Racism is #1 factor in preterm birth disparity

November 24, 2022

By: Dr. René Settle-Robinson, DPM
Author and Podiatry Specialist in Milwaukee, WI.

As a black woman Podiatric Surgeon, I know all too well the stressors that contribute to poor health outcomes and healthcare disparities. My Sorority, Zeta Phi Beta Sorority, annually contributes to the March of Dimes. As a young girl, I remember trying to fill a page with dimes to donate from my allowance to help Mothers and Babies through pregnancy. It was the March of Dimes that convened a work group of professionals to explore the causes of the black-white disparity in preterm birth rates between 2017 and 2019.

After reviewing 456 articles, the work group concluded that the effects of racial prejudice is the number one cause of the healthcare disparity between black women and white women with regard to preterm birth.

The effects of racism include stress from lifelong experiences of discriminatory practices, environmental injustice responsible for exposure to toxins from air pollution, and socioeconomic factors regarding multi generational poverty.

Racism is experienced by black people from a young age even when they’re not mature enough to quite figure out exactly what is going on. Prejudicial treatment in primary schooling often results in punitive suspension and/ or expulsion from school that puts that child at a disadvantage for entering college and the labor market down the road. Public schools in black communities are so chronically underfunded it’s degrading. This results in lack of access to things such as extra curricular activities, quality coursework, and advanced coursework. These are all major contributors to how well prepared for life and college black students become. Our first black female Supreme Court Justice strongly attributed her success to access to the extra curricular activities available to her in high school.

Blacks are far less likely to get a bachelors degree and rarely from a prestigious institution.

For those black women who were successful getting bachelors degrees and advanced degrees and entering professions on the doctorate level, the question was posed as to whether this socioeconomic advantage would skew the incidence of preterm birth in a direction comparable to white incidence of preterm birth, and the opposite was found. It was discovered that upwardly mobile black women do not make the income attributed to their degrees that their white counterparts with the same education command. There is also the additional stress of increased racial prejudicial treatment in being the only Black woman in their area with this type of education and professional responsibility. Upwardly mobile Black women remain likely to live in toxic, segregated Black communities.

The stress of prejudicial treatment from slavery and 100 years of Jim Crow continuing to this day contributes to changes in the body. That stress causes inflammation, temporary vasoconstriction, elevated blood pressure, immune system changes, and behavioral changes. That inflammatory stress response experienced during pregnancy results in depression, anxiety, prolonged elevated blood pressure, and a higher incidence of preeclampsia. And, of course, economic hardship is a major stressor, too.

Environmental injustice is linked to red lining. Red lines were drawn on maps to mark areas unsuitable for living based on the toxicity of the environment. Businesses that pollute the air, water, and soil, usually locate in these redlined communities. These were the areas where blacks were allowed to live.

These redlined neighborhoods allowed the banks and insurances to charge higher interest rates, charge more for their services, or deny services altogether. Red lining financially and unfairly marginalizes blacks while unfairly advantaging whites. These redlined communities have greater air pollution, water pollution, and soil pollution than areas that are not red lined. There is a lack of trees and plants in these communities to provide for natural reduction of air pollution and protection from the heat. These areas are heat islands with a higher heat index in the summer and are more flood prone than other communities.

The particulate matter prevalent in air polluted communities provide toxic exposure that contributes significantly to preterm birth. Particles are small enough to enter your lungs and your blood stream increasing the development of asthma, diabetes, heart disease, premature death, preterm birth, and other poor health outcome conditions. Environmental injustice, a form of structural racism, identifies the disproportionate exposure to toxic substances in black, segregated, redlined communities.

Socioeconomic stressors are also related to prejudicial practices in hiring, wages, and promotions. These circumstances systemically perpetuate poverty in the black community. Concentrated poverty, chronic stress, exposure to environmental hazards, lack of employment opportunities, limited access to green space, limited access to healthcare, and limited access to leisure activities and exercise contribute to higher incidence of mental health problems, violence, and crime.

The black community contributes the least to the global warming crisis but suffers the most consequences. We can change these circumstances by partnering with our elected officials to negotiate change. Global warming is only insurmountable when no one is willing to try. Together, there is nothing we cannot do.