“Anyone who looks through enough statistics will eventually find numbers that seem to confirm a given vision.” — Thomas Sowell, The Vision of the Anointed
In the ideological universe of moralistic warriors fighting against injustices operating on group characteristics, disparity always means discrimination, while correlation is definitely causation. The propensity for confirmation biases is so great that academic rigor and research norms often take a backseat to intellectual spectacles filled with “Aha!” moments. No wonder a flawed study claiming black newborns are better cared for by black doctors is cited an astounding 786 times in medical literature! But the abuse of faulty research does not just stop behind the gates of ivory towers. The problem has grave public policy consequences.
The Abundant Birth Project (ABP), pioneered first in San Francisco to address “racial disparities in birth outcomes,” is a perfect example of how shoddy academic work can be weaponized to promote racial spoils. Touted as “the first pregnancy income supplement program in the US,” ABP provides unconditional cash supplements of up to $1,000 per recipient to 150 expectant mothers who are black or Pacific Islander as “a strategy to reduce preterm birth and improve economic outcomes for our communities.” It is a public welfare program with race as a determining criterion for unconditional government handouts.
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When the initiative was piloted in San Francisco in 2020, SF Mayor London Breed endorsed the program as “a model to address racial birth disparities throughout the region and state, and across the country.” Politica soon poured in, leading to an additional $6.5 million in funding to expand the program statewide to cover Alameda, Contra Costa, Los Angeles, and Riverside counties. Recently, San Diego County Health and Human Services Agency rolled out a similar program called “Black Infant Health Program,” providing “a culturally affirming environment” and “complimentary client-centered case management” to only “pregnant African-American women, infants, and communities.”
Supporters of ABP and its derivatives across the state argue that targeting race is a vital tool to combat “obstetric racism,” a leading cause of maternal mortality among African American women and a strong factor affecting preterm births. They also present higher death rates among racial and ethnic minorities from diabetes, high blood pressure, asthma, and heart disease as evidence behind such government preferences.
In other words, awarding direct, race-preferential government assistance is argued to be necessary for alleviating a cohort of health issues disproportionately plaguing black women. However, ABP by itself was designed to only address risks of preterm birth. The convoluted logic derives from a cohort of popular grievance studies documenting racial disparities in health.
One such study, showing racism against “Black birthing people,” is a 2023 journal article from Social Science & Medicine. Surprisingly, the study contains a measly sample size of 34 participants and puts out outlandish claims such as “the Black Lives Matter Movement is necessary.” Another piece of research, which is cited as evidence of “obstetric racism,” or racism in pregnancy, labor, and birthing, is a Medical Anthropology article by an anthropologist who analyzes “the birth stories of Black women living in the United States.”
Not only are over-the-top grievance studies generalized to legitimize the theory of systemic inequities as an overarching structure behind disparities, but somewhat more rigorous research is also misinterpreted. To demonstrate that their guaranteed income project selects applicants based on a “holistic” model that is not race-preferential, ABP administrators rely on a 2018 academic paper on risk factors for preterm birth published by the European Journal of Obstetrics & Gynecology and Reproductive Biology.
Drawing from a cohort analysis of 2,339,696 pregnancies in a five-year period, the paper studies 23 maternal risk factors and creates a cumulative risk scoring tool to “identify women at the lowest and highest risk for preterm birth regardless of race/ethnicity or socioeconomic status.” The study identifies a cumulative risk factor with an adjusted odds ratio (aOR) above 1.5 as high-risk for preterm birth. Among the 23 factors, five have an aOR of over 1.5: previous preterm birth (5.24), preexisting hypertension (3.47), preexisting diabetes (2.29), sickle cell anemia (2.25), and black (1.52). Note that being African American by itself qualifies a woman, even though it is a much weaker determinant than the other four individual-level factors. The multivariable logistic model also finds that women with a risk score higher than 3 were 12.2 times more likely to have a preterm birth. The authors conclude that prevention efforts should target these cumulative risk factors and be specific to the individual.
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However, ABP advocates treat the 2018 study as a scientific stamp of approval for blatant racial classifications. Excluding more consequential factors, such as having preexisting hypertension and preexisting diabetes, renders race-based interventions ineffective at addressing preterm birth risks. Put simply, such welfare programs specifically target race in an exclusionary manner, and the racial criteria are not narrowly tailored to satisfy a compelling public interest in reducing preterm births. Therefore, these programs unambiguously violate the Equal Protection Clause in the U.S. Constitution, as well as the same guarantee in the California Constitution.
The opposite side of racial preferences is racial discrimination. Under the guise of promoting equity, many policy instruments use racial classifications liberally to select beneficiaries, thereby inviting legal scrutiny regarding their constitutionality and legality. This is why my group, the Californians for Equal Rights Foundation, is working with the American Civil Rights Project and individual San Francisco taxpayers to take California and San Francisco to court to challenge ABP.
More importantly, the glaring issue of abusing research for politics must be contended with. There is no easy answer to complex questions as weighty as maternal and infant health. Actually, there is no easy answer to easy questions either.
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It’s been said that one ought to be careful what one asks for lest one actually get it.
“…“higher death rates among racial and ethnic minorities from diabetes, high blood pressure, asthma, and heart disease…”
The fallacy here is the presumption that the rates of risk factors are the same — let’s just look at obesity:
The US Dept of H&HS’s Office of Minority Health bluntly states that “[i]Individuals who are overweight or obese are at a heightened risk of developing conditions such as high blood pressure, elevated blood lipids, diabetes, and increased LDL cholesterol, all of which are significant contributors to heart disease and stroke.”
They explicitly mention all of the above with the exception of asthma, and obesity also exacerbates that, as does second-hand cigarette and marijuana smoke.
So then what are the relative obesity rates relative to race?
The H&HS Office of Minority Health also states that “Non-Hispanic Black or African American students in grades 9–12 were 50% more likely to be obese than non-Hispanic white peers in 2023, and that Non-Hispanic Black or African American female students were almost 2 times more likely to be obese than non-Hispanic white female students.”
Female high school students become the birthing mothers of the next decade, and if Black ones are almost 2 times more likely to be obese, might that be a relevant fact in childbirth morbidity and mortality?
A 2023 study of adults age 18 and over who were obese (Body Mass Index (BMI) of 30.0 or greater) found that 42.9% of Blacks and 33.2% of Whites were overweight, a 1.3 ratio.
The solution is simple — force everyone who is Black to eat less and exercise more.
Sure there is a major problem with this being racist, not to mention a major violation of personal liberties, but if our goal is to improve Black health and Black maternal health, this is how we do it.
And hence I suggest that Black activists want to be careful what they ask for lest they actually get it…
And then the one thing that (to the best of my knowledge) has never been studied is past abortions as a risk factor to subsequent successful pregnancies. Do not forget that the Black abortion rate is considerably higher, QED….