Introduction
The Black-white infant mortality gap is not something new, however much of the conversation surrounding the topic in the last few years or so outside of academic journals has left people shocked. This is because there have been efforts to reduce the overall infant mortality crisis, but not much to educate the people and address the widening disparity between Black infants and their counterparts. I want to engage with literature from the last decade or two because the history of infant mortality in itself is a motivation for me. The Center for Disease Control reports that “infant mortality for non-Hispanic Blacks to be 11.4 and 4.9 for non-Hispanic whites,” (2016). These numbers motivate me to look at two things, what has changed and what hasn’t changed in the efforts to reduce this major health disparity. In studying the past, I attempt to look at how structural racism and discrimination is embedded into institutions such as health care, education, housing, etc and how ineffective methods can be without addressing this. Hence why in the grand scheme of things the problem with the Black-white infant mortality gap remains.
In conducting a prior literature review, I found that the existing body of literature on the Black-white infant mortality gap mainly approaches social and economic factors. However, when socioeconomic status is controlled for the disparity continues to exist as we’ve seen with successful Black tennis player Serena Williams who had a traumatic childbirth experience (The Guardian, 2018). With the particular method I’ll use I hope to look at how research has approached factors side by side or even addressed the obvious role structural racism and discrimination plays in Black infant mortality. I want to be able to conduct this research from a demographic standpoint, however with the particular method I’ll be using I will have to find a way to remedy the issue of a small sample size.
I want to use a comparative-historical approach to conduct my research and address my question. A comparative-historical approach is the most useful method for my research because I want to establish that the Black-white infant mortality gap has long existed, but it has not been explored through a structural racism lens until recently. I believe this method will allow me to track what has and hasn’t changed as I mentioned in the introduction in regard to how infant mortality has been addressed and researched. A comparative historical approach looks at major transitions in society, such as this major health disparity I will explore. In conducting a comparative-historical research I want to create an explanation for why the Black-white infant mortality gap exists in respect to time and place.
I chose this particular method of research because it can be applicable to just about any topic or question. Another strength of choosing this particular method is that you avoid problems with reactivity and panel conditioning. This means I don’t have to worry about participants changing their answers or behaviors because another researcher has already done the observations needed. However, since I am looking at already existing sources it is something I have to consider. The major strength found in comparative-historical approach is that it gives you a combination of idiographic and nomothetic explanations. In my research I believe finding general explanations across cases will be the easy part, however for an idiographic approach it will be dependent on what sources I use and if those sources do a good job of investigating individuals. The major weakness in my research method is the small N problem, which is in regard to having a small sample size to draw general explanations or claims from. I think this weakness is what discourages people from conducting comparative-historical research. Nonetheless, I believe the way you choose primary sources and how many you choose can somewhat resolve this issue.
Operationalization and measurement
In the context of a comparative-historical approach in order to conduct my research I will have to have key terms and definitions to base my searches on. I believe a major help will be looking at previous contextual definitions within the literature I reviewed. With the help of my literature review I know that race and racial discrimination will be key words in my research. However, this requires going beyond the dictionary definition and recognizing that race is socially constructed and that we have to base it on how individuals self-identify in accordance to the census, (Lecture, 3-1). Racial discrimination can be contextualized to mean actions or behaviors against an individual on the basis of their self-identified race. In addition to this, racial discrimination can be in the form of differential access as well. In my search I will look at racial discrimination with respect to the domain at which it occurs. This means prioritizing clinics and hospitals as points of physician-patient interaction. Some variables may be looking at reported incidences either verbal or written to further gauge the incidence of racial discrimination during pregnancy. Since I’m approaching my research topic and question from a qualitative standpoint I will not be engaging with indexes and scales, however the sources I chose may have already set particular measures. For instance, they may use interview or focus groups to further establish the relationship between black infant mortality and racial discrimination. The main measure I want to incorporate is a nominal measure that gives respect to the kind of sources I gather and their quality.
Reliability and Validity
Since comparative-historical research is a method of qualitative research I cannot conduct particular tests of reliability and validity. I still believe I should have a method of evaluating the sources I will use. In order to do this, I have to thoroughly engage with the sources I’ll use by asking questions about what primary sources I will use, where I got them from, and the analytics of what I actually searched for. Since I am conducting a comparative-historical research I want to look for primary sources in the form of empirical scholarly work that addresses infant mortality, race, and racial discrimination. In order to vet the materials I will use I am going to use databases such as Scopus and PubMed. These search engines have biomedical literature from many different journals and sites, but they are also peer reviewed which gives me an insight to the authors background and authenticity of the work. These search engines also allow me to set my particular time period (roughly late 1980’s to present) in order to eliminate work that falls outside of that range. In my actual search for work I plan to play close attention to things such as description of participants used, personal biases from the researcher, and their sampling methods. For example, how exhaustive and exclusive are the questions being asked in a particular method of interviewing or focus groups. Since this is a comparative-historical research I plan to compare different cases that accurately portray the role of racial discrimination in infant mortality with respect to time and space (states, cities, counties).
Data Collection and Sources
Following the hallmarks and process of comparative historical research I first want to establish that the sources I am looking for are relevant work and literature regarding the relationship between racial discrimination and infant mortality. I want to look at work from the last two or three decades to establish a pattern of change in the way the Black-white infant mortality is researched and talked about. In doing so, it will help me approach the infant mortality gap from a life course perspective, establishing ground that research needs to move in a new solution-oriented direction. In using the particular search engines I have in mind I want to look for studies that have an actual measurable outcome. I think the hardest part of my research method will be how time consuming it will be looking for material that fits well into the parameters. However, I want to keep in mind that even though my goal is to identify a pattern I can’t base my sources solely on the outcome I want out of the research.
Sampling
For a comparative-historical research design the sampling pertains to the material because we don’t have people or populations to sample from. So as far as the actual material we want to collect I want to gather studies within the United States pertaining to the relationship between infant mortality and racial discrimination. I chose the United States because it is where I reside, but it is also where we can see the greatest gap between Black and white infant mortality due to structural racism. In order to reduce my search I want to look at case studies that focus on both areas of poverty and access to health care to really see what changed in our approach to this maternal and child health issue. As far as other measures go, I want to look for original work that focuses primarily on Black/African-American women. Since my method of research doesn’t sample people I think it can be closely related to a non-probabilistic method. Methods such as expert on purpose and snowball sampling give me a basis of what to do because I am looking for scholarly work, which establishes authority and gives me a point of reference to go off of. As far as sample size goes, I think I want to look at a small sample analysis that is more in-depth. I don’t necessarily know the sample size because it will be dependent on the material that is available to me, and how exhaustive my search is.
Comparison and Critiques
As I mentioned the conversation surrounding the infant mortality gap and racial discrimination has shifted drastically, and in order to prove this I must gather enough sources that will allow for comparison. For my comparative-historical research I hope to use a more within subject comparison. A within subject comparison means looking at cases that perform at all the same levels in regard to the criteria I am searching for. For example, although the cases I study will be from different cities and counties they will have the same methods in regard to how they measure perceived discrimination and its consequences on Black mothers and infants. I want to implement a within subject design because I want to control for any factors that will change my sources outcome. This is important to my overall research question because it will establish that the relationship has existed throughout history and still persists today.
Ethics
Ethics is an important component to all research even comparative-historical research, which doesn’t require you to actually engage with participants. My motivation for conducting this research is important in establishing moral principles to go by. I want to be critical of the type of sources I choose because my goal is to establish research that proves the history of racial discrimination in regard to infant mortality in hopes of preventative methods. In order to do this I don’t want to choose sources that will only follow the outcome I have in mind. I can also be cautious of the authors I choose to represent in my overall body of work, closely examining how they treated participants, what methods they used, and what their goals and motives were.
Conclusion
In conclusion, I want to use a comparative-historical research method in order to establish a relationship between infant mortality and perceived racial discrimination. I chose this particular method opposed to other kinds because I believe outside of academic journals and literature the public could benefit the most from this research. A comparative-historical approach allows for an integrative method that encompasses many questions people may have missed in their own research. For example, in most of the literature I reviewed the main factors were social and economic giving little to no precedence to the real-life effects perceived discrimination can have on both Black mothers and infants. I have a few goals for the research, which I believe will help in understanding why I chose the method and how it will answer my overall research question. First, I want this research to be a source of education for the public, especially for Black women and even for other minority groups who will face differential treatment and access to resources on the basis of their identity. Conducting a comparative-historical approach will also allow for people to see how the issue has persisted, however the way it has been researched is what needs to change. My second goal for this research is to assess the problem then develop necessary ways to mitigate the gap through intervention and prevention, such as retraining physicians, making resources readily available to Black women, and acknowledging the overall role racism plays in reinforcing health disparities.