How the Racist Legacy of Redlining Affects Black Maternal Health
The journey into parenthood is arduous without the added layer of racism. Already dismissed by systemic racism in the American healthcare system, birthing people of color find the odds stacked against them even during pregnancy. This is exasperated by the lingering effects of discriminatory housing policies that increase the risk of premature pregnancy and pregnancy-related mortality in Black birthing people. [Editor’s note: While pregnancy is not exclusive to women, studies on pregnancy and reproductive health focus primarily on cis women.]
Racial inequity for people of color in the U.S. begins at birth. Black women are 50% more likely to have a premature baby than white women (CDC). Preterm birth, or delivery before 37 weeks of pregnancy, can result in higher rates of death. Preterm births are one of the leading causes of infant mortality globally and are highest amongst Black, Pacific Islander, and Native newborns in the U.S. (CDC). It is estimated that one million children under the age of five die each year due to preterm birth complications (WHO).
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A 2021 study analyzing preterm birth disparities (JAMA) found that historic redlining practices play a modern-day role in Black maternal health. When the researchers took 64,804 birth certificates from 2005 to 2018 in 15 Rochester, New York zip codes and overlaid them with old redlining maps, they saw that preterm births were highest in areas historically zoned as “hazardous” (JAMA Network). They concluded that there was a link between historic inequity and modern childbirth disparities.
“Our findings provide further evidence of the influence of a legacy of structural racism [and] the disproportionate burden of adverse pregnancy outcomes for Black women in the U.S.,” the study says. “This is the factor that likely gives rise to the so-called immigrant paradox, in which immigrant women have better health outcomes on arrival to the U.S. than after multiple years of living within the U.S.”
Redlining a series of racist federal and local policies that trapped Black and Brown people in low-income neighborhoods.
The Home Owners’ Loan Corporation (HOLC) and Federal Housing Administration (FHA) created color-coded maps that assigned “mortgage security” grades to residential neighborhoods. These maps, which determined who received mortgages, identified predominantly Black and immigrant neighborhoods as red or “hazardous,” preventing homeownership and creating lasting disinvestment in neighborhoods of color (Mapping Inequality).
The legacy of redlining continues to play a significant role in the racial inequality in housing, the lack of generational wealth and class mobility, and the overall quality of life for Black people (Teen Vogue).
Living in redlined areas that lacked adequate health centers and quality grocery stores left inhabitants to develop illnesses at higher rates. Women in formerly redlined zones have increased chances of “adverse obstetric outcomes” like severe maternal depression, chronic stress, substance use disorder, and pregnancy-related hypertension (JAMA). 41 Black women die for every 100,000 births each year, the highest of any race. Black women are three times more likely to die due to pregnancy-related complications than white women (CDC, CDC), causing some expecting mothers to be “terrified of giving birth” (DCist).
The path to parenthood doesn’t have to be like this. Having an advocate like a midwife or a doula during and after pregnancy can be beneficial to pregnant Black birth people who are constantly faced with barriers in the healthcare system. Researchers have found that those who had a doula during their pregnancy had lower preterm birth rates than those who did not (Birth). Groups like Sista Midwife, a New Orleans birth advocacy organization, help connect Black doulas and womb wellness practitioners to families who need them.
“Weathering,” the persistent exposure to social and racial stress, is wearing down Black women’s health (Medical News Today). This deterioration from insufficient maternity care and support is literally coded in the neighborhoods they permit people of color to live in.
• Preterm birth is one of the most common causes of infant mortality in the United States.
• Black women are more likely to have a premature pregnancy due to socioeconomic factors and stressors.
• Outdated housing policies, like redlining, continue to have rippling effects on communities and Black maternal health.
*This piece was originally published on 4/30/2021. It was updated and edited by The ARD on 5/24/22.