White babies has decreased since the 1999 Health Status Report and that the number of low birth weight babies born in Berkeley is decreasing as well.
Why Look at Low Birth Weight?
Low birth weight (LBW) is recognized as a sensitive predictor of development throughout life. Low birth weight infants are at greater risk for health problems throughout life, but especially in the first year of life. These problems include asthma, cerebral palsy, learning disabilities, insulin resistance syndrome, hypertension and cardiovascular disease. The social, emotional and financial impact of a low birth weight baby on families is considerable. The cost to school systems for special education is substantial and some children are labeled as "learning disabled" throughout their school years (Journal of Health and Social Behavior, 1999). Initial hospital care costs on average $50,000 per low birth weight baby (Obstetrics and Gynecology, 1995). Unfortunately, studies show that a child born of low birth weight is also more likely to have decreased job skills and increased encounters with the criminal justice system (British Journal of Psychiatry, 2001).
Studies indicate that being at risk for having a low birth weight baby is not a genetic predisposition but is due to many factors, including stress, that may be related to discrimination and racism (Maternal and Child Health Journal, Vol. 5, No. 2, 2001). Success in decreasing the percentage of low birth weight babies in Berkeley requires both focused resources and the will to change behavior of the entire community, including the medical community.
In 1999, utilizing previously unpublished data from the National Center for Health Statistics, the Berkeley Health Status Report compared low birth weight percentages in Berkeley with other cities of comparable size. For the years 1993-1995, Berkeley had the largest racial disparity gap of any city in the U.S. of comparable size.
For the three year period, 1993 through 1995, the rate of low birth weight births among White Berkeley residents was 42 per every 1,000 live births while among African Americans, the low birth weight rate was 166 per 1,000 live births. The ratio of African American to White low birth weight was 4:1. This Low Birth Weight Report shows significant improvement over a 10-year period in the disparity gap for low birth weight. In the three-year period 1999 through 2001, the ratio of African American to White low birth weight babies decreased to approximately 3:1.
Low birth weight babies are comprised of two major groups: 1) preterm infants or premature infants, and 2) intrauterine growth retarded infants. Preterm infants are those born at less than 37 weeks of gestation. Multiple birth babies (e.g. twins) are frequently born preterm and this is noted in the analysis that follows. Intrauterine growth retarded infants are those born small for a known gestational age. This Report also shows that for all racial groups, prematurity is the main association with low birth weight; 60% of low birth weight babies born to African American and Latina women, and 63% to White women were related to preterm births. This finding is significant because it directs us to programs that address interconceptual care. Interconceptual care involves maintaining the health status of a woman from the time of delivery until conception of the next pregnancy.
Analysis of the Berkeley birth record data from 1990 – 2001 shows multiple associations of low birth weight with twins, smoking and late prenatal care. In addition, chronic, long-term conditions affecting women’s health before and during pregnancy, such as hypertension and diabetes, are also associated with low birth weight.
As a Health Department, we focus on low birth weight because it is preventable. This Report provides us with local data to examine the disparity in low birth weight more closely and, in so doing, help us to better understand the causes and to design effective prevention programs that will address the problem.
Frequently Asked Questions About Low Birth Weight in Berkeley
Is Low Birth Weight Associated with a Genetic Predisposition?
Multiple large-scale studies have shown that there are more genetic differences within major ethnic groups than between them and that all humans originate from the same genetic pool. Social scientists have cautioned against using genetics as a cause of health disparity in low birth weight because of the lack of any concrete evidence. Indeed with the recent coding of the human genome, there is no consistent gene that can be identified as the “race” gene.
Is Low Birth Weight Associated with Lack of Prenatal Care?
Many people assume that the rate of low birth weight would be improved by ensuring that all women have access to adequate and early prenatal care. In 2000, Berkeley was the only health jurisdiction in the State to meet the Healthy People 2010 standard that 90% of all women receive prenatal care in the first trimester of pregnancy. Analysis of 2001 birth records shows that 96% of White women enter prenatal care in the first three months of pregnancy and 91% of African American women do. This outstanding record indicates that current systems of care and outreach in Berkeley have been successful in assuring access to care but are not sufficient to eliminate health disparities by themselves.
Is Low Birth Weight Associated with Teen Births?
Low birth weight babies are also associated with teen pregnancy. However, Berkeley has had the lowest teen birth rate in the state since 1996 and thus, teen pregnancies are not a contributing factor in the low birth weight disparity in Berkeley. The school-based Berkeley High School Health Center, an on-site full service confidential medical and mental health care clinic at Berkeley High School, provides an effective Teen Pregnancy Prevention Program that includes confidential family planning. In addition, for those few teens that decide to continue their pregnancy, there is an effective, comprehensive Teen Parenting Program funded through the Regional Perinatal Council that assists in assuring healthy pregnancies and healthy newborns.
Is Low Birth Weight Associated with Income or Education?
Disparity in income and/or education is associated with a small portion of low birth weight disparity in Berkeley. This analysis is done by using source of payment for delivery as a proxy for income. From 1990 through 2001, birth record data shows that 39% of all low birth weight babies born in Berkeley have Medi-Cal as the source of payment. However, African American women had the highest proportion (68.2%) and White women the lowest (8.6%). In addition, analysis of census data from 1990 through 1997 indicated a serious gap in education level between African Americans and Whites in Berkeley. Further analysis showed that income and/or education accounted for approximately 25% of the disparity in low birth weight.
Is Low Birth Weight Associated with other Medical Conditions?
An exhaustive review of 334 medical records at Alta Bates Hospital revealed that African American women who give birth to low birth weight babies are more likely to be older, poor (55% received Medi-Cal), hypertensive and diabetic. African American mothers of low birth weight babies had substantially higher rates of substance use (nicotine, illicit drugs) whereas White mothers of low birth weight babies had selective reductions (abortion of one or more fetuses of a multiple pregnancy) and multi-substance use (nicotine, alcohol, illicit drugs). Based on this review of medical records, substance abuse is a critical factor associated with low birth weight regardless of the mother’s race or ethnic origin. Despite this fact, it is extremely important to note that hospitals have no consistent policy for testing mothers for substance use. In fact, this chart review found that poor women and African American women were more likely to be tested for drugs based on their insurance status (i.e. Medi-Cal).
Is Low Birth Weight Associated with Other Factors?
Eliminating racial and ethnic health disparities requires a greater understanding of the factors contributing to their development. The published literature suggests that many non-medical factors such as stress, environment, quality of health care, domestic violence and high altitude can be associated with low birth weight. The Institute of Medicine, a prestigious Washington-based medical institution, issued a special report in April 2002 indicating institutionalized racism as the main source of health disparities. Institutionalized racism refers to the incorporation of mainstream (i.e. white, middle-class) attitudes or values that work to the disadvantage of non-white ethnic groups and can result in discriminatory policies or behaviors.
Interventions in Berkeley
To address the issue of racial and ethnic disparities in low birth weight in Berkeley, aggressive fundraising and program development by the Berkeley Public Health Division resulted in the Berkeley Black Infant Health Program, a Centering Pregnancy prenatal care program, an Expanded WIC Breastfeeding Program, and a substance abuse training program for City staff and Berkeley providers. An overall decrease in low birth weight rates in 2000 and 2001, as well as decreases in the number of low birth weight babies in all racial groups, may be directly attributable to the effectiveness of these programs. The Berkeley Public Health Division also initiated a unique community empowerment model to build Community Action Teams in South and West Berkeley (CATs). Community Action Teams engage residents, particularly those most vulnerable for poor health outcomes, to develop strategies to promote health in their community. Utilizing the assets of the residents, CAT members share knowledge and skills to develop long-term leadership for change. It is intended that this long-term leadership will play a key role in decreasing and eventually eliminating disparity in low birth weight rates.
This report summarizes significant change in low birth weight rates in Berkeley over the past four years. While cumulative data for 1998-2001 indicate that there is still a 3:1 disparity in low birth weight between African Americans and Whites, we have registered some success in decreasing the number of low birth weight babies in all racial and ethnic groups. This success has been accomplished by instituting systems of care that directly affect individual women. Our task ahead as a community is to identify and address the root causes of systematic, institutional and individual behaviors and actions associated with low birth weight.
City of Berkeley Public Health Division
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