Beyond Antibiotics: Obstetrical Interventions, Surgical Capacity, and the Persistence of Racial Stillbirth Disparities in the US South

Matthew Purcell, London School of Economics

This paper uses obstetrical case records from Lincoln Hospital (Durham, NC), a preeminent Black hospital in the US South, and Duke University Hospital, which had a predominantly white patient population, to analyse the role obstetrical practices played in the persistent Black-white stillbirth disparity across the mid-20th century. Adopting Løkke’s (2012) framework linking antibiotic availability to increased obstetrical interventions, particularly caesarean sections, I compare intervention rates within the two hospitals. I find a continued preference for forceps over caesarean sections within Lincoln Hospital, contrary to the trends Løkke found in Denmark. Moreover, the limited use of caesarean sections resulted in many high-risk births receiving no intervention. By looking at the physicians attending births, I show that the surgical capacity at Lincoln Hospital was limited, resulting in most physicians choosing forceps paired with a local anaesthetic rather than the more specialised caesarean operation. Qualitative evidence indicates that the racially discriminatory medical education system created capacity constraints, hindering the adoption of caesarean techniques by Black physicians. This study shows how unequal access to clinical training attenuated the potential benefits of antibiotics for intrapartum care. The interplay of innovation and human capital, shaped by racial exclusion, offers one explanation for the persistence of the Black-white stillbirth gap.

No extended abstract or paper available

 Presented in Session 86. Gender and Health: From Coal Miners to Motherhood