Birth outcome racial disparities: A result of intersecting social and environmental factors

Abstract

Adverse birth outcomes such as preterm birth, low birth weight and infant mortality continue to disproportionately affect black and poor infants in the United States. Improvements in healthcare quality and access have not eliminated these disparities. The objective of this review was to consider societal factors, including suboptimal education, income inequality, and residential segregation, that together lead to toxic environmental exposures and psychosocial stress. Many toxic chemicals, as well as psychosocial stress, contribute to the risk of adverse birth outcomes and black women often are more highly exposed than white women. The extent to which environmental exposures combine with stress and culminate in racial disparities in birth outcomes has not been quantified but is likely substantial. Primary prevention of adverse birth outcomes and elimination of disparities will require a societal approach to improve education quality, income equity, and neighborhoods.

Twitter-derived measures of sentiment towards minorities (2015–2016) and associations with low birth weight and preterm birth in the United States

“…In 2014, black infants were still 18% more likely to be born preterm and 48% more likely to be low birth weight compared to white infants. 8 Maternal health behaviors, adequacy of prenatal care, and sociodemographic characteristics do not fully explain the observed disparities. 9 However, there is some evidence that discrimination is an important risk factor for adverse birth outcomes.…”

Spatial patterns of adverse birth outcomes among black and white women in Massachusetts – the role of population-level and individual-level factors

“…In the United States, the rate of PTD and LBW is higher in non-Hispanic black women than in non-Hispanic white women; rates of PTD and LBW in 2017 in black women were 13.93% and 13.89% while for white women they were 9.05% and 7.00% respectively (Martin et al 2018). Despite many studies, the underlying causes of this disparity are not well understood (Burris and Hacker 2017;Kent et al 2013;Lu and Halfon 2003;Manuck 2017).…”

Reducing Inequities in Adverse Birth Outcomes among African American Women in the United States: A Focus on the Life Course Perspective

“…In the US, African American women are more likely to be exposed to air pollution than other racial groups. Those who reside in segregated neighborhoods with poor quality houses located in close proximity to industrial sources of allergens such as dust mites and pollutants such as air particulates and lead, have an increased risk of preterm birth (Burris & Hacker, 2017). Lead is a neurotoxic metal that is able to cross the placenta.…”

“…This is primarily due to the heavy focus on improving access to prenatal care and not on the risk and social factors that put African American women at risk throughout their life course. Given that many of the factors related to the disparities in birth outcomes are rooted in social inequities and experiences along the life course of African American women, it seems reasonable that efforts to reduce these disparities should focus on a comprehensive approach aimed at the causes of the inequities and the lived experiences of African American women throughout their life course, and not just on access to care (Burris & Hacker, 2017). Situating solutions to this issue within the theoretical framework of the LCP is a reasonable approach as this framework sees the disparities in birth outcomes not as independent segmented events in the life of African American women, but as the result of cumulative and differential exposure to risk and protective factors across their life course.…”