Social and cultural factors in the etiology of low birthweight among disadvantaged blacks

This report gives results from eight intensive, exploratory interviews with Black women who suffered infant deaths within one year after delivery. Interviews were conducted as a final step in a research project to discover the correlates of very low birthweight among disadvantaged women in a city which maintains among the highest low birthweight and infant mortality rates in the United States. Qualitative results are presented within the context of a case/control study based on an in-depth medical record review. Statistical results showed that prenatal care, alcoholism, migrant status, smoking, hypertension history and previous poor pregnancy outcome distinguished women with very low birthweight infants. The medical record review also implicated violence, weak social support systems, poor social and psychological adjustments and ineffective contraception. Interview results further explore the social and psychological context of pregnancy for the disadvantaged inner city Black woman. Three-quarters of all women are unmarried at the time of delivery, and interviewed women expressed bitterness and resentment toward the men in their lives for non-support. They received the most help from 'girlfriends', and not consistent support--as expected--from mothers and female kin. Answers to open-ended questions and responses to a specially designed interview section on attitudes and beliefs suggest that these women conceptually dissociate three important areas of cultural focus: relationships with men, pregnancy and childbirth; and, that they value the 'gestator' role as separate from the role of 'mother'. They espouse contradictory beliefs about men: they believe that men are predatory and not trustworthy, but also more mainstream beliefs that call for reliance on the opposite sex. Because of their unstable relationships with men and their long histories of poor pregnancy outcome and termination, they face frequent disappointment. Responses to items in the attitudes and beliefs section suggest that these women feel powerless, hopeless and that life is somewhat meaningless. However, items designed to test Lewis' 'culture of poverty' do not support the concept of a consistent intergenerational poverty lifestyle. The report closes with a section on program and policy development in several areas: public health recordkeeping, health style education programs, special training programs for physicians and other health personnel, and some type of program to combat the social alienation and psychological distress of inner city women during pregnancy.