Community Events and Pathways to Inequities in Birth Outcomes

项目概要/摘要 在美国，黑人妇女早产（PTB）、低出生体重（LBW）婴儿或 与白色妇女相比，一岁以下儿童的死亡率。这种令人深感不安的种族化的不利模式 只要有数据，生殖结果就一直存在。数十年的医学和公共卫生研究 已经记录了孕产妇和儿童健康方面种族不平等的程度，尽管婴儿总数 尽管为改善产前护理和幼儿教育举措做出了努力，但死亡率仍有所下降。 这个问题的棘手性表明了结构性种族主义--社会通过以下方式助长歧视： 强化不公平的制度，反过来又强化歧视性的信仰、价值观和资源分配， 种族健康不平等的根本原因拟议项目的总体目标是了解 哪些警察暴力行为-一种普遍存在的结构性种族主义形式-对生殖健康结果产生负面影响 在黑人妇女中，这加剧了人口一级不良生育结果的不平等。该项目将测试 假设种族化的警察暴力事件与不良出生结果有直接和间接联系 与白色女性相比，了解警察暴力种族化的机制 是黑人妇女心理社会压力的来源，这将导致新的干预目标，可能会减少种族不平等。 出生结果。该项目有三个具体目标。目的1：量化与空间和环境相关的PTB和LBW风险， 社会接近一名黑人男子被警察杀害和随之而来的内乱。这项基于人群的队列研究 利用明尼苏达州卫生部的重要记录来评估黑人妇女是否经历了更糟糕的分娩 在Philando Castile被警察杀害以及随后的内乱之后，它还将评估空间 靠近事件发生地和内乱增加了所有妇女分娩结果恶化的风险。目标二： 量化警察暴力对黑人妇女PTB和LBW风险的影响。使用一个准实验因果关系 该框架并利用美国每个县13年的出生记录， 在美国，警察暴力与黑人妇女中PTB和LBW的风险更大有关。目标3： 阐明种族化的警察暴力如何影响怀孕期间的黑人妇女的生活经验。一个在线 调查管理的黑人妇女（n=200）谁是怀孕和生活在两个社区的事件高- 警察暴力概况（明尼苏达州双子城和路易斯安那州巴吞鲁日）将评估与警察暴力有关的社会心理压力， 随后在每个城市对妇女进行了50次深入访谈，以描述警察暴力对生育的影响 结果，并确定模式和机制。这个项目的长期目标是消除出生方面的不平等 黑人女性的结果。这一及时而紧迫的项目不仅符合NICHD预防怀孕的目标， 相关并发症和减少孕产妇和婴儿死亡，但它将进一步强调 种族化的警察对社会的暴力，支持大规模改变警察与社区互动的论点。

PROJECT SUMMARY/ABSTRACT Black women in the US are twice as likely to experience a preterm birth (PTB), a low birth weight (LBW) infant, or the death of a child before age one compared to white women. This profoundly disturbing racialized pattern of adverse reproductive outcomes has endured for as long as data have been available. Decades of medical and public health research have documented the magnitude of racial inequity in maternal and child health, and it persists although the total infant mortality rate has declined and despite efforts aimed at improving access to prenatal care and early childhood initiatives. The intractability of this problem suggests structural racism—the ways in which societies foster discrimination by reinforcing inequitable systems that in turn reinforce discriminatory beliefs, values, and distribution of resources—as a root cause of these racial health inequities. The overall objective of the proposed project is to understand the degree to which acts of police violence—a pervasive form of structural racism—negatively impact reproductive health outcomes among black women and exacerbate inequities in adverse birth outcomes at the population level. This project will test the hypothesis that incidences of racialized police violence have both a direct and an indirect link to negative birth outcomes among black women compared to white women. Understanding the mechanisms through which racialized police violence is a source of psychosocial stress for black women will lead to novel intervention targets that may reduce racial inequities in birth outcomes. The project has three specific aims. Aim 1: Quantify the risk of PTB and LBW related to spatial and social proximity to the killing of a black man by police and the ensuing civil unrest. This population-based cohort study leverages vital records from the Minnesota Department of Health to assess if black women experienced worse birth outcomes following the killing of Philando Castile by police and the subsequent civil unrest. It will also assess if spatial proximity to the site of the incident and civil unrest increased risk for worse birth outcomes among all women. Aim 2: Quantify the impact of police violence on PTB and LBW risk among black women. Using a quasi-experimental causal framework and leveraging 13 years of birth records available from every county in the US, this aim assesses if incidents of police violence across the US are associated with greater risk for PTB and LBW among black women. Aim 3: Illuminate the lived experience of how racialized police violence impacts black women during pregnancy. An online survey administered to black women (n=200) who were pregnant and living in two communities with incidents of high- profile police violence (Twin Cities, MN, and Baton Rouge, LA) will assess psychosocial stress related to police violence, followed by 50 in-depth interviews in each city with women to characterize the impact of police violence on birth outcomes and to identify patterns and mechanisms. The long-term goal of this project is to eliminate inequities in birth outcomes for black women. This timely and urgent project not only aligns with NICHD’s goal of preventing pregnancy- related complications and reducing maternal and infant death, but it will further underscore the negative impact of racialized police violence on society, bolstering arguments for large-scale change in police-community interactions.