Preterm births (PTB) are the nation’s second-leading cause of infant mortality and an area of stark health inequity. Black pregnant people in the U.S. experience it at rates approximately two times that of white pregnant people.
Defined as birth less than 37 weeks gestation, those who are born preterm are at higher risk for major adverse health outcomes in childhood and adulthood. Researchers at the University of Minnesota have taken a unique approach to looking at preterm birth disparities in Minneapolis, examining it through the lens of racism and policing. Their study found that the odds of preterm birth for people living in a neighborhood with a high police presence were significantly higher than the odds of their ethnic counterparts in a low-police presence area.
Reasons behind preterm birth disparities
The preterm birth disparity has persisted despite increased access to prenatal care among Black women and is not explained by differences in health behaviors, as they affect individuals of all socioeconomic statuses, one study found. Because of that, the study took to look at structural racism as a root cause of the inequity.
Segregation is one contributing factor, as Black pregnant women who live in areas with high levels of segregation are more likely to give birth prematurely. Residential segregation puts Black people in neighborhoods disproportionately affected by poverty, violence and crime. The higher levels of crime give rise to what many have deemed hyper-policing.
Setting up the study
The data used in this study came from 1,059 people who gave birth in all Minneapolis Fairview hospitals in 2016.
Researchers gathered patients’ addresses and ethnicity and examined police contact data at the census tract level, using the police incident data from the City of Minneapolis Police Incident Report from 2012-2016.
The report only includes contact between police and the public, where officers filed official reports and crime reporting coding was assigned. Because of that, the incidents do not represent all contact between police and members of the public.
Researchers then divided the number of police incidents by the census tract population estimate and separated the data into high and low categories.
Researchers found the patient’s level of exposure to police during their pregnancy correlated with higher numbers of PTBs, affirming their hypothesis.
“It’s not surprising, but it’s affirming,” one of the researchers, Tongtan Chantarat, said. “We found that police contact is associated with increased risk for preterm birth for Black and white pregnant persons. But since the frequency of contact is racialized, what I mean by that is like, if you’re living in a Black neighborhood, you’re more likely to be exposed to the risks that would make you get sick.”
The study only looked at police contact, but Tongtan said people should also consider other forms of stress-inducing inequities.
“Being exposed to police is only one part of racialized stress mechanism that people of color are exposed to. It’s not a complete picture; for example, if you’re a Black worker, even if you’re equally qualified as another white worker, the likelihood of you getting the same job is lower than your white workers. So that’s a different stress that also affects your health.”
Increase in preterm birth across all ethnicities in the study
Across all ethnicities in the study, the odds of preterm birth for people living in a high police presence neighborhood were higher than the odds of their counterparts in a low-presence neighborhood. The increase was 100% for U.S.-born Black individuals, 90% for white individuals and 10% for Black individuals born outside of the U.S.
Tongtan says the relatively low, 10% increase for Black individuals born outside of the U.S. could be explained by the “immigrant enclave effect.”
“For a lot of foreign-born individuals living in neighborhoods among other foreign-born (individuals), they do have better support and more social support can sort of buffer the negative health effects from other racism-related exposures,” he said.
It could also be the fact that for police exposure to affect a person, it may take time. Immigrants might have a shorter exposure to the racialized pattern of police, according to Tongtan. Although it is a smaller increase than the other racial groups in the study, it is still an increase.
“We’re trying to show that being exposed, being in contact with police all the time, makes your stress and your health worse. That happened for every group, both Black and white pregnant people,” Tongtan said. “The extent of the increase of the risk may be slightly different. But I think the more important thing to highlight is that they both increase.”
Research like this is important to understanding the challenges people face, and finding ways to improve those outcomes, said Fairview System Executive Director of Community Health Equity Diane Tran.
“Trying to ask questions that haven’t been asked before, maybe about particular populations that haven’t been addressed or those issues haven’t been acknowledged previously, gives us insight into what is happening, what the current state is, what the trends are and why that’s occurring,” Tran said. “Having that baseline is really critical to having a authentic accurate, full picture of what’s taking place in our communities, such that we’re able to understand what we can do to take action to impact.”
Once that research has been completed, it is important to act on what was learned. For example, after finding out about low colon cancer screenings for Latinx and African American males, Fairview developed specific programs to make screenings more accessible to them.
The data from this study is now five years old. Tongtan is curious to see what a study in more recent years would find, considering the murder of George Floyd and the killings of Daunte Wright and Amir Locke.
“I encourage other groups to replicate our study with our recent data to see if they find similar patterns of risk or does it shift in whatever way after what happened in Minneapolis in 2020,” Tongtan said.
He’s hopeful that the findings will inform policy change.
Although this link has been established, some communities want increased police presence. In January, Minneapolis’ Lowry Hill neighborhood voted to pay the city up to $210,000 to do additional police patrols. That neighborhood is 85.4% white and in 2019 had a median household income of $80,955.