Structural Heteropatriarchy and Birth Outcomes in the United States

Abstract

Emerging evidence links structural sexism and structural discrimination against lesbian, gay, and bisexual (LGB) populations to poor health outcomes, but studies have yet to examine the combined effects of these mutually reinforcing systems of inequality. Therefore, we developed a composite measure of structural heteropatriarchy—which includes state-level LGB policies, family planning policies, and indicators of structural sexism (e.g., women's political and economic position relative to men)—and examined its relationship to birth outcomes using data from Waves I to V of the National Longitudinal Study of Adolescent to Adult Health. Multivariate regression analyses demonstrated that higher levels of heteropatriarchy were associated with an increased risk of preterm birth and decreased birth weight, net of important covariates. There was no association between clinical low birth weight and heteropatriarchy, or interactions between heteropatriarchy and individuals' race, ethnicity or sexual identity, suggesting a negative effect of heteropatriarchy on birth outcomes for all pregnant people. This study demonstrates the importance of considering gender and sexuality as mutually reinforcing systems of oppression that impact population health. Future research should examine the impact of heteropatriarchy on additional health outcomes and in conjunction with other structural inequalities such as racism and transgender oppression.

Interlinking structural racism and heteropatriarchy: Rethinking family structure's effects on child outcomes in a racialized, unequal society

“…All of these factors may influence children's family composition, family resources, and parenting. To directly engage both the heteronormative and patriarchal norms that undergird structural heteropatriarchy, Everett et al (2022) created a holistic scale that included state and county measures of men's compared to women's earnings, labor force participation, and unemployment rates. It also included indicators of voting behavior, conservative religiosity, abortion access and policy, and policies pertaining to lesbian, gay, and bisexual equality.…”

“…Indeed, few scholars studying family structure have pointed to structural racism as a cause of family structure variance, opting instead to interpret variance as culture‐made or born out of individual choice (James et al, 2018; Jensen & Sanner, 2021). And the family field has yet to systematically study the HNF's structural advantage over other family forms or to fully integrate macro‐level forces into theoretical models, analyses, or interpretations of the data (Everett et al, 2022; Letiecq, 2019). We contend that this analytical myopia is reflected in the predominant conceptual model often brought to bear on the question of whether and why family structure matters for children, a model that focuses on variation in the individual‐ and family‐level circumstances of family life but ignores how White and Black families continue to negotiate their unequal positions in the social contract with the web of institutions in which family life is embedded.…”

“…For instance, a person or group of people can hold a set of beliefs about the intrinsic inferiority or superiority of certain racial groups (i.e., ideological or individual-level racism), but racism can also exist in a society in the absence of individual racists, when the structures that uphold that society foster racially discriminatory outcomes (Bonilla-Silva, 1997). Similarly, structural heteropatriarchy sustains a set of political, cultural, and economic systems that favor cisgender men and diminish access to power and resources among women and sexual and gender identity minorities regardless of whether actors within those systems hold sexist or stigmatizing beliefs or attitudes (Everett et al, 2022). In this way, these pillars of White supremacy form an interlocking matrix of domination engineered to maintain the marginalization of Black men, women, and children and other minoritized and marginalized people to the systematic, and often unearned advantaging of those at the top of the racialized heteropatriarchal hierarchy (Brown, 2021;Collins, 1990Collins, , 1998Letiecq, 2019;Walsdorf et al, 2020).…”

Transgender-Specific Adolescent Mental Health Provider Availability is Substantially Lower in States with More Restrictive Policies

“…Our religiosity measure, which indexed the percentage of evangelical Christians and/or Mormons in each state, has been widely used as a state-level covariate in structural stigma research with transgender and other stigmatized populations (Everett et al, 2022;McKetta et al, 2022), and research demonstrates that members of these religious denominations (vs. other religious groups; e.g., mainline Protestants) hold more negative attitudes towards transgender individuals and transgender rights/protections (Pew Research Center, 2016Public Religion Research Institute, 2021;Todd et al, 2020).…”

Society for Medical Anthropology Statement on Supreme Court Dobbs v. Jackson Women's Health Organization Decision

“…The Dobbs decision threatens these tenets in ways that further entrench interlocking inequalities based on racism, sexism, ableism, and other forms of marginalization. States that now have abortion bans already had some of the nation's highest rates of maternal mortality, infant deaths, and other poor neonatal outcomes (Ely and Driscoll 2021;Everett et al 2021;United Health Foundation 2022). Abortion bans will amplify these disparities, especially for low-income and historically marginalized people (Watson 2022).…”