Maternal and Infant Health At the Cross-roads of Racism and Colorism

 April 17, 2019: Jaime Slaughter-Acey, PhD, MPH

For over 40 years now, Black infants have had an infant mortality rate ~double the rate of White infants.1,2 Likewise, rates for other perinatal indicators of the nation’s health, preterm birth (<37 weeks’ gestation), low birthweight (<2500 grams), and maternal morbidity and mortality, also reflect longstanding racial disparities of similar or greater magnitude. Last year (2018), NY Times Magazine author Linda Villarosa brought renewed attention to a very old problem by asking the question, “Why America’s Black Mothers and Babies are in a Life or Death Crisis?[JS1] ” Ms. Villarosa correctly answered, it “has everything to do with the lived experiences of being a Black woman in American.” 

Empirical research consistently shows racial disparities in perinatal health outcomes persist despite consideration for socioeconomic status and other traditional risk factors (e.g., health behaviors, chronic comorbidities). In the last two decades, population health researchers have come to acknowledge race as a social construct,3,4 with an ever-increasing body of evidence studying racism as a social determinant of maternal and infant health outcomes.[JS2] 5-7 Still, most racial disparities research fails to consider skin color, our most visible physical attribute, it social meaning and intersection with race.

For Black Americans, racism and colorism are part and parcel of daily lived experiences that extend over the lifespan—birth, childhood, adolescence, and adulthood—with intergenerational implications.8  Racism is a system for continued maintenance of social dominance and oppression that structures opportunities and assigns value to interpersonal exchange based on individuals perceived or assigned race/ethnic group.9 Colorism is a phenotype-based continuum that assigns privilege and disadvantage based upon the color of one’s skin.10  Privilege is allocated to individuals with lighter complexions and more European-like features while disadvantage is assigned to those with darker complexions and more Afrocentric features.8,11,12  Colorism is an institutional outgrowth of white supremacy and is more prevalent in societies that have a history of slavery and/or colonization.10 Thus, skin tone is not simply a physical trait reflective of value neutral bodily differences. 10

Figure 1.  Colorism operates across multiple social contexts

Figure 1. Colorism operates across multiple social contexts

A popular misnomer about colorism is that it functions only within communities of color as a form of internalized racism. In truth, colorism operates across multiple social contexts since it manifests from cultural racism, individual and societal beliefs in the supremacy of one group over another group that have become rooted into the cultural standards of our institutions, ideology, and everyday actions.13 Therefore, one can experience colorism not just from within one’s own racial/ethnic group (in-group colorism), but from other racial/ethnic groups and society as a whole (out-group colorism), Figure 1.  

Experiences of marginalization related to racism and colorism may combine, overlap or intersect with other systems of oppression related to aspects of social identity to affect health. America’s Black women face multiple and simultaneous sources of chronic stress, stigma and discrimination that are tied to her identities as a woman, a racial/ethnic minority, and her skin color, Figure 2. The social significance of skin tone for Black women has been documented in relation to educational and economic attainment, the marital market, and psychosocial attributes including self-esteem, racial identity and socialization, and perceived stress (See Herring, Keith, & Horton, 2004; Keith 2009; Adams et al, 2016 ).  Research investigating the impact of colorism on Black women’s health outcomes is in its infancy, but existing studies suggest skin tone, as a proxy for colorism, is a predictor of systolic and diastolic blood pressure,16,17 perceived stress,18 and body mass index,16,19 and allostatic load for Black women.20 

Figure 2 . Race, Skin Color, and Gender intersect to affect Health for Women of Color

Figure 2. Race, Skin Color, and Gender intersect to affect Health for Women of Color

There is a need for population health research to consider the implications of racism and colorism on the health of Black women, especially with regard to perinatal health outcomes given the magnitude of Black-White disparities. Through funding from the Russell Sage Foundation[JS3] , my research team is examining the multidimensional nature of race and its intersection with skin color in relation to the African American women’s birth outcomes—specifically preterm birth, low birthweight, and fetal growth restriction. Preliminary findings among a subsample (n=700) of Black women living in Metropolitan Detroit, MI suggest maternal skin tone is an important predictor of preterm birth and low birthweight risk (Figure 3).

Figure 3 . % PTB and LBW in Black Women (N=700), Stratified by Self-reported Skin Tone, 2009-2011

Figure 3. % PTB and LBW in Black Women (N=700), Stratified by Self-reported Skin Tone, 2009-2011

Disclaimer: This work has been supported in part by Grant # 96-18-03 from the Russell Sage Foundation to Dr. Slaughter at the University of Minnesota. The LIFE study was funded by NIH grant no. [R01HD058510] to Dr. Misra at Wayne State University. Any opinions expressed are those of the author(s) alone and should not be construed as representing the opinions of the Russel Sage Foundation or NIH.


1.            Mathews T, MacDorman MF. Infant mortality statistics from the 2009 period linked birth/infant death data set. National vital statistics reports. 2013;61(8):1-28.

2.            Singh GK, van Dyck PC. Infant Mortality in the United States, 1935-2007. M a CHB Health Resources and Services Administration (Ed) Rockville, Maryland: US Department of Health and Human Services. 2010.

3.            Smedley A, Smedley BD. Race as biology is fiction, racism as a social problem is real: Anthropological and historical perspectives on the social construction of race. Am Psychol. 2005;60(1):16-26.

4.            Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care: Summary. National Academy Press; 2002.

5.            Misra DP, Slaughter-Acey JC, Giurgescu C, Sealy-Jefferson S, Nowak A. Why Do Black Women Experience Higher Rates of Preterm Birth? Current Epidemiology Reports. 2017;4(2):83-97.

6.            Alhusen JL, Bower KM, Epstein E, Sharps P. Racial Discrimination and Adverse Birth Outcomes: An Integrative Review. J Midwifery Womens Health. 2016;61(6):707-720.

7.            Giurgescu C, McFarlin BL, Lomax J, Craddock C, Albrecht A. Racial discrimination and the black-white gap in adverse birth outcomes: a review. J Midwifery Womens Health. 2011;56(4):362-370.

8.            Keith VM, Nguyen AW, Taylor RJ, Mouzon DM, Chatters LM. Microaggressions, Discrimination, and Phenotype among African Americans: A Latent Class Analysis of the Impact of Skin Tone and BMI. Sociological Inquiry. 2017;87(2):233-255.

9.            Omi M, Winant H. Racial formation in the United States. Routledge; 2014.

10.          Keith VM. A colorstruck world: Skin tone, achievement, and self-esteem among African American women. Shades of difference: Why skin color matters. 2009:25-39.

11.          Hunter M. The persistent problem of colorism: Skin tone, status, and inequality. Sociology Compass. 2007;1(1):237-254.

12.          Hunter M. “If You're Light You're Alright” Light Skin Color as Social Capital for Women of Color. Gender & Society. 2002;16(2):175-193.

13.          Jones J. Constructing race and deconstructing racism: a cultural psychology approach. In: Bernai G, Trimble J, Burlew A, eds. Handbook of Racial & Ethnic Minority Psychology. Thousand Oaks, California: SAGE Publications, Inc.; 2003.

14.          Glenn EN. Shades of difference: Why skin color matters. Stanford University Press; 2009.

15.          Adams EA, Kurtz-Costes BE, Hoffman AJ. Skin tone bias among African Americans: Antecedents and consequences across the life span. Dev Rev. 2016;40:93-116.

16.          Armstead CA, Hébert JR, Griffin EK, Prince GM. A question of color: The influence of skin color and stress on resting blood pressure and body mass among African American women. Journal of Black Psychology. 2014;40(5):424-450.

17.          Sweet E, McDade TW, Kiefe CI, Liu K. Relationships between skin color, income, and blood pressure among African Americans in the CARDIA Study. Am J Public Health. 2007;97(12):2253-2259.

18.          Uzogara EE. Dark and sick, light and healthy: black women's complexion-based health disparities. Ethn Health. 2017:1-22.

19.          Hargrove TW. BMI Trajectories in Adulthood: The Intersection of Skin Color, Gender, and Age among African Americans. 2018;59(4):501-519.

20.          Hargrove TW. Light privilege? Skin tone stratification in health among African Americans. Sociology of Race and Ethnicity. 2018:2332649218793670.

 [JS1]Link out to article

 [JS2]The When the Bough Breaks episode from the docuseries Unnatural Causes might be a good link out.

 [JS3]Link out to my grant announcement on RSF website.

Matters of Life and Death: Racism and the Global Struggle for Black Lives

We are dying, our people are dying... —Marielle Franco speaking to a group of Black Women at Casa Das Pretas about the military intervention in Rio de Janeiro’s poor, Black communities, March 14, 2018

September 14, 2018: Sharrelle Barber, ScD, MPH

As a social epidemiologist who examines the links between structural racism and racial health inequalities, I am particularly concerned about the lives (often truncated) and deaths (too often, violent) of Black women and men. Though my passion and commitment to this work is rooted in my identity as a Black woman born and raised in the South, the renewed urgency in explicitly examining racism cannot be divorced from the violent and unjust deaths that have punctuated my career in academia and the resulting activism sparked by the Black Lives Matter movement which began five years ago. Nor can it be separated from leaders in the public health and medical community—in particular Black women like Dr. Camara Jones, Dr. Chandra Ford, Dr. Mindy Fullilove, and Dr. Mary Bassett—who have challenged us to name racism as a cause of poor health and a fundamental driver of racial inequalities in morbidity and mortality in the United States. As Dr. Bassett adeptly reminds us, the way we “frame a problem is inextricable from how we solve it.” And as my colleague and friend Dr. Zinzi Bailey notes in a recent publication in The Lancet, “without a vision of health equity and the commitment to tackle structural racism, health inequities will persist, thwarting efforts to eliminate disparities and improve the health of all groups…”

About two years ago, I began research that applied this critical lens to Brazil, recognizing that the fight against racism and the struggle for Black Lives is a global one. Extending the scope of my research to Brazil was not far-fetched; rather, it was a logical expansion rooted in striking parallels I observed between the two contexts. Like the U.S., Brazil’s history is rooted in the vicious and violent legacy of slavery, as Portuguese colonizers imported an estimated five million west and central Africans as slaves during its nearly 300-year history in the country, 10 times the number imported by the United States. Brazil was also the last country in the Americas to abolish slavery, in 1888, and according to data from the 2010 census, has the largest African-descended population outside the continent of Africa. And although mainstream narratives perpetuate the myth of  a “racial democracy” in Brazil, racism and discrimination in the country run deep and manifest in systems and structures of power and privilege that maintain the marginalized status of individuals of African descent.

My recent collaborative work examining residential segregation—one of the most visible manifestations of structural racism—and its links to chronic disease using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) was my first attempt at demonstrating, empirically, how racism is embodied in Brazil. But it was on March 14, 2018 that I became keenly aware that just like the United States, racism in Brazil can be violent. And deadly.

At the suggestion of a colleague, I attended an event in downtown Rio de Janeiro, Brazil, entitled “Young Black Women Moving Power Structures” as part of the 21 Days Against Racism Campaign taking place across several cities in Brazil. My colleague encouraged me to attend the event to deepen my understanding of grassroots, anti-racist activism in Rio and to meet Marielle Franco, an encounter that would prove to be transformative.

Marielle Franco was a Black, queer, feminist human rights activist born and raised in the Maré favela, located in Rio’s North Zone. In 2016, she was voted into local office, receiving the fifth highest vote count out of 51 city councilors elected that year. Marielle was the only Black person on the Rio city council and was part of the mere 5% of Black and Indigenous women occupying seats of power in local government in Brazil. Marielle’s political platform was rooted in the longstanding legacy of Black feminist activism in Brazil and reflected an ethic that valued the lives of those who have, quite literally, been forced to the margins of Brazilian society: Blacks, women, the poor, and individuals who identify as LGBTQ+).

Marielle was also very critical of Brazil’s public security policies, which she argued served to “control and rebuke” Black and poor communities and fuel Brazil’s growing prison industrial complex. Marielle’s denouncement of state-sanctioned violence echoed the activism against Black Genocide in Brazil that spans decades and, in its contemporary form, is embodied in Vidas Negras, Brazil’s grassroots movement for Black Lives. As a sociologist with training from one of the most prestigious institutions in Brazil—Pontifical Catholic University of Rio de Janeiro, she brought a critical analysis to the issue and compiled empirical data to illustrate that “Racism is Not an Opinion”:

Marielle’s policy and advocacy weren’t just about the numbers.  During work early in her career with the Human Rights Commission in the Rio de Janeiro state legislature, Marielle routinely met with and advocated for the families of victims of police brutality. She understood, first-hand, the gut-wrenching reality of losing a loved one to senseless violence and was committed to using her voice and her platform to make a difference. In February 2018, her public critique of state-sanctioned violence intensified when the federal government implemented an intervention that put military forces in charge of local police in Rio. In her very vocal public denouncement of the federal intervention, she made sure the names and faces directly affected were known. In an op-ed she submitted to Jornal do Brasil on the morning of March 14, she wrote a scathing synopsis and critique of the intervention and dared to “say the names” of Black women who had been killed due to what she described as a “senseless war”: Alba Valéria Machado. Natalina da Conceição. Janaína da Silva Oliveira. Tainá dos Santos.

She went on to say that

“Black women living on the peripheries lose their children to this deadly viciousness… And the deaths have a consistent racial identity, social class, and neighborhood of dwelling”.

Furthermore, she asserted that “violence” is a direct by-product of entrenched inequalities, and cannot be solved with weapons, but with policy:

“Without a doubt, public security should no longer be pursued with weapons, but with public policy in all areas: health, education, culture, and the creation of jobs and income.”

A poster for Marielle’s March 14th Casa Das Pretas advocacy event.

At the gathering of young Black Women on March 14, Marielle called attention to the ongoing violence. But like the fierce and empowering leader she was, she viewed those gathered in the room as the embodiment of the power, strength, and resistance necessary to bring about radical change, asserting that it was necessary for Black Women to “occupy every place with our bodies.” Only then would Black lives, women’s lives, poor lives, and queer lives truly matter.

I left the event inspired and in awe of Marielle and the courageous Black Women I encountered at Casa Das Pretas. But less than an hour later, the life was literally sucked out of me, when I received the news that four bullets to the head in a targeted political assassination had taken her life, and the life of her driver Anderson Gomes.

To say the least, this moment changed me. It shook me to my core. But just like the senseless deaths of Sandra, Charleena, Nia, and countless other Black women, Marielle’s death ignited in me an even deeper commitment to continuing my research examining structural racism and health inequalities both domestically and abroad. For me, this means naming and challenging racism in our scientific and public discourse, using data to make the invisible visible, mobilizing data and research for action and advocacy, and ensuring that our dialogue about racism, health inequalities, and the struggle for Black Lives is, in fact, a global one . For me, this work has quite literally become a Matter of Life and Death.

Today, September 14, 2018, marks the 6-month anniversary of Marielle Franco’s assassination.

*This guest blog originally posted via Robert W Johnson Foundation New Connections.

Revisiting Frederick Douglass' “WHAT TO THE AMERICAN SLAVE IS YOUR 4TH OF JULY?”

A recent conversation with doctoral student, Natalie Bradford, who is re-reading Frederick Douglass' seminal speech, "The Meaning of July 4th for the Negro", prompts this blogpost. Douglass delivered the speech on July 5, 1852 at a celebration of the Fourth of July hosted by the Rochester (New York) Ladies' Anti-slavery Society. Imagine the courage it took to deliver the speech as he did through the prism of the African American experience, which is the experience of being a perpetual, intimate witness to both the beautiful ideals of the American project and the utter hypocrisy with which it is implemented. The speech remains instructive in 2018 as stark departures from those ideals now characterize the national landscape: persistent white supremacy, overt anti-black and other forms of racism, nativism and anti-immigrant hostility, exploitation of/extraction from Native lands, Islamophobia and anti-Semitism, racialized mass incarceration, and a myriad of practices and policies buttressing economic inequality.

Re-visiting this speech on the Fourth of July is a way to honor Douglass' work by learning from it. Below are two excerpted readings of it; the second one is a brief excerpt for those seeking a shorter version that captures the spirit of the full one.


Collins Airhihenbuwa asks "Is being ‘two-faced’ cultural, racial and/or gendered?"

Collins Airhihenbuwa asks "Is being ‘two-faced’ cultural, racial and/or gendered?"

Two faced? This question of expressing one view in one space, yet turning around and expressing an opposite view on the same subject in another space remains at the core of the legacy and currency of distrust and suspicion in racial and gendered spaces. The question of trust across identity spaces, whether racial, gender or global, is particularly most revealing and yet pivotal in leadership.