Each year, maternal care expands in resources and knowledge. Equipped physicians can diagnose birth defects long before a mother gives birth. Absurdly, poor twenty-first century mothers in Atlanta lack access to this prenatal care, which would play a vital role in the reduction of infant mortality. Without prenatal care, mothers endanger not only their lives but also the lives of their unborn infants." (2005) proposed solution provision of adequate access to prenatal care for women in Atlanta by the Children's Healthcare of Atlanta and local hospitals has been stated for free monthly screening however this provision will depend on the ability of groups in Atlanta to raise funding for this provision. Ashman (2005) states: "In urban areas such as Atlanta, Georgia, the poverty level affects the rates of infant mortality. Individuals with lower incomes and lower job status have a greater likelihood of experiencing the loss of an infant due to lack of financial accessibility to prenatal care than individuals from higher income environments such as White Plains, New York." Ashman states that the key in reduction of infant morality begins with "addressing financial accessibility in underprivileged urban areas such as Atlanta. The work of Ziba Kashef entitled: "Persistent Peril: Why African-American Babies Have the Highest Infant Mortality Rate in the Developed World" relates that African-American women "have long had higher rates than whites of low-birth weight and preterm babies, the leading cause of infant mortality or death in the first year of life." (2006) Kashef relates a recent study reported in the Journal of the American Medical Association, which relates that "one particular disparity - the gap between black-white baby deaths - has not just persisted by actually grown in recent years despite federal efforts to eliminate the difference." (Kashef, 2006) Kashef additionally states that research has "debunked the notion that socioeconomic status and related factors are the source of the problem" (2006) and points out the following facts:

1) College- and graduate-school educated black mothers have a higher infant mortality rate than white moms who did not finish high school;

2) Black women who get prenatal care in the first trimester have double the infant mortality rate of white mothers with first-trimester care; and 3) Black women with similar levels of prenatal care as Hispanic women (generally less educated and with lower incomes than blacks) have higher rates of low birth weight, preterm deliveries, and infant mortality. (Kashef, 2006)

Research has demonstrated that even when controlling for various factors such as poverty, housing employment, medical risk, abuse, social support..." And other factors that "90% of the differences in birthweight between black and white moms remains unaccounted for." (Kashef, 2006) Genetics has failed to provide the answers as well. Experts are beginning to search beyond the woman's individual risk factors during pregnancy and to view "a more complete, long-term perspective on women's health. Healthy women beget healthy children...so when you start to talk about the health of the mother, you have to really look at her life course experiences, and some of that actually depends on the health of 'her' mother." (Kashef, 2006) Research has shown that a child "is more likely to be born low birth weight if her mother was also born that way." (Kashef, 2006) Kashef relates that culture has been shown to be directly related to infant mortality in African-American women in that women of the same race who are foreign-born have lower rates of infant mortality than those born in the United States and raised in the African-American culture.

The work of Collins et al. (2005) entitled: "Very Low Birthweight in African-American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination" relates a study with the objectives of determining whether the lifetime exposure of African-American women to "interpersonal racial discrimination is associated with pregnancy outcomes." The method of the study reported by Collins et al. is a case-control study among 104 African-American women who delivered very low birthweight preterm infants and 208 African-American women who delivered non-low-birthweight term infants in Chicago Illinois. Collins et al. relates that for many years it has been acknowledged that African-American infants are more than twice as likely as White infants to die in their first year of life." (2005) Collins et al. relate that infant birthweight "is a primary determinant of infant mortality risk." (2005) Collins et al. states that "An extensive literature has treated pregnancy as a condition influenced by proximal...

(2005) state findings that "not only a persistent but a widening racial gap in the incidence of VLBW infants..." (Collins et al., 2005) Also reviewed are findings that behavioral risk factors such as smoking cigarettes and using alcohol and illicit drugs during pregnancy have "a negligible impact on the racial gap. Numerous epidemiological studies have found that the racial differential in the rate of VLBW infants exists among women who reside in nonimpoverished neighborhoods." (Collins, et al., 2005) Quite a number of epidemiological studies have stated findings that "the racial differential in the rate of VLBW infants exists among women who reside in impoverished neighborhoods." (Collins et al., 2005)
The work of Rich-Edwards et al. is reported by Collins et al. To have stated speculation of maternal lifetime exposure to interpersonal racism related chronic stress as a factor putting African-American women and their newborn babies at risk for infant VLBW There have been formulation of new conceptual models in an attempt to disseminate the stress of a chronic nature and any link to stress of the preterm or prematurely delivered infant less than 37 gestational weeks and the consequent risk of VLBM. In the speculation of Rich-Edwards et al. is the idea that "chronic stress from a maternal lifetime exposure to interpersonal racism is a risk factor for infant VLBW." (Collins et al., 2005) it was proposed by Misra et al. that "social factors are antecedent to both psychosocial and biomedical factors; the latter are in turn risk factors for infant VLBW." (Collins et al., 2005) Collins et al. reviews the work of Hogue et al. who held that the 'classic host' or the 'pregnant woman' along with the 'environment' such as chronic stressors added to the third element or the 'agent' meaning the "immediate emotional or physical stressors" (Collins et al., 2005) formed what was termed to be a "triangle of epidemiological causality." (Collins et al., 2005) Chronic stress is more prominently featured in the life of an African-American woman than in the daily lives of women who are of the White race. There have been former studies on "the relation between chronic stress and infant birthweight" yet few studies have focused on the possible link between the normal range of exposure to discrimination based on race "a nonrandom and race-related source of stress - and infant VLBW." (Collins et al., 2005)

Collins et al. relates: "To the extent that population differences in chronic stress from lifetime exposure to interpersonal racial discrimination underlie the observed racial differential in the rate of VLBW infants, one would expect an association between this exposure and VLBW among African-Americans." (2005) it is held to be plausible on a biological level that a causal association exists between the exposure to chronic stress among African-American women due to interpersonal racism and infant VLBW. The work of Wadhwa et al. states findings that "chronic maternal exposure to stress - through maternal cardiovascular, immune/inflammatory, and neuroendocrine processes - is detrimental to infants' birthweight." (Collins et al., 2005) Even more important is the finding that "psychophysiological stress is likely to accelerate the release of corticotrophin-releasing hormone, which initiates cascade of events leading to preterm delivery." (Collins, et al., 2005) the response of African-American women to perceived racial bias and internalization that response shows a "...fourfold greater risk of hypertension." (Collins, et al., 2005) Because of all this information Collins et al. conducted a case-control study of African-American women in urban Chicago in order to determine the extent of chronic stress due to racial discrimination on the interpersonal level in terms of the effect upon VLBW births.

The work of Steven J. Hoffman entitled: "Progressive Public Health Administration in the Jim Crow South: A Case Study of Richmond, Virginia, 1907-1920" relates that the work of Levy (1910) acknowledged that he had "felt for some time that no further lowering of the infant mortality could be brought about by the further improvement in the general milk supply of the city" and added that he had long ago become "convinced that the next move should be to instruct the mothers in the care of their babies" (Hoffman, 2001) Levy realized success in gaining funding for the Health Department's adoption of a visiting nurse program in 1910 to help stem the rising tide of infant mortality."…