Now, a new study focused on Rochester, New York, points to redlining – a New Deal-era, government-backed practice that effectively segregated neighborhoods and discouraged investment in minority communities – as helping to fuel preterm birth rates that are significantly higher for Black mothers than their white peers.
Published in JAMA Network Open, the study suggests that the influence of long-term, systemic racism and structural inequity potentially “ripples forward in time, with impacts that extend beyond measurable socioeconomic inequity.”
Two co-authors of the study – Elaine Hill, an economist in the University of Rochester Medical Center Department of Public Health Sciences, and Dr. Stefanie Hollenbach, an assistant professor in the URMC Department of Obstetrics and Gynecology – tell U.S. News in a joint email interview that the results “were striking but, sadly, not surprising.”
Neighborhoods that essentially were deemed undesirable for investment and mortgage lending decades ago “were associated with a persistent, increased risk” of women giving birth before their baby had developed to term, Hill and Hollenbach say. The findings come amid what the study calls “particularly prominent racial and ethnic disparities in the U.S., with non-Hispanic Black women experiencing a preterm birth rate at least 50% higher than non-Hispanic White women.”
Using birth certificate information gleaned from a nine-county database of the Finger Lakes region in New York state, the study compared obstetric outcomes from 2005 to 2018 with a historical Home Owners’ Loan Corporation map of Rochester. The HOLC was a government-backed agency that used refinancing to address home foreclosures during the Great Depression, and its color-coded maps classified urban neighborhoods by perceived risk for investment. Neighborhoods home to more people of color or immigrant groups were often categorized as risky and colored red, which many believe fueled a segregated system in which people were unable to access typical home loans and poor, mostly minority communities suffered from a lack of meaningful investment.
The study encompassed more than 64,000 births within 15 ZIP codes that corresponded to one or more HOLC classifications: “One contemporary ZIP code overlapped with the historic D “Hazardous” designation, and (one) contemporary ZIP code overlapped with historic regions characterized as A “Best” or B “Still Desirable,” according to the study.
Researchers found that the prevalence of preterm birth was lowest at 7.55% in the ZIP code historically defined as “Best” or “Still Desirable,” and was highest – at 12.38% – in the ZIP code historically defined as “Hazardous.” In classifications between the two extremes, the share of preterm births ranged from 11.14% in “Still Desirable” or “Definitely Declining” areas, 9.68% in “Definitely Declining” areas, and 11.91% in “Hazardous” or “Definitely Declining” areas.
An association between preterm births and redlining was present even when researchers adjusted for community-level poverty, educational attainment and maternal and paternal race. Researchers also found higher odds of severe maternal depression, substance use disorder, pregnancy-associated hypertension and neonatal complications among women and births in the “Hazardous” area compared with those in the “Best” or “Still Desirable” area.
“These associations underscore the echoes of the past – imparting higher morbidity for members of communities impacted by a legacy of disinvestment,” the study says.
In the study, researchers acknowledged their work is limited by the fact that only 1 ZIP code each fell into the extreme positive and negative ends of HOLC designation. Still, given that the study’s data range begins in 2005 – nearly 40 years after the federal Fair Housing Act outlawed redlining – it presents more evidence that the historic, negative designations of some neighborhoods appear to have “a persistent impact on health inequity that is influenced by race, but extends beyond this social construct as well,” Hill and Hollenbach tell U.S. News.
Babies born early usually have a greater degree of health problems than babies born after 37 weeks of gestation, which can include serious issues with major organs such as the brain and lungs. Premature infants often must spend time in hospital intensive-care units after birth, are at higher risk of readmission to the hospital or death once they go home, and can have chronic health issues over their lifetimes.
Hill and Hollenbach say they recognized it as an opportunity to explore “how this historic underpinning of institutionalized racism could be impacting modern outcomes.” They say their research underscores the need to examine the legacy of systemic racial discrimination to “unpack” why Black women and their newborns are at higher risk of complications than whites, “as well as a variety of other health outcomes.”
Redlining maps, they say, can be a key to unlocking ways to eliminate health disparities.
“If we hope to reduce and eventually eliminate health inequity including racial disparities in outcomes, a broader scope of understanding of the contributions to these disparities is critical to informing interventions towards dismantling them,” they say. “Redlining maps are now available for more than 200 cities across the U.S. and could be used for targeting these interventions.”