Relationship of Paternity Status, Welfare Reform Period, and Racial/Ethnic Disparities in Infant Mortality.

The objective of this study was to examine the relationship of paternity status, welfare reform period, and racial/ethnic disparities in infant mortality. The study used retrospective analysis of birth outcomes data from singleton birth/infant death data in Milwaukee, Wisconsin, from 1993 to 2009. Multivariate logistic regression was used to examine the relationship between paternity status, welfare reform period, and infant mortality, adjusting for maternal and infant characteristics. Data consisted of almost 185,000 singleton live births and 1,739 infant deaths. Although unmarried women with no father on record made up about 32% of the live births, they accounted for over two thirds of the infant deaths compared with married women with established paternity who made up 39% of live births but had about a quarter of infant deaths. After adjustments, any form of paternity establishment was protective against infant mortality across all racial/ethnic groups. Unmarried women with no father on record had twice to triple the odds of infant mortality among all racial/ethnic groups. The likelihood of infant mortality was only significantly greater for African American women in the postwelfare (1999-2004; odds ratio = 1.27; 95% confidence interval = 1.10-1.46) period compared with the 1993 to 1998 period. Study findings suggest that any form of paternity establishment may have protective effect against infant mortality. Welfare reform changes may have reduced some of the protection against infant mortality among unmarried African American women that was present before the welfare legislation. Policies and programs that promote or support increased paternal involvement and establishment of paternity may improve birth outcomes and help reduce infant mortality.

An investigation of paternity status and other factors associated with racial and ethnic disparities in birth outcomes in Milwaukee, Wisconsin.

OBJECTIVE: To examine factors associated with preterm birth and low birthweight and the role of paternity status in birth outcomes among racial/ethnic groups in Milwaukee. METHODS: Retrospective analysis of data on 151,869 singleton live births (1993-2006) from the City of Milwaukee, Wisconsin. Multivariate logistic regression models were used to examine demographic and medical factors associated with racial/ethnic disparities in preterm birth and low birthweight. RESULTS: African-Americans, whites, Hispanics, and women of "other" racial groups accounted for 46%, 33%, 16%, and 5% of births, respectively. Preterm birth and low birthweight rates were three times greater for African-American women compared to whites. Compared to white women, the odds of preterm birth were 82% and 35% greater for African-American and other minority women, respectively. All minority women had greater adjusted odds of low birthweight than whites, with African-American women at greatest risk (OR 2.36:2.23-2.49). Across racial/ethnic groups, significant predictors of both outcomes included being unmarried with no child's father on record, maternal smoking, chronic hypertension, previous preterm birth, and inadequate and adequate plus prenatal care. Paternity status had a gradient effect for whites and Hispanics with unmarried women with no child's father's name on record at greatest risk, followed by those with court-established paternity and those with paternity statement at lowest risk for both outcomes. CONCLUSIONS: Implementing policies/programs that promote smoking cessation, proper management of maternal conditions, targeted interventions for women with previous preterm birth, and paternal involvement have the potential to reduce disparities in birth outcomes.