New research reveals that minority women living in highly separated, predominantly Black neighborhoods are more likely to experience severe pregnancy-related health problems than those living in areas with minimal segregation.
As per US News, the investigation, published on Thursday in JAMA Network Open, included information on more than 166,000 births to South Carolina residents that occurred either before or during the COVID-19 pandemic, from January 2018 to February 2020 and March 2020 to June 2021, respectively.
Researchers also used a county-level measure of residential segregation that reflected the likelihood Black residents would interact with white residents and vice versa, with a score of 60% or higher indicating a high rate of isolation and a score of 40% or less indicating a greater likelihood of “Black vs. white exposure.”
In the minority racial and ethnic groups studied – Black, Hispanic, and “other,” which includes Asians and American Indians – women who lived in high-segregation communities had a higher risk of experiencing severe maternal morbidity requiring a blood transfusion than women of the same group who resided in a low-segregation area. Severe maternal morbidity refers to a spectrum of pregnancy-related problems, such as heart failure, eclampsia, and renal failure.
Regardless of residential segregation, Black women’s rates of severe maternal morbidity were continuously greater than those of white women over both time periods. In low-segregation communities, Black women faced roughly 1.5 times the risk of serious pregnancy problems compared to white women; in highly segregated communities, this discrepancy expanded.
During the pandemic, unadjusted rates of severe maternal morbidity increased among Black and Hispanic women living in high-segregation areas, as well as among Hispanic women residing in low-segregation areas. The likelihood of developing severe maternal morbidity after receiving a transfusion was also lower among Hispanic women than among white women in low-segregation communities but nearly doubled in high-segregation locations.
Peiyin Hung, an assistant professor in the Department of Health Services Policy and Management at the University of South Carolina’s Arnold School of Public Health, asserts that the disparities in outcomes are related to the poorer socioeconomic conditions and less access to health care services that are frequently observed in predominantly Black communities.
“Everything can be traced back to social determinants of health,” adds Hung. Residential areas have a significant impact on access to resources such as job markets, transportation, health care, and food. Hung adds that strongly segregated Black areas tend to have less health care options, both in terms of physical facilities and virtual health platforms, due to a lack of high-speed internet connectivity.
During the early pandemic, “many women of color did not feel comfortable entering medical settings,” Hung explains. And these localities receive inadequate broadband infrastructure investments in order to receive proper care.
The authors of the study also attribute large disparities in maternal health outcomes between white women and women of color to structural racism, noting that an association between severe maternal morbidity and segregation exists for people of color despite controlling for individual factors such as education, insurance, and obesity.
“The residents of Black segregated communities had worse maternal morbidity outcomes, which may be due to historical and institutional racism rather than individual socioeconomic constraints,” notes the study. Cumulative and mutually reinforcing discrimination in housing, education, work, criminal justice, economic prospects, and health care increases the risk of unfavorable maternal outcomes among ethnic minority communities.
The findings of the JAMA study are comparable to those of a 2021 study that indicated that women living in majority-Black neighborhoods in Philadelphia were more likely to experience severe pregnancy-related health problems than those living in majority-white districts.
In a report published this week by the Government Accountability Office, the maternal mortality rate for Black or African American women increased from 44.0 per 100,000 live births in 2019 to 68.9 in 2021, while the rate for Hispanic women increased from 12.6 per 100,000 to 27.5 over the same time period. In contrast, the rate for white women grew from 17.9 per 100,000 to 26.1.
The new study also indicates that a woman’s immigration status may affect her care and outcomes in South Carolina, indicating that “only pregnant women with legal residency would receive medical coverage.”
Federal and state authorities can lower maternal risks associated with segregation, according to Hung, by bolstering economic and employment stability in the most vulnerable communities. “We must genuinely bring all stakeholders together to solve these causes that have historically contributed to racial residential segregation,” adds Hung.
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