Study links redlining, contemporary preterm birth rates

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Preterm birth is associated with a range of negative long-term health outcomes. Now, a new study from researchers at the University of Rochester draws a link between the historic practice of redlining and these dangerous births. 

The study, which used historical and modern data from the city of Rochester and Monroe County, shows dramatic increases in the rates of preterm birth between areas rated most and least desirable by lenders over 80 years ago.

The modern racial disparity in preterm birth and infant mortality in the United States is well-documented. According to the Centers for Disease Control and Prevention, in 2020 the rate of preterm births (those before 37 weeks) among Black mothers in the U.S. was nearly 50 percent higher than that of white or Hispanic women. In Monroe County, babies are born with low birth weight, a leading cause of infant mortality, two and a half times more frequently to Black women than to white women. 

Source: City of Rochester

The practice of redlining began in the 1930s when the Home Owners Loan Corporation assigned a rating to neighborhoods based on a variety of criteria, including the number of immigrant and Black families. Neighborhoods with the most non-white residents were deemed “hazardous” to lenders and the maps were used to delineate areas where mortgages could and could not be insured. These areas, outlined in red on the HOLC maps, would go on to experience decades of disinvestment as poverty was concentrated in specific inner-city areas, and residents were unable to secure mortgages to buy their homes. Research interest in the practice of redlining and its lasting socioeconomic, environmental, and health impacts has grown in recent years and the new study is the first to directly connect the practice of redlining to preterm birth.

Researchers from the departments of obstetrics and gynecology, and public health sciences at UR reviewed birth data for Monroe County from 2005 to 2018 and compared occurrences of preterm birth to the HOLC map of Rochester. Their analysis found a 60 percent increase in the rate of preterm births between ZIP codes designated as “desirable” and those designated “hazardous” on the 1938 map. Births before 28 weeks increased 250 percent. Additionally, when comparing secondary outcomes, there was also a significant increase in severe maternal depression, and lower rates of breastfeeding between these zones.

“This is further evidence of the influence of a legacy of structural racism on the disproportional burden of adverse pregnancy outcomes for Black women in the U.S.,” says Stefanie Hollenbach M.D., an assistant professor in the URMC Department of Obstetrics and Gynecology and co-author of the study. “The fact that racially discriminatory home lending patterns from the 1940s are associated with contemporary preterm birth rates can inform us that the legacy of government-sanctioned discrimination persists to this day.”

The findings underscore a growing body of research into the connections between the racism that is fundamental to many institutions and the disparities found in modern society. The researchers also suggest that their findings could lead to more studies on the associations between a variety of social or environmental factors and preterm birth. 

“In our study, historic redlining was associated with worse outcomes in pregnancy and childbirth experienced by Black women in the modern day,” says Elaine Hill, study co-author and economist in the URMC Department of Public Health Sciences. 

A future study could look at the roles of income, insurance access, and life stressors on the occurrence of preterm birth and other negative maternal and infant outcomes.

“These findings suggest the potential influences of a system of profound structural inequity that ripple forward in time, with impacts that extend beyond measurable socioeconomic inequality,” Hill says. 

Roblyn Powley is a student at St. John Fisher College.

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