The Association between Structural Racism and Infant Mortality: A Systematic Review

Abstract: The evidence that links structural racism to disparities in infant mortality across racial groups needs closer examination, given its central role in achieving health equity. We undertook a systematic review using four databases (MEDLINE, Academic Search Complete, APA PsycInfo, and SocINDEX) to determine whether structural racism is associated with infant mortality rates (IMR). The review used the PRISMA guidelines. Relevant articles between 1955 and 2024 were included. A narrative synthesis was conducted informed by critical race theory. Data quality was assessed using the Critical Appraisal Skills Program (CASP) checklist. Thirty-three studies were included covering six domains of structural racism: income, education, housing, civil/political rights, health care and health behaviours, and the justice system. All included studies were conducted in United States (U.S.). Racial inequality was associated with higher Black infant mortality with little or no effect on White infant mortality in all domains. The findings from this study are consistent with structural racism adversely affecting the IMR of Black infants in the U.S.