Smoking and Babies Just Don't Mix
Why Babies Die

Root Causes

Many women do all that they can to be healthy before they become pregnant and take every precaution during pregnancy to have the healthiest baby possible. However, there are a number of larger challenges many women face that can have an impact on both their pregnancies and on the choices they can make. These challenges are some of the root causes of many infant deaths.

Community-wide issues impact not only the choices individuals can make but also shape the policies and systems that we all must operate in. Consider available healthy food as one example. Fresh fruits and vegetables are important parts of good nutrition for all pregnant women. Yet, in the Winston-Salem area, poorer neighborhoods have few grocery stores and many fast food restaurants while richer areas of town have lots of grocery stores and few fast food places. Which provide healthier food for pregnant women? Even when women are aware of healthy choices, their options might be limited simply by their surroundings.

Each of the three root causes listed here (stress, racism, and poverty) are all inter-related and build upon one another.

Root Causes:


Too much negative stress may increase a pregnant woman’s risk of preterm labor, low birthweight, and possible miscarriage. Stress impacts pregnancy in many ways.

  • Stress to the mother or to the baby during pregnancy seems to produce a stress-related hormone called CRH (corticotropin-releasing hormone). CRH prompts the body to produce a chemical called prostaglandins. That chemical triggers contractions and may cause a woman to go into premature labor. (Note: more research on these hormones is currently underway.) Babies torn too early face huge medical problems and often struggle to live.
  • Pregnant women who suffer high levels of stress and anxiety may be more likely to have low birthweight babies even if they are not born premature.

What kinds of stress matter?

To the mother:
Long-term or chronic stress

Stress a pregnant woman might feel day in and day out from issues like racism, economic difficulties, or domestic violence
Specific stress
Specific issues that come up during a pregnancy might also be very stressful. These might include not getting enough rest, having to stand all day at work, an unsupportive partner or family, skipping meals and not having good nutrition, or trying to do too much.

To the baby:
physical stress to the fetus might also trigger the CRH hormone and contribute to labor starting too early. One example of fetal stress could be not enough blood flowing to the placenta.

Take these steps to reduce stress in your life and to more effectively handle the stress you cannot avoid:

Recognize when you are stressed.
Try to pinpoint specific things that cause you stress and decide which of those you can change. Do you try to accomplish too much? Try to please everyone? If you become pregnant, you might want to cut back on other obligations and focus some more on your own peace of mind.

Rest when you need it. There are a million things to do when you’ve got a baby on the way. The best thing you can do for that baby is to take it easy. Cut back on unnecessary activities that increase your stress level. Don’t be afraid to ask family members or friends for support.

Make time to relax every day, even if only for 10 minutes. If you can, try going into a room without a phone or anywhere that you won’t be interrupted. Lie down or recline in a chair or sit outside in a quiet place if the weather is nice. Breathe deeply and try to clear your mind and just unwind. If you are a single parent with other children, try this during a break at work or ask a neighbor to watch the kids for a few minutes. You can even try relaxation or deep breathing in a parked car or on the bus – just don’t miss your stop!

Find your friends. We all need support from friends, family, partners, or co-workers sometime. A great way to relieve stress is to spend time relaxing or talking with people who will build you up. Have a good friend you haven’t see in a while? Give her a call or send a note. Ask your partner to go for a walk in a nearby park or even just around the block. Invite some friends over for a potluck supper one night. Try to stay away from the people you know will be an emotional drain on you or make you feel unhappy.

Don’t try to manage your stress with “quick fixes.” Cigarettes, alcohol or street drugs might make you feel better and relieve stress for a little while, but it doesn’t take long for their harmful effects to catch up to you and a baby. Going on a shopping spree is fun until you have to pay the bill. Try using one of the other suggestions in this list to reduce your stress instead.

If you can’t sleep, feel constantly overwhelmed, or are having panic attacks, talk to a doctor or health care provider. Everyone’s’ situation is different and all people handle stress in different ways. If you find that you simply can’t reduce your stress on your own, call a doctor for help.

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Racism exists in many facets of American society today. Whether it is overt or hidden, racism can have negative effects on all people of color and particularly on pregnant women.

Are there racial differences in healthy or unhealthy births?

  • In our community (Forsyth County), African American women are almost three times as likely to have a baby die than white women are.
  • Across the entire United States, African American women are usually twice as likely to have a baby die as white women.
  • African American women in our community and in our country are also much more likely to give birth to low birthweight babies, the infants who are most likely to have major health problems.
  • These differences are not genetic and inherent to all African women in the world. When you compare the percent of low birthweight babies born to African American women to the babies born to women now in American who moved here from Africa, we find that babies of African American women are still much more likely to be low birthweight.
  • There is something about growing up African American in America that puts African Americans at risk to have more low birthweight babies.

Racism and the issue of Stress

  • American people of color face discrimination, frequent racial insults, and even environmental racism on a daily basis.
  • Social and economic injustice exists in many parts of our society today. For example, African American workers may make less money than whites, may feel that they are not treated in a culturally competent way when they go see a doctor, and many face discrimination in all walks of life from housing to education to employment.
  • This impact of racism against African Americans may be similar to or different from the experience felt by other minority groups in this county. Injustice against Latinos, Native Americans, or Asians may be experienced very differently and have different consequences.
  • Many researchers think that the experience of living with racism adds a layer of stress to the everyday lives of African American people in the United States. This stress may exist for all African Americans, regardless of income or education level.

What could RACISM have to do with unhealthy babies?

  • The broad social issue of racism may lead to increased stress for pregnant African American women.
  • Studies suggest that very high levels of stress may increase the risk of preterm labor and low birthweight. Pregnant women with high levels of stress have been found to have higher levels of the hormone that might help trigger labor.
  • Women under stress may also try to reduce stress in unhealthy ways such as using cigarettes, alcohol or other drugs, over eating or skipping meals.

Working against Racism:
Top 5 Things You Can Do to Fight Bias, Bigotry and Racism

from the National Conference For Community and Justice

  1. Look in the Mirror. It is hard for most of us to acknowledge our own biases. Take the time to stop and evaluate how you interact with those that are different from you.
  2. Get Smart. Take the time to find out more about the cultures, societies and religions that are unfamiliar to you. Education is the key to eliminating the spread of bias, bigotry and racism.
  3. Listen and Speak Up. Be aware of what you hear on TV, the radio, from your neighbor, teacher, colleague or friend. Speak up when you hear someone spreading bias, bigotry or racism.
  4. Venture Out. When we think in new ways, meet new people, and embrace new ideas, we expand our capacity for understanding. Being open to different perspectives and lifestyles is one of the best examples you can provide for others to follow.
  5. Make a Commitment. Do not stand still. Get involved. Join an organization in your community that inspires you. Participate in programs or honest conversations focusing on human relations issues that are important to you and your community.

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Poverty is another challenge that puts stress on pregnant women and their babies every day in our community. Living with little income impacts choices women are able to make on a daily basis.

Is POVERTY a problem in this country? YES.

  • 33% of African American children and 30% of Latino children live in poverty (1999).
  • In the United States, 1 out of every 2 single mothers who have never been married (and their children) live below the federal poverty level (1998).

The high cost of being POOR


  • Thousands of people have moved off of welfare and gone to work – but many are in low paying jobs. The majority of people who have moved from welfare to work are now Working Poor. These are people who work but still do not make above poverty-level wages.
  • 1 out of every 6 non-elderly American families are working poor.
  • More than half of low-wage working parents do not get paid sick leave or vacation time – meaning they are one family illness away from being laid off.
  • Employment discrimination based on race is a very real problem in the United States. Pay for black workers across the United States is approximately 65% of that for whites.
  • In many communities, people do not have the skill and education to prepare them for well paying jobs. Black men without a high school education have the highest unemployment rate in our country – 17%.


  • Decent, affordable housing is a critical problem for over 14 million people in the United States.
  • Financial planners recommend that families not spend more than 30% of their household income on rent or mortgage. Many low-wage families spend 50%.

Health Care

  • Medicaid coverage typically stops at about 60% of the federal poverty level – approximately $10,000 earned income per year for a family of four.
  • Just because you have a job doesn’t mean you can get health insurance at work (even if you can afford it). Only 26% of workers who make less than $25,000 per year have health insurance available through their work compared to 83% of workers who make over $75,000 a year.


  • Childcare can be a very large portion of the working family’s budget. The national average cost for childcare for one child is $4,000 to $6,000 each year – the same as one year of college tuition at a public university.

How can poverty impact pregnancy and a baby’s health?

  • Many of the working poor are people who have no health insurance but make too much money to qualify for Medicaid. Women in this category may be less likely to get routine health care, regular check ups, or prenatal care once they get pregnant.
  • Nutrition is critically important during pregnancy and early in a child’s life. Fresh fruits and vegetables are needed for a healthy pregnancy, yet they are some of the most expensive items in the grocery store.
  • Grocery stores are often hard to find in low-income neighborhoods and, even when they are located close to where low-income people live, their food is often more expensive.
  • Financial hardships during pregnancy create a constant stress endured by the mother.
  • Studies suggest that very high levels of stress may increase the risk of preterm labor and low birthweight. Pregnant women with high levels of stress have been found to have higher levels of the hormone that might help trigger labor.
  • Women under stress may also try to reduce their stress in unhealthy ways such as using cigarettes, alcohol or other drugs, over eating or skipping meals.

Addressing poverty


  • You may qualify for the Earned Income Tax Credit.
  • If you do not make much money, you may not be required by the government to file your taxes. Do your taxes anyway and ask if you can get the Earned Income Tax Credit.
  • This credit is an incentive for people to work. If you work full time but do not earn above poverty-level wages, you may be eligible for a hefty tax refund.
  • In Forsyth County, there are many free tax clinics where you can go to have your taxes prepared at no cost. Tax preparers may charge $200 or more to prepare your taxes. You may qualify to have your taxes prepared free of charge by a trained volunteer. Go to to see a current list of free tax clinics offered in Forsyth County.

Take advantage of the resources available in this community.

  • There are many services here for low-wage or unemployed people that might be helpful to you. Goodwill Industries offers job-training programs for people without much work experience. Forsyth Technical Community College offers a wide range of classes and training opportunities and you may qualify for some scholarships or loans. There are some agencies like Crisis Control Ministries that offer assistance with food or the rent for people who qualify. Call First Line Information at 727-8100 to see where you may be able to get the help or training you need.

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Contact Information

The Forsyth County Infant Mortality Reduction Coalition is a community partnership housed within the Forsyth County Department of Public Health.

(336) 703-3260

Did You Know . . .

We spend more than $35 million per year on our very sick and very premature babies in this community.