When she first heard the statistics about infant mortality rates, Tonya Lewis Lee, wife of the celebrated director Spike Lee, was alarmed. The numbers showed that each year more than 8,000 African-American babies die within the first 12 months of their lives. But when Lewis Lee learned that women’s socioeconomic and educational status—factors long believed to drive the phenomenon—did not affect the high death rate among Black babies, she was even more astonished.

“People tend to think of infant mortality as an issue for poor women or women who don’t have access to quality health care,” Lewis Lee says. “But while those things do have an effect, the fact remains that when we look at the rates of infant mortality for Black women, it doesn’t matter how well off you are financially or your level of education. A Black woman with a high level of education and income still faces an increased risk of losing her child before its first birthday as compared with her poorer, uneducated white sister.”

Lewis Lee produced a documentary about the issue, titled Crisis in the Crib: Saving Our Nation’s Babies, for the Office of Minority Health (OMH), which released the film on September 9, 2009, in recognition of National Infant Mortality Awareness Month. She shot much of the footage in Memphis after being invited to a service there organized by OMH and companies from the city and surrounding areas to honor babies born in Shelby County who died too young.

The film opens with a scene of Lewis Lee and others arriving at Shelby County Cemetery in Tennessee’s largest city on a clear, bright Sunday. The next shot shows 402 white stakes placed in the earth. The camera pans across the space as purple ribbons fastened atop the stakes flutter madly in the breeze. 

Tonya Lewis Lee and Spike LeeGetty Images/Walter McBride

The markers acknowledged the brief lives of infants who died before their first birthday in Shelby County in 2006 and 2007. At the time, Lewis Lee, an author and producer of children’s television programs, was a spokesperson for OMH’s infant mortality awareness campaign A Healthy Baby Begins With You. She worked with federal and local officials, students and residents to raise awareness about the frightening number of Black newborns who die before their lives even really begin.

“At the bottom line, infant mortality is an indicator of the health of our nation—and we are sick,” she said, during her acceptance speech when the Congressional Black Caucus honored her for the film.

According to the Centers for Disease Control and Prevention (CDC), the United States’ infant mortality rate is the highest among the world’s 27 wealthiest nations. One measure of a country’s health, this figure reflects the number of deaths of infants under 1 year old per 1,000 live births in a given year.

In 2013 in the United States, non-Hispanic Black mothers experienced the highest infant mortality rate: about 11 deaths per 1,000 live births.

Indeed, Black babies are almost three times more likely than white babies to die before reaching their first birthday. What’s more, recent data show that infant mortality rates among Black people are on the rise in some states. A report by the Population Reference Bureau confirmed that the infant mortality gap between Blacks and whites has persisted through the years. Additionally, African-Americans consistently suffer higher infant mortality rates compared with other racial and ethnic groups in the United States, and this disparity endures.

Today, definitive explanations for this trend continue to elude researchers. “Despite improvements, disparities in infant mortality are chronic and persistent,” says Garth Graham, MD, MPH, a former assistant deputy director of OMH.

Eventually, the campaign spawned a second phase that organized Black college students to act as ambassadors tasked with educating and training their peers and young people in the community at large about preconception. “We want our peer educators to send that message to our youth,” Garth said about the rollout. “You can’t wait for pregnancy to start doing the right things. You need to start the day you are born.”

Lewis Lee agrees. “Healthy living and preconception health can help us accomplish real change in our community,” she says.

As a chubby 13-year-old, Lewis Lee started her own journey to becoming more health-conscious, beginning with awareness and adjustments to her lifestyle. “My doctor and mother had me going for weekly weigh-ins and a consultation on nutrition and exercise,” she says. “By the time I was 16, I knew that I had to exercise and watch what I ate.”

Her sister reinforced those lessons with advice Lewis Lee continues to follow. “When I was 24 years old, she said to me, ‘Tonya, you need to start exercising now on a regular basis so that by the time you get to 40, this is just what you do,’” she recalls. “That’s just the best advice I’ve ever gotten.”

But staying on the path to good health is difficult. When Lewis Lee became pregnant with her son, Jackson, and later her daughter, Satchel, she admits that she gained close to 60 pounds each time. 

Courtesy of Movita

“I just ate whatever I wanted to eat, then dealt with it afterward. But it was hard work doing that,” she says.

Eventually, Lewis Lee came to appreciate the benefits of consistently embracing a healthy lifestyle.

“I’m very fortunate to have both of my parents [still alive], but when they were the age that I am now, they were taking medication for high blood pressure or high cholesterol,” she says. “But I’m not taking those medications now, and I know that that’s partially because of the lifestyle that I have chosen to live.”

Then she adds, “Ultimately, I may have to end up doing that, but at least I have kept it at bay for this long.”

Lewis Lee acknowledges that if more African-American women, and men too, take care of their health from early in life, this may reduce the number of infants dying in Black communities. But before they become pregnant, women can increase their chances of having a healthy baby by thinking about their goals for having or not having children and how to achieve those goals, addressing health issues with their health care provider before getting pregnant and adopting a healthy lifestyle.

Some specific steps women can take to minimize premature births, low-birth-weight babies and birth defects—the most common causes of neonatal deaths—include maintaining a healthy weight and diet (with food and nutritional supplements if needed), engaging in regular physical activity, not smoking, abstaining from recreational drugs and limiting alcohol consumption.

In addition, pregnant women should visit the doctor to check their health and manage any chronic conditions they have and medications they’re taking.

The CDC also recommends that mothers-to-be who are in abusive relationships seek help to address intimate partner violence and talk with their health care providers about depression or other mental health issues.

The main point the agency stresses is that if health care providers and women work together before and during pregnancy to solve problems if they arise, women’s chances for healthy outcomes can be improved.

With this more proactive and preventive approach to health care, doctors can guide patients who are at high risk of delivering a very small or sickly baby to hospitals that specialize in these kinds of problematic deliveries.

Lewis Lee says she’s very careful about sticking to a wholesome lifestyle because she knows that diet and exercise are connected with our physical and mental well-being. Indeed, both affect the health of pregnant women and their babies in unique and sometimes unforeseen ways.

The hardworking entrepreneur, author and health advocate certainly practices what she preaches. “I think women put themselves last, but we have to put ourselves first,” she says. “When you think about your body as that vehicle that’s going to get you through this life, you’re more likely to take care of it.”

The Race-Stress Theory

Is there really a correlation between racism and poor birth outcomes?

In an effort to explain the difference in infant mortality rates between Blacks and whites, scientific findings show that stress and racism are constant factors in African-American women’s lives, which may have a pronounced effect on their pregnancies.

Research has suggested that maternal stress affects both a mother’s health and that of the baby in her womb. But scientists aren’t sure exactly how. Some researchers have observed that women at the highest risk for preterm birth had higher levels of stress hormones, such as cortisol, CRH and ACTH, circulating in their bodies. What’s more, women who experienced frequent episodes of discrimination were diagnosed with high levels of these hormones, which can affect a fetus’s development and predispose it to diseases later in life.

“I know that there’s a lot of research being done,” says Tonya Lewis Lee, an advocate for infant mortality awareness in Black communities and the wife of award-winning film director Spike Lee.

“What I have found in my travels and in talking to doctors and researchers who are doing this work is that there is stress that we carry in our genes from our mother and from our grandmothers that affect our health,” she adds. “More and more, our scientists are getting into that research, and they’re finding not just anecdotal evidence, but the true science behind this race-stress theory.”

Still, researchers emphasize that much remains unknown about the relationship between racism and poor birth outcomes and more research is needed, especially studies that take into account the pervasive, chronic and multidimensional experiences of interpersonal and structural racism throughout the course of our lives.

Scientists also note that it’s unclear how or why other racial minorities escape the outcome disparities that African Americans experience.

Lewis Lee says she’s happy that we are finally beginning to understand that stress really does have an impact not only on our individual lives but also on the lives of our children.