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African-American women are more likely to lose a baby in the first year of life than women of any other race or ethnicity. Doctors and researchers have been trying to understand what makes black infants so vulnerable, and now they think it has to do with how their mothers are treated in this country. NPR's Rhitu Chatterjee has this story as part of our series on discrimination, You, Me And Them. And a warning here - there is a racial slur in this story.
RHITU CHATTERJEE, BYLINE: It was 2009, and things were going really well for Samantha Pierce.
SAMANTHA PIERCE: I was newly married. I had a son. I was a higher-up in my company. I had a lot on my plate.
CHATTERJEE: Pierce lives in Cleveland, and she worked at a small nonprofit that helped people deal with predatory lenders.
PIERCE: That was the company that I was in charge of. And when I tell you I was kick-ass community organizer, I was - I was pretty kick-ass.
CHATTERJEE: Life was good, and it was about to get better.
PIERCE: Hey, we're pregnant (laughter).
CHATTERJEE: Pregnant with twins. Pierce thought she was a poster child for healthy pregnancy. She had a college degree. She was taking prenatal vitamins, had great health care and everything was going smoothly, until one day...
PIERCE: I was about five months pregnant with the twins when I discovered that I was leaking fluid.
CHATTERJEE: After a week in the hospital, her water broke, and she gave birth to her twins.
PIERCE: They lived for about five minutes each of them, but they couldn't breathe. They didn't have lungs. We got to hold them, talk to them. I could see them breathing, but I could also see when they stopped breathing, you know.
CHATTERJEE: Pierce was devastated. She says for months she couldn't bear to look at her stomach. It felt like a cemetery.
PIERCE: A walking tomb. It was just walking evidence of loss, of failure. I couldn't even do the one thing I was put on this planet for, which was bear children.
CHATTERJEE: What she didn't know then was that her twins were part of a chilling statistic. Arthur James is an OB-GYN in at The Ohio State University's Wexner Medical Center in Columbus.
ARTHUR JAMES: Black babies in the United States die at just over two times the rate of white babies in the first year of life.
CHATTERJEE: That's because black mothers like Samantha Pierce are more likely to give birth prematurely, and James has seen countless black mothers lose their babies. He says it just doesn't seem right.
JAMES: You ask yourself what is it about being black that places us at increased risk for that kind of experience.
CHATTERJEE: Neonatologist Richard David says scientists used to think high levels of poverty and lack of education are to blame. David's of the University of Illinois at Chicago and has been studying this for decades.
RICHARD DAVID: We knew that African-American women were more likely to be poor and that fewer of them had completed their education by the time they were bearing children.
CHATTERJEE: But that doesn't explain it all, he says, because of this - a college-educated woman like Samantha Pierce is more likely to give birth to a premature baby than a white woman who didn't even finish high school.
DAVID: That's exactly the kind of case that makes us ask the question, what else is there? What are we missing?
CHATTERJEE: He says some people asked, was it genetics? Now, if genes were at play, women from Africa would also be more likely to have premature babies. So David and his colleague looked at the babies of immigrant women from Africa. It turns out that their babies were more like white babies - bigger, more likely to be full term. David says it clearly wasn't genetics. Then many years later, he discovered something startling. The next generation, the grandchildren of those African immigrant women, were more like African-American babies - smaller, more likely to be premature.
DAVID: So there was something about growing up black in the United States and then bearing a child that was associated with a lower birth weight.
CHATTERJEE: He says there is something different about growing up black in America - discrimination.
DAVID: It's hard to find any aspect of life that's not impacted by racial discrimination in this country.
CHATTERJEE: David and other scientists have found that African-American women who say they've faced discrimination are more likely to have preterm deliveries and therefore more likely to lose their babies. Samantha Pierce didn't know any of this when she was pregnant back in 2009, but she did know discrimination. She was 7 or 8 the first time someone called her the N word. She was with a mother in Murray Hill, Cleveland's Italian neighborhood.
PIERCE: We were just driving through, and we were called niggers just going up the hill.
CHATTERJEE: The memory still makes her blood boil.
PIERCE: You know, it does not matter that my mother owned her home. It does not matter that we owned that car 'cause we did. It did not matter that I went to private school 'cause I did. When I was riding up Murray Hill, I was a nigger, and so was my mother.
CHATTERJEE: Pierce says it wasn't the only time she was made to feel inferior for being black. It happens even today, like having to fight for a promotion over a white colleague or when she's shadowed at stores by the staff even when she's with a white friend.
PIERCE: So when I say, Deb (ph), did you see that clerk? She was watching our every move. And my white friend will be like, no, she wasn't. (Laughter) I'm telling you she was, and now she's watching you 'cause you're with me. And those types of things, they happen every day.
CHATTERJEE: It's frustrating, she says, and stressful. Arthur James says when someone's stressed out all the time, their bodies are flushed with stress hormones. And for pregnant women...
JAMES: Higher levels of stress hormones increases the incidence of preterm labor.
CHATTERJEE: When Samantha Pierce first learned about this a few years after her twins died, it was as if a light bulb went off.
PIERCE: So stress leads to labor, and African-American women live a more stressful life, and so we hit preterm birth at an alarming rate.
CHATTERJEE: That understanding changed her life. She became determined to fight back against all that stress for herself and for other black women.
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CHATTERJEE: So she turned to exercise as a buffer against the stress. Now she spends a lot of time working out here at this gym in Cleveland, and she's also a personal trainer. Her clients are mostly African-American women. She says exercise could also provide social support, something a lot of black women say they don't have.
PIERCE: You know, we really are hard on ourselves, and so we actually really need other women, especially other black women, to say, I see you. You're doing fine. Keep going.
CHATTERJEE: Pierce says she can't change how society treats black women, but she wants to change how black women cope with their stresses. If they can make their bodies more resilient, she hopes it will give the next generation a better chance of surviving. Rhitu Chatterjee, NPR News.
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