Low Birth Weight Inequities in Context: Racial Segregation, Neighborhood Factors, and Preconception Care.

Abstract

Black women experience disproportionately higher rates of low birth weight, preterm delivery, and infant mortality. At least some amount of this disparity results from differences in exposure to detrimental social factors. Segregation is one social force shaping the distribution of power and resources and, therefore, women’s exposure to negative social environments. Using data from California Vital Records and the US Census, paper 1 evaluates the relationship between racial isolation and low birth weight for black, Hispanic, and Asian/Pacific Islander women. Isolation from whites predicts higher risk of low birth weight for black women specifically through an increased risk of small for gestational age births. For Hispanic women, isolation from whites predicts and increase in low birth weight for US-born women, but not foreign-born women, suggesting that ethnic enclave effects may not persist in this group. Finally, for Asian/Pacific Islander women, isolation predicts lower risk of low birth weight as a result of decreased risk of appropriate for gestational age preterm birth.

Social capital is one mechanism through which segregation may impact birth outcomes. In Paper 2, analyses using data from California Vital Records and LAFANS suggest that higher levels of perceived social reciprocity are associated with lower risk of low birth weight for foreign-born women, but not for US-born women. Reciprocity predicts higher rates of low birth weight for Hispanic women, indicating that social reciprocity may be a unique stressor for US-born Hispanic women. For black women, social capital measures did not predict low birth weight outcomes.

Paper 3 explores the potential for preconception care – a proposed public health intervention – to alleviate racial inequities in pregnancy outcomes. Preconception care may have positive impacts on individual women’s health. However, preconception care utilizes a clinical, individualistic, non-specific approach that does not address either the clinical or social drivers of racial inequities in birth outcomes, and should be reconsidered as a strategy for reducing these gaps. Taken together, these analyses provide insight into inequities in birth outcomes for women of color living in segregated neighborhoods, and evaluate policies aimed at mitigating this disparity.