Those who view racism as a historical phenomenon may be shocked to learn that the Black infant mortality rate in the modern era is 2.3 times higher than that of White infants, a racial disparity that’s wider than the one found in the 1850s, when enslaved infant mortality was estimated to be 1.6 times higher than that of White infants (Owens & Fett, 2019). Their American Journal of Public Health report shows that some racial disparities have worsened over time, contradicting the assumption that progress is inevitable. In The 1619 Project, Ibram X. Kendi argued that our country has “been defined by two forward motions: one force widening the embrace of Black Americans and another force maintaining or widening their exclusion.” While many emphasize our nation’s racial progress, fewer seem willing to acknowledge the other half of the story. But, as Kendi noted, “Black people today are still weathering the highest unemployment rate, and incarceration rates, and the lowest life expectancy and median wealth.”

One explanation for the disparities observed between White and Black infant mortality rates in the modern era is the devaluing of Black lives. During chattel slavery, Black people of African descent were considered property. White enslavers bought and sold Black men, women, and children at public auctions, took out insurance policies on them, used them as collateral to secure loans, and left them to their next-of-kin as inheritance. Throughout this period, each Black infant added to the property holdings of enslavers. Under the 17th-century legal doctrine of Partus Sequitur Ventrum, which is Latin for “that which is born follows the womb,” any child born to an enslaved woman would share her fate. While enslaved Black women were often prohibited from nursing their infants for long, as they were expected to nurse White babies, a sign of their subordinate status, slavery provided a financial incentive to ensure the survival of Black infants.

According to Owens and Fett (2019), “White women’s childbearing built free patriarchal lineages while southern laws forced enslaved Black women to bear children who would build capital for enslavers.” They noted that “the disparity in maternal and infant health lies with the commodification of enslaved Black women’s childbearing and physicians’ investment in serving the interests of slaveowners.” In 1857, abolitionist Frances Ellen Watkins Harper explained that “A hundred thousand newborn babes are annually added to the victims of slavery…instead of listening to the cry of agony, they listen to the ring of dollars and stoop to pick up the coin.” Her comments suggest that those who financially benefited from this arrangement were unconcerned with the human cost of slavery and align with a statement in a National Archives essay, that “child slaves were viewed by their masters and society in general as valuable assets with a monetary value of their own and an investment for the future.” Abolition, while essential to racial progress, shifted this dynamic.

Following the Civil War, two movements emerged that align with Kendi’s theory. One pursued racial progress, as seen in the passage of the 13th Amendment, which abolished slavery; the 14th Amendment, which established birthright citizenship and “equal protection”; and the 15th Amendment, which guaranteed Black men the right to vote. The other, identified by the passage of Black Codes, sought to undermine these newly established rights. While Black infants and children helped create generational wealth for White families throughout the chattel slavery era, in the aftermath, their value plummeted. Oral accounts have helped to “capture otherwise hidden historical processes that linked the [Jim Crow Era’s] institutional racism and child mortality,” according to Elman et al. (2025). For instance, researchers found that the “Black-White child mortality gap [was] widest among Arkansas mothers economically tied to the plantation vs. subsistence agriculture; exposed to worse health environments; living in tenant farm vs. owned-farm households; and with limited individual resources such as literacy.” Sadly, these racial disparities persisted. When researchers examined data from 1915 to 2017, they found that while the infant mortality rate declined for both Black and White infants, a sign of healthcare advancements, the Black-White disparity in mortality generally increased through 2000 (Singh et al., 2019).

While Owens and Fett (2019) suggested the gap between Black and White infant mortality rates is wider in the modern era than it was during the 1850s, it’s essential to consider that during this period, enslaved infants had poorer health outcomes across the board. Conditions on Southern Plantations were so dismal for the physical health of enslaved infants that many were stillborn or died before their first birthday. According to Steckel (1986), the historical absolute mortality rate for enslaved infants was higher at 350 to 500 per 1,000 births (35–50%) during the 1850s than the modern absolute mortality rate at 10 to 11 per 1,000 births. Slavery created poor living conditions for Black people from cradle to grave, often shortening the span between the two. So, while the Black-White gap is wider today, we mustn’t overlook the fact that a greater percentage of Black babies were dying during chattel slavery. Scholars have attributed the high rate of enslaved Black infant mortality during this period to the poor nutrition of enslaved pregnant Black women and newborns, untreated infectious diseases, and overexertion, as they were expected to labor throughout their pregnancies and shortly after giving birth.

Given the abolition of chattel slavery and the passage of civil rights legislation, why does the high rate of Black infant mortality persist? In the modern era, the high rate of Black infant mortality can be attributed to the high rate of preterm births, lower birth weights, and pregnancy complications. Evidence suggests the cumulative impact of racism can explain this disparity between Black and White infant mortality. David et al. (2004) found that “the lifelong accumulated experiences of racial discrimination by African American women constitute an independent risk factor for preterm delivery,” which is associated with lower birth weights and worse health outcomes. According to a Yale School of Medicine report, “Black women and their infants face risks in their pregnancies and deliveries as a direct consequence of obstetric racism and the interlocking systems of oppression that affect the lives of these women (Clouser, 2022). While Josiah et al. (2023) suggested “targeting implicit biases is foundational to improving health outcomes for Black birthing women,” we must also consider the broader social determinants, which Jang and Lee (2022) associated with adverse infant outcomes, such as “economic stability, education, healthcare access and quality, neighborhood and built environment, and social and community context.” Based on their findings, our society should consider the role of medical racism holistically if we hope to improve health outcomes for Black women and their infants.

Lastly, there is evidence that slavery itself has an adverse impact on the Black infant mortality rate in the modern era. For example, Reece (2022) found that “counties that had more enslaved people in 1860 have lower Black life expectancies and higher White life expectancies today.” Furthermore, they noted that “slavery was a stronger predictor of contemporary life expectancy than other traditional factors such as health access, neighborhood safety, and health behaviors.” While racism remains a controversial topic in America, and the current administration has taken steps to limit discussions and formal research examining the causes, and potential solutions for lasting racial disparities, the health and wellness of Black women and infants requires us to consider how unjust systems of the past, such as slavery and Jim Crow, continue to place Black people at a disadvantage, even the most vulnerable among us. The fact that the racial disparity between Black and White infant mortality is estimated to be wider now than during the 1850s points to a society that has failed to reckon with its legacy of racism, that has denied the impact of race while maintaining disparate conditions.