A study led by Boston University School of Public Health (BUSPH) suggests that neighborhoods with fewer educational, health, environmental, and socioeconomic resources may increase the risk for preterm birth and contribute to the racial gap in preterm birth in the Commonwealth. Preterm birth, defined as a live birth before 37 weeks of pregnancy, is a leading cause of infant mortality in the United States, disproportionately affecting Black and Hispanic communities. While individual-level factors such as poverty, age, and health status may contribute to racial/ethnic disparities in preterm birth, broader structural challenges may also be driving the racial gap in this birth complication.
The study examined preterm births in Massachusetts, where 1 in 11 live births are premature, and found that the social characteristics of a birthing parent’s neighborhood are associated with the risk of experiencing an early delivery. Published in JAMA Network Open, the study revealed that more than half of Black and Hispanic infants were born into very low-opportunity neighborhoods, and babies born into these neighborhoods had a 16-percent greater risk of being born preterm. Researchers assessed neighborhood opportunity level based on educational, health, environmental, and socioeconomic characteristics identified in the Childhood Opportunity Index (COI), a widely used composite measure that includes 44 indicators by census tract.
The study sheds light on the health consequences of structural racism and historically discriminatory practices, such as redlining and disproportionate exposures to pollutants, which continue to shape modern-day neighborhood conditions. The COI serves as a valuable measure of both historic and ongoing structural racism, as neighborhood social opportunity is inequitably distributed by race and ethnicity. The researchers suggest that the context of social opportunity impacts children’s health before birth and may contribute to persistent racial and ethnic inequities in preterm birth, even after controlling for maternal health and individual social position.
Dr. Candice Belanoff, the lead author of the study and clinical associate professor of community health sciences at BUSPH, emphasizes the importance of addressing the inequitable distribution of resources and access to neighborhood opportunity in order to reduce or eliminate the racial/ethnic gap in birth outcomes. By looking beyond the individual and considering the broader structural challenges that drive disparities in preterm birth rates, efforts can be made to improve access to resources and create more equitable neighborhood conditions for all birthing parents and infants.
Using Massachusetts birth certificate data for over 260,000 singleton infants born in metropolitan areas, the researchers explored possible links between neighborhood opportunity levels and preterm births. Preterm birth rates were highest among Black and Hispanic infants, with these communities being more likely to be born into very low child opportunity neighborhoods compared to White and Asian or Pacific Islander infants. Despite the cultural richness and activism present in lower opportunity neighborhoods, economic exclusion and exposure to toxic environmental substances still pose significant challenges for residents, emphasizing the need for addressing neighborhood inequalities to improve birth outcomes and reduce racial disparities.
The findings of the study underscore the need to address structural challenges and inequities in access to resources that impact birth outcomes and contribute to racial gaps in preterm birth rates. By acknowledging the role of neighborhood social opportunity in shaping health outcomes for infants before birth, policymakers and public health officials can work towards creating more equitable neighborhood conditions and resources that support positive birth outcomes for all communities. Efforts to reduce racial and ethnic inequities in preterm birth require a comprehensive approach that addresses systemic barriers and promotes access to quality education, health care, and environmental protections for all birthing parents and infants.
