Structural Racism and Adverse Birth Outcomes in the US South: A Multigenerational Perspective

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Project Summary Abstract Chronic material deprivation and the ‘wear and tear’ of everyday discrimination are key social factors thought to contribute to Black women’s poor birth outcomes. These processes are embedded within structural racism, which is the larger system of policies, practices, ideologies, and institutions that reinforces racial inequality by creating differential access to resources and opportunities. To date, however, most research on structural racism and poor birth outcomes considers maternal exposure to only one or two dimensions of structural racism, at a single point in time, thereby underestimating its contribution to Black women’s birth outcomes. The goal of this project is to examine the effects of multigenerational exposure to structural racism on birth outcomes among Black women in the US South. We will measure exposure to multiple dimensions of structural racism for South Carolina Black grandmothers and mothers in the same family, and determine their relationship to children’s adverse birth outcomes (low birth weight, preterm birth, small for gestational age). We will generate a unique, integrative dataset of births between 1989-2020 that are linked along the maternal line and merged with multiple administrative data sources measuring different dimensions of structural racism. The proposed project will: (1) quantify Black women’s exposure to four dimensions of structural racism; (2) examine the association between the four dimensions of structural racism and adverse birth outcomes both within and across generations of Black mothers; and (3) assess the contribution of structural racism to the Black/White disparity in adverse birth outcomes. The proposed study will move the field beyond individual-level interventions focused on modifiable risk factors, which have not been sufficient to improve Black women’s birth outcomes. Because Black women face structural barriers to accessing goods, services, and opportunities, the focus must shift upstream. By systematically examining multiple dimensions of structural racism across generations, we will gain important insight into the factors that disproportionately affect Black women’s birth outcomes over time. Knowledge gained from this study will guide policy-makers’ decisions regarding possible sectors (e.g., criminal justice, education) in which to intervene to improve birth outcomes for Black mothers.