How structural racism, neighborhood deprivation and maternal characteristics contribute to inequities in birth outcomes

Decades of disparities in health between infants born to Black and white mothers have persisted in recent years, despite policy initiatives to improve maternal and reproductive health for Black mothers. Although scholars have increasingly recognized the critical role that structural racism plays in driving health outcomes for Black people, measurement of this relationship remains challenging. This study examines trends in preterm birth and low birthweight between 2007 and 2018 separately for births to Black and white mothers. Using a multivariate regression model, we evaluate potential factors, including an index of racialized disadvantage as well as community- and individual-level factors that serve as proxy measure for structural racism, that may contribute to white-Black differences in infant health. Finally, we assess whether unequal effects of these factors may explain differences in birth outcomes. We find that differences in the effects of these factors appear to explain about half of the underlying disparity in infant health.