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Showing results for tags 'Social determinants of health'.
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News Article
Revealed: The trusts with ‘unacceptable’ outcomes for Black and low-income women
Patient Safety Learning posted a news article in News
The trusts where Black women and those from the most deprived communities are facing “unacceptable” disparities in outcomes against a range of maternal care metrics have been identified in a new NHS England dashboard. HSJ’s analysis of the new dataset, the publication of which was mandated by health and social care secretary Wes Streeting in June, comes as Baroness Valerie Amos is due to publish the next stage of her report of maternity services later this month. The data suggests that those identifying as Black and living in the “most deprived” communities experienced higher rates of pre-term birth nationally last year – with rates almost three times as high as white and less deprived women at some providers. Pre-term birth rates for Black and “most deprived” women were nearly three times as high as white and “least deprived” women at Ashford and St Peter’s Hospitals Foundation Trust, which had one of the highest overall rates nationally. And although Homerton Healthcare and Kingston and Richmond FTs had low overall pre-term birth rates, Black women receiving care there had rates twice as high as white women. Black women also experienced higher rates of postpartum haemorrhage nationally, according to the data. Read full story (paywalled) Source: HSJ, 17 February 2026 -
Content Article
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NHS England has set a target that cervical cancer will be eliminated in England by 2040. Although progress has been made in detecting and treating cervical cancer, there are still many women who are reluctant to go for cervical screening, or who face barriers to accessing screening. These barriers include perceived discrimination, lack of understanding the risk of cervical cancer and unmet access needs. This contributes to persistent health inequalities amongst particular groups. Patient Safety Learning has pulled together 13 useful resources shared on the hub about how to improve access and overcome barriers to cervical screening. 1. Cervical screening, my way: Women's attitudes and solutions to improve uptake of cervical screening This research by Healthwatch explored why some women are hesitant to go for cervical screening. Based on the findings of a survey of more than 2,400 women who were hesitant about screening, it makes recommendations to policymakers on how to improve uptake, including: improvements to the way data about the disability and ethnicity of people attending screening. producing an NHS-branded trauma card for affected women to bring to appointments. ensuring staff are effectively trained on accessibility and adjustments to care. looking at the possibility of home-based self-screening. 2. Facing a smear test after my trauma In this BMJ article, Ruth Ajayi shares her experience of cervical screening after a traumatic childbirth, and how healthcare professionals could offer more compassionate, flexible care. 3. Exploring the inequalities of women with learning disabilities deciding to attend and then accessing cervical and breast cancer screening, using the Social Ecological Model Women with learning disabilities are less likely to access cervical and breast cancer screening when compared to the general population. In this study, the Social Ecological Model (SEM) was used to examine the inequalities faced by women with learning disabilities in accessing cervical and breast cancer screening in England. The study highlights key barriers to access for women with learning disabilities. 4. “We’re not taken seriously”: Describing the experiences of perceived discrimination in medical settings for Black women Black women continue to experience disparities in cervical cancer despite targeted efforts. One potential factor affecting screening and prevention is discrimination in medical settings. This US study in the Journal of Racial and Ethnic Health Disparities describes experiences of perceived discrimination in medical settings for Black women and explores the impact of this on cervical cancer screening and prevention. The authors suggest that future interventions should address the poor quality of medical encounters that Black women experience. 5. Top tips for healthcare professionals: Cervical screenings This article by the Royal College of Obstetricians & Gynaecologists and the My Body Back Project offers tips for healthcare professionals to make cervical cancer screening attendees feel as comfortable as possible during their appointments. Cervical screening can be very daunting for some women, and for those who have experienced sexual violence it can be triggering and cause emotional distress. The article provides tips on communication, making the environment calm and safe, sharing control and building trust with women. 6. Cervical screening uptake: supporting positive patient experiences is key In this blog, Steph explains why Cervical Cancer Prevention Week is an opportunity to validate and help improve patient experiences. She calls for more information to be shared with both patients and doctors that helps to increase compassion, understanding and accessibility. 7. Cervical screening for people with learning disabilities: Learning resource for sample takers This learning resource from the NHS Wessex Cancer Alliance explains the misconceptions and barriers to cervical screening, the consent and best interest decisions, and the role of the sample taker and the reasonable adjustments that can be made. 8. The Eve Appeal: What adjustments can you ask for at your cervical screening? The Eve Appeal want to raise awareness of what adaptations women and people with a cervix can ask for during their screening to make the appointment more comfortable. 9. How can reframing women’s health improve outcomes? An interview with Dr Marieke Bigg Dr Marieke Bigg is the author of a 2023 book, This won’t hurt: How medicine fails women. In this interview, Marieke discusses how societal ideas about the female body have restricted the healthcare system’s approach to women’s health and describes the impact this has had on health outcomes. She also highlights areas where the health system is reframing its approach by listening to the needs of women and describes how simple changes, such as allowing women to carry out their own cervical screening at home, can make a big difference. 10. Having a smear test. What is it about? This download A4 Easy Read booklet from Jo's Cervical Cancer Trust uses simple language and pictures to talk about smear tests. It explains what a smear test is, has tips for the person having the test and has a list of words they might hear at their appointment. 11. Health Improvement Scotland: Cervical screening standards Published by Healthcare Improvement Scotland in March, the new cervical screening standards include recommendations to ensure women receive accessible letters and information about screening and healthcare professionals are trained to support women to make informed choices. 12. Cervical cancer screening in women with physical disabilities This US study explored how the cervical cancer screening experiences of women with physical disabilities (WWPD) can be improved. Interviews with WWPD indicated that access to self-sampling options would be more comfortable for cervical cancer screening participation. The authors highlight that these findings that can inform the promotion of self-sampling devices for cervical cancer screening. 13. Cervical screening - a guide for survivors of rape, sexual assault and sexual abuse This guide by The Eve Appeal and The Survivors Trust gives information about attending cervical screening for survivors of rape, sexual abuse or assault. It offers tips that may help patients feel more comfortable about their appointment. It is part of the #CheckWithMeFirst campaign to help raise awareness of the challenges survivors of rape, sexual abuse and sexual violence may face when accessing cervical screening. Have your say Are you a healthcare professional who works in women’s health or cancer services? We would love to hear your insights and share resources you have developed. Perhaps you have an experience of cervical screening or cervical cancer that you would like to share? We would love to hear from you! Comment below (register as a hub member for free first) Get in touch with us directly to share your insights -
Content ArticleHealth disparities are systemic and deeply rooted in social and economic inequities. Patients living in deprived areas, from racially minoritised communities, or facing additional challenges such as homelessness or intellectual disabilities experience worse health outcomes. These disparities are compounded by mistrust in healthcare, low health literacy, cultural barriers, and discrimination. This report focuses on patients with blood disorders and/or cancers who experience health inequalities, and therefore have worse outcomes and experiences of care than patients who don’t. We looked at how social and economic factors affect the health of people living with blood disorders and cancer. Report key findings: Patients living with cancer and/or blood disorders experience significant barriers to care including delays in diagnosis, unequal access to services, and systemic discrimination, These patients also reported challenges navigating healthcare, a lack of communication, and economic burdens such as high transportation and medication costs, Social determinants of health like inadequate housing and living in deprived areas further worsened outcomes, Participants emphasised mistrust in the healthcare system, particularly among racially minoritised and LGBTQ+ communities, and highlighted the need for better coordination, cultural sensitivity training, and localised services. The project involved a literature review on health disparities and social determinants affecting patients with cancer and blood disorders. Discussions were held with local and condition-specific charities, and we conducted focus groups and a case study interview with patients and carers. These efforts aimed to gather diverse perspectives and first-hand accounts of lived experiences.
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Content ArticleThe estimated number of Americans who are medically disenfranchised—at risk of lacking access to primary care due to an inadequate supply in their local community—has nearly doubled since 2014. The insufficient number of primary care providers in the United States poses a serious public health threat, leaving nearly one-third of the population vulnerable to preventable chronic diseases and emerging threats like Covid-19 and influenza. This report describes America’s medically disenfranchised population and how, with expanded resources, Community Health Centers can begin to address gaps in primary care.
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Content ArticleThe Maternal, Newborn and Infant Clinical Outcome Review Programme has published an MBRRACE-UK Perinatal Confidential Enquiry report on the care of recent migrant women with language barriers who have experienced a stillbirth or neonatal death. Looking at the care of 25 women and their babies, this report found that services did not meet the needs of these women effectively. Other key findings include: 96% of the women had a documented need for an interpreter, however, only 27% took place with a documented professional interpreter over 589 separate contacts with healthcare services. 68% of women didn’t book their pregnancy, or booked late in their pregnancy, highlighting gaps in antenatal care. Only 51% of women whose baby died received documented bereavement care in the community. There was a lack of research to inform service development for women new to the UK and non-English speakers. Recommendations In addition to stating the continued relevance of previous recommendations, this report contains five new recommendations for improvement: Ensure that the number of women who require language support, and the support provided at each visit, is recorded systematically. This includes documenting the use of professional interpreting services at clinical care interactions and when supporting women through the navigation of care pathways, as well as recording when these services are not available. The resulting data should be used to implement quality improvement measures, and be assessed against existing NICE guidance. Ensure services provide advocacy for women who have been in the UK for less than a year, or do not speak or understand English, to support care navigation. This should incorporate midwifery and obstetric care when indicated. Support research to understand women’s and healthcare professionals’ views on the barriers and facilitators to accessing and navigating maternity and neonatal care for women who have been in the UK for less than a year, or do not speak or understand English and require professional interpreting services. Use the findings to co-design services. Pilot the provision of an initial assessment appointment for migrant women of childbearing age when they first access health care services. The purpose would be to carry out a holistic assessment of their reproductive healthcare needs, provide information about reproductive health and availability of maternity services, and to understand any concerns they may have about accessing healthcare services. Develop provision for multiple routes of access to maternity care. These routes should include the ability for a health or social care professional, in any setting, to make a direct referral to maternity services on behalf of a woman with her consent.
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Content ArticleSocioeconomic inequality in infant mortality in the UK is rising. This study published in The Lancet Regional Health Europe aimed to identify contributory maternal and pregnancy factors that can explain the known association between area deprivation and infant mortality. In this large cohort study of 392,606 mother-child dyads in England, the study showed a marked inequality in infant mortality risk. Of the 23 factors examined, four factors were identified as potentially important: maternal depression, preterm birth, smoking during pregnancy, and maternal age younger than 20 years at childbirth. These four collectively accounted for almost one-third of the socioeconomic inequality in mortality.
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Content ArticleThis review by the UCL Institute of Health Equity (IHE) concludes that racism damages health and wellbeing and drives inequalities in London. Racism in the capital is widespread and persistent causing damage to individuals, communities and society as a whole. Its impacts are experienced in different ways and to varying levels of intensity related to individual experiences, socioeconomic position and other dimensions of exclusion such as disability, age and gender. The intersections with other dimensions of exclusion can amplify the effects of racism. The focus of this review is on the effects of racism on health and its contribution to avoidable inequalities in health between ethnic groups – a particularly unacceptable form of health inequity. It is urgent that society tackle the damage to health and wellbeing as a result of racism. The review is part of a series of evidence reviews funded by the Greater London Authority (GLA) to build the evidence for reducing health inequalities in London through action on specific social determinants of health. The other three reviews cover housing, the cost of living and adult skills.
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News Article
NHS ‘should give councils more grief’ on health
Patient Safety Learning posted a news article in News
The 10-Year Plan’s focus on the NHS risks sidelining the need for more effective action by national and local government on prevention, public health directors are warning. Association of Directors of Public Health president Greg Fell also told HSJ integrated care boards should “give us [councils] more grief” to take more action on prevention, rather than prioritising NHS upstream interventions that are not as effective as primary prevention. Mr Fell, director of public health at Sheffield City Council, said policy makers, NHS leaders and media too often looked to growing “preventive” treatments – such as weight management treatment, and weight-loss drugs – as the solution to problems like growing obesity and falling healthy life expectancy. He said the routine “framing” of prevention as something the NHS can solve with upstream treatments risked diverting from national and local government actions that could make a much bigger difference. Mr Fell said such interventions – and the high-profile GLP-1 drugs for obesity – may be worthwhile, but for overcoming the big health threats were “like emptying an ocean with a teaspoon or, being kind, a soup ladle”. He said: “The answer is way upstream of better treatment. [It] is effective regulation of junk food industries, and that isn’t primarily a Department of Health and Social Care thing, and certainly not an NHS problem. It’s a problem across the government.” Mr Fell said he expected the 10-Year Plan “would be pretty good” but means “the bandwidth has been taken by the NHS”. He called for government to outline its plan for preventive cross-government action as part of its health mission, beginning a “debate about the right mix of policies” across multiple government departments, local government, and others. “We haven’t yet seen much on the health mission,” the director of public health said, adding that it would need to cover tobacco control, alcohol, air quality, obesity, and “how does all that hang together across the totality of government?” Read full story (paywalled) Source: HSJ, 31 March 2025 -
EventuntilThe University of Manchester’s Healthier Futures Research Platform is mobilising research across disciplines at the University of Manchester to address health inequalities and ensure healthier futures for all. The University of Manchester's Healthier Futures research platform is hosting its inaugural annual lecture event, taking place at the Renold Innovation Hub, in Manchester's Sister innovation district, on the evening of 28 November 2024. Join the University of Manchester's President, Professor Duncan Ivison, and Director of Healthier Futures, Professor Dame Nicky Cullum, for this year’s opening lecture, which will be delivered by Dr Cordelle Ofori, Director of Public Health for Manchester. Cordelle will focus on health inequalities in Manchester and beyond. The lecture will start at 6.00pm, and will be followed by a Q&A session and drink’s reception. This event marks the beginning of an annual tradition that aims to foster interdisciplinary connections, share innovative research, and inspire collaborative efforts to address pressing health inequalities and challenges. Register for the event
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EventThe Health Equity Network (HEN) 2024 conference will take place on Tuesday 8 October in Birmingham. The agenda will feature an excellent array of speakers and a discussion panel. HEN also plans to announce the result of applications to the Health Equity Fund. Registration details will be published soon.
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EventDecades of research has shown that the health of the population in England is unequal, with people who live in more deprived areas experiencing illness earlier in life and dying younger. Previous Health Foundation analysis has projected that 9.3 million people could be living with major illness by 2040, which is 2.6 million, or 39%, more people than in 2019. In April, the Health Foundation’s REAL Centre published its second report in their ‘Health in 2040’ series, this time exploring how current patterns of ill health vary with deprivation across England, and to what extent this is projected to change by 2040. The findings have important implications for health inequality among the working age population and how it poses a challenge to labour supply and economic growth. This webinar will convene experts to explore what the findings mean for how we might need to change as a society, and what can we do to better prepare for the future. Register
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Content ArticleThe early use of automated external defibrillators (AEDs) improves outcomes in out-of-hospital cardiac arrest (OHCA). This study in the journal Heart investigated AED access across Great Britain according to socioeconomic deprivation. The authors found that in England and Scotland, there are differences in distances to the nearest 24/7 accessible AED between the most and least deprived communities. They concluded that equitable access to ‘out-of-hours’ accessible AEDs may improve outcomes for people with OHCA.
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Content ArticlePeople living in deprived areas experience the most significant health inequalities in terms of access, experience and outcomes. There are large reductions in life expectancy for those living in the most deprived areas compared to people living in the least deprived areas. NHS England commissioned a research project into access, experience and outcomes related to health services in socio-economically deprived communities. This communications and engagement toolkit is an output of the research. The toolkit is designed to be used by communications and engagement professionals and others across the NHS with a responsibility for communicating to and engaging with people in the most deprived areas. This toolkit provides: Information on who lives in the most deprived areas – for example by age, ethnicity and education. General principles to consider when developing communications and engagement materials for people living in deprived areas. Guidance to use when communicating about specific services – for example accessing GPs or mental health services. Considerations regarding opportunities to use communications to improve interactions between healthcare professionals and patients living in deprived areas. A communications and engagement checklist to use when developing materials. It is not necessary to read the whole toolkit. You can access what is most relevant to you. Click the boxes at the top of each slide to navigate to the sections that are useful to you. Click the ‘home’ icon in the top right of the page to return to the start and select a new topic.
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Content ArticleThere are an estimated 363,000 adults experiencing multiple disadvantage in England—they may be experiencing a combination of homelessness, substance misuse, mental health issues, domestic abuse and contact with the criminal justice system. The Changing Futures programme works in partnership in local areas and across government to test innovative approaches and drive lasting change across the whole system, in order to provide better outcomes for adults experiencing multiple disadvantage. This prospectus provides information for partnerships interested in submitting an expressions of interest to be part of the Changing Futures programme.
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Content ArticleToo many women are dying from disadvantage in one of the poorest parts of England, according to ground breaking new research which serves as an urgent wake-up call for levelling up efforts. The report by Agenda Alliance and Changing Lives, Dismantling disadvantage has found that in 2021 a woman in the North East of England was 1.7 times more likely to die early as a result of suicide, addiction, or murder by a partner or family member than in the rest of England and Wales. Today’s new research was conducted to better understand the lives and needs of disadvantaged women in the North East, including Newcastle, coastal areas and Gateshead and Sunderland; some of the poorest regions in the country. Working with women with lived experience at every stage, the study involved 18 in-depth interviews, 47 survey responses; focus groups; data analysis and multiple meetings with affected women, practitioners and policy makers.
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Content ArticleSepsis, characterised by significant morbidity and mortality, is intricately linked to socioeconomic disparities and pre-admission clinical histories. This study in eClinical Medicine looked at the association between non-COVID-19 related sepsis and health inequality risk factors amidst the pandemic in England, with a secondary focus on their association with 30-day sepsis mortality. It found that socioeconomic deprivation, comorbidity and learning disabilities were associated with an increased odds of developing non-COVID-19 related sepsis and 30-day mortality in England. This study highlights the need to improve the prevention of sepsis, including more precise targeting of antimicrobials to higher-risk patients. It also revealed that people with learning disabilities were almost four times as likely to develop the life-threatening illness. People with chronic liver disease were just over three times as likely, and chronic kidney disease stage 5 over 6 times more likely to develop non-COVID-19 sepsis. Cancer, neurological disease, immunosuppressive conditions, and having multiple prior courses of antibiotics were also associated with developing non-COVID-19 sepsis.
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Content ArticleAortic valve replacement (AVR) is a life-saving procedure for symptomatic severe aortic stenosis (AS), which relieves symptoms, increases life expectancy and improves quality of life. Little is known about the rate of AVR provision by gender, race or social deprivation level in the NHS across England. However, a large analysis examining AVR on the health service in England – the first of its kind – reveals striking inequalities in its provision. Women, black and Asian people, and those living in the poorest parts of the country are much less likely to receive the life-saving procedure, the study shows. “In this large, national dataset, female gender, black or south Asian ethnicities and high deprivation were associated with significantly reduced odds of receiving AVR in England,” the authors wrote. Dr Clare Appleby, a consultant cardiologist at the Liverpool Heart and Chest hospital NHS foundation trust and an author of the study, said public health initiatives to understand and tackle these inequalities should be prioritised. “Severe symptomatic aortic stenosis is a serious disease that causes mortality and reduces quality of life for patients,” she said. “Left untreated it has a worse prognosis than many common metastatic cancers, with average survival being 50% at two years, and around 20% at five years.” Further research and public health initiatives to understand and address inequalities in the timely provision of AVR are important and should be prioritised in England.
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Content ArticleThe latest data from the Office for National Statistics (ONS) provides the most comprehensive and up to date national profile of ethnic inequalities in mortality overall and from common physical conditions. It shows a complex picture of ethnic inequalities in mortality in England, with differences between people from ethnic minority and the White British groups, between different ethnic minority groups, and across different health conditions. This King's Fund blog looks at the complex interplay of factors drives ethnic differences in health.
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Content ArticleA global shortage of an estimated 18 million health workers is anticipated by 2030, a record 130 million people are in need of humanitarian assistance, and there is the global threat of pandemics such as COVID-19. At least 400 million people worldwide lack access to the most essential health services, and every year 100 million people are plunged into poverty because they have to pay for healthcare out of their own pockets. There is, therefore, an urgent need to find innovative strategies that go beyond the conventional health-sector response. WHO recommends self-care interventions for every country and economic setting as critical components on the path to reaching universal health coverage (UHC), promoting health, keeping the world safe and serving the vulnerable.
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News Article
Poor people much more likely to die from sepsis, study finds
Patient Safety Learning posted a news article in News
Poor people and those with existing health problems are much more likely to die from sepsis, one of the UK’s biggest killers, a study has found. Sepsis, or blood poisoning, is a potentially fatal condition triggered when the body reacts to an infection by attacking its own tissues and vital organs. It leads to an estimated 48,000 deaths a year in Britain. Research from the University of Manchester has disclosed for the first time how some groups are at much higher risk of dying from the condition than the general population. An analysis of 248,767 cases of non-Covid sepsis in England between January 2019 and June 2022 has found that the most deprived people are twice as likely to die from it within 30 days. The findings, published in the journal eClinicalMedicine, also show that: People with learning disabilities are almost four times more likely to get sepsis. People with liver disease have about three times greater risk. Patients with chronic kidney disease that is at stage 5 are more than six times as likely to develop it. “This study shows socioeconomic deprivation, comorbidity and learning disabilities are associated with an increased risk of developing non-Covid related sepsis and 30-day mortality in England.” Read full story Source: The Guardian, 23 November 2023 -
News Article
‘Cost of living crisis’ contributing to stillbirths, research finds
Patient Safety Learning posted a news article in News
The cost of living squeeze is a significant factor in some stillbirths, according to case reviews carried out in one of England’s most deprived areas. The review was undertaken in Bradford last year, and concluded: ”the current financial crisis is impacting on the ability of some women to attend essential antenatal appointments”. Missing these appointments was a factor in a range of maternity safety events, including stillbirths, it said. The researchers are now calling for new national funding to help ensure expectant parents do not miss important appointments because they cannot afford to attend. The research findings include: ‘Did not attend’ rates increased due to lack of funds for transport to antenatal appointments; “Lack of credit on phones prevented communication between women and maternity services, for example, making [them] unable to rearrange scans or appointments”; Wide spread incidence of “digital poverty, [for example] a lady with type 1 [diabetes] was unable to monitor her glycaemic control over night due to only having one phone charger in the house”; and “Families with babies on a neonatal unit going without food in order to finance transport to and from the unit.” Read full story (paywalled) Source: HSJ, 25 August 2023 -
Content ArticleThis article summarises the findings of research by Healthwatch into the impact of the cost of living crisis on people's decisions about accessing health and care. The research, which surveyed 2000 adults in England, was conducted four times between October 2022 and March 2023. It suggests that people are increasingly avoiding vital health and care services due to the fear of extra costs. Examples include avoiding: going to a dentist because of the cost of checks ups or treatment booking an NHS appointment because they couldn’t afford the associated costs, such as accessing the Internet or the cost of a phone call buying over the counter medication they normally rely on taking up one or more NHS prescriptions because of the cost. Healthwatch sets out a series of recommendations, including ensuring that the support available to help with healthcare costs is communicated to those that need it.
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Content ArticleEngland is the only country in the UK to still charge patients for prescriptions, with charges having been abolished in Wales and Scotland in 2007 and 2011, respectively. However, for patients in England, the cost is rising; in March 2023, the government announced an inflationary increase of 3.21%, bringing the prescription charge up to £9.65. And the number of people eligible to pay could increase, following government proposals to raise the upper age exemption for free prescriptions from 60 to 65 years. This article looks at the impact of prescription charges on health inequalities, particularly focusing on the impact of the cost of living crisis. The reporter speaks to pharmacists who regularly see patients making difficult choices about which prescriptions to collect, as well as highlighting research that suggests many patients with long term conditions are forgoing their medications as they cannot afford them.
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Content ArticleIn the UK today, nearly 40% of the population are living in poverty because of low income. This means that nurses and midwives are likely to meet people experiencing poverty and deprivation as part of their everyday work and should be ready and able to help them access the assistance they need to overcome the associated challenges. This article in the British Journal of Nursing examines the link between financial status and people's health and wellbeing. The article includes a case study and suggestions as to how nurses and midwives can promote financial wellbeing. Related reading The Dahlgren-Whitehead rainbow (1991) The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows (14 September 2021)
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Content ArticleThis paper, published by the National Bureau of Economic Research (NBER) aimed to explore how parental wealth and race affect maternal and infant health outcomes in California. The authors used administrative data that combines the California birth records, hospitalisations and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to provide new evidence on economic inequality in infant and maternal health. The paper also used birth outcomes and infant mortality rates in Sweden as a benchmark, finding that infant and maternal health is worse in California than in Sweden for most outcomes throughout the entire income distribution. Key findings Babies born to the richest 20% of families are the least healthy. They are more likely to be born premature and at a low birth weight, two key risk factors for medical complications early in life. This is because their mothers are more likely to be older and to have twins (which are more common with the use of fertility treatments). However, even with those early risk factors, these babies are the most likely to survive both their first month and first year of life. Rich and poor mothers were equally likely to have high-risk pregnancies, but the poor mothers were three times as likely to die—even within the same hospitals. Maternal mortality rates were just as high among the highest-income Black women as among low-income white women. Infant mortality rates between the two groups were also similar. Babies born to the richest Black women (the top tenth of earners) tended to have more risk factors, including being born premature or underweight, than those born to the richest white mothers—and more than those born to the poorest white mothers.
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