What Matters More, Maternal Characteristics or Differential Returns for Having Them? Using Decomposition Analysis to Explain Black-White Racial Disparities in Infant Mortality in the United States

Studies have found that socioeconomic factors alone cannot explain the high incidence of infant deaths among black Americans, and structural racism may be producing these differences in IMR across racial groups. Using data from the 1988 National Maternal and Infant Health Survey, we applied decomposition analysis to test how much of the black-white differences in IMR were determined by racial differences in (1) characteristics (e.g., socioeconomic, demographic and geographic) versus (2) rates of return on those characteristics (e.g., ability to translate the characteristics into healthy infants), with the latter indicative of racism. The black IMR was found to be over twice as high as the white IMR. Differences in socio-demographic characteristics did not explain gap. Instead, the differential returns on the characteristics of black mothers and their inability to translate their characteristics to produce healthy infants, accounted for a larger part of the black-white IMR inequality, providing evidence of institutional racism. Attention must be paid to broader structural factors that may be creating and contributing to the maintenance of racial disparities in IMR.