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Research Shows Racism Impacts Neonatal Intensive Care, Often Resulting in Worse Quality of Care, Higher Mortality for Minorities


African American women are 49% more likely to give birth early, which is linked to increased mortality, making preterm birth or low birth weight the leading cause of infant death among black infants. A review article in the August 2019 Pediatrics, “Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review,” found that unequal quality of neonatal care may be a contributing factor. The study, which publishes online July 29, found racial or ethnic disparities in care received at neonatal intensive care units (NICU) that often-disadvantaged black infants, and often resulted in worse outcomes for the babies. Researchers reviewed more than 560 studies, focusing on 41 studies of interest, and found research showing disparities in care for non-white patients in the NICU, for example:

  • African American women were less likely to deliver in top-tier hospitals and “minority-serving” hospitals had significantly higher neonatal mortality rates.

  • Patient-to-nurse ratio was significantly higher in “minority-serving” hospitals, and moms and babies there received 50% less care.

  • Low birth weight infants of African American mothers were less likely to receive referrals for early intervention and high-risk infant follow up.

  • African American mothers reported receiving limited breastfeeding education and support during pregnancy, childbirth, NICU stays, postpartum, and recovery in the community.

Researchers concluded that targeted quality improvement efforts hold promise for improving racial/ethnic equity in care delivery.

Editor’s Note: A solicited commentary, “Disparities in Neonatal Intensive Care: Context Matters,” will be published in the same issue of Pediatrics.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit and follow us on Twitter @AmerAcadPeds