How Structural Racism, Neighborhood Deprivation, and Maternal Characteristics Contribute to Inequities in Birth Outcomes

Overview

This study examines the persistent disparities in birth outcomes between infants born to Black and white mothers in the United States from 2007 to 2018. The research focuses on understanding how structural racism, neighborhood deprivation, and maternal characteristics contribute to these inequities. The authors utilize multivariate regression analysis and decomposition techniques to evaluate the impact of racialized economic segregation, neighborhood disadvantage, and maternal-level factors on adverse birth outcomes such as preterm birth and low birth weight.

Findings

• Racial Disparities: The study documents persistent disparities in infant health outcomes where  infants born to Black mothers experience significantly higher rates of preterm birth and low birth weight compared to those born to white mothers, irrespective of neighborhood advantage levels.
• Structural Racism: Measures such as the Index of Concentration at the Extremes (ICE) and Neighborhood Deprivation Index (NDI) highlight the influence of structural racism on birth outcomes. However, these measures alone do not fully explain the disparities.
• Maternal Characteristics: Factors such as Differences in maternal education, age, marital status, and parity between black and white mothers are significant contributors to birth outcome disparities,  with white mothers generally benefiting more from these factors than Black mothers.
• Unequal Effects: Even when residing in similarly advantaged neighborhoods, Black mothers and their infants derive fewer health benefits compared to their white counterparts, suggesting differential impacts of structural factors on health outcomes.

Implications for Policy and Practice

• Comprehensive Policy Approaches: Policies addressing racial disparities in infant health must target multiple systems and be tailored to the specific needs of Black mothers and infants. This includes expanding access to quality healthcare, improving neighborhood conditions, and addressing systemic racism in housing, education, and employment.
• Healthcare System's Role: The healthcare sector should play a proactive role in addressing health inequities by ensuring equitable access to care, increasing the number of providers of color, and fostering culturally competent care practices.
• Resource Allocation: Transfer policies aimed at reallocating resources to match those available to white populations may help reduce disparities but are unlikely to eliminate them without addressing the differential effects of these resources.