Police contact associated with increased preterm birth rates
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Police contact was associated with an increased risk for preterm birth among pregnant women in and around Minneapolis, according to a study published by JAMA Network Open.
A wide range of environmental and psychosocial factors and interactions may influence preterm birth, which is why it is important to understand whether living in a community with a disproportionate police presence affects the risk of preterm birth, the researchers said.
Background behind the study
“Racism, not race, is the cause of racial health inequities,” study author Rachel R. Hardeman, PhD, MPH, Blue Cross Endowed Professor of Health and Racial Equity at the University of Minnesota School of Public Health, told Healio.
“We also know that structural racism, specifically practices by law enforcement that disproportionately target Black communities, has been shown to cause direct as well as community harms,” Hardeman said.
Minneapolis has been the center of multiple high-profile killings by police in the past 5 years, Hardeman continued, and the killing of George Floyd shows that not much has changed between 2016 and now in terms of racialized public safety practice and in the prevalence of police brutality in the city.
“In conversations about reform, it is critical to include research on the impacts current policing practice has on community health. My colleagues and I look at the multidimensional aspects of structural racism that lead to negative health outcomes seen among Black people, in this case the intersecting factors of disproportionate policing and neighborhood segregation in Minneapolis,” Hardeman said.
The researchers also noted previous studies showing that aggressive policing can be demeaning, invasive and distressing for those who are targeted and that there are associations between police violence and harms to community health.
“If you feel like you, your loved ones and your neighbors are being targeted by the police, it can cause harmful stress and anxiety. This kind of stress and anxiety is bad for the body. This can translate into problems during pregnancy and higher odds of preterm birth,” Hardeman said.
What the study showed
The study examined 8,545 women who gave birth to live single babies between Jan. 1 and Dec. 31, 2016, at Fairview Health System facilities in Minneapolis. These women lived in the 116 census tracts in Minneapolis or in 15 bordering census tracts.
The cohort included 745 white women (70.3%), 121 Black women born in the United States (11.4%) and 193 Black women born outside the United States (18.2%).
According to the findings, 48.8% of the Black women born in the U.S. (n = 59), 49.7% of the Black women born outside of the U.S. (n = 96) and 13.8% of the white women (n = 103) lived in census tracts in the third tertile of police contact rates.
Similarly, 38% of the Black women born in the U.S. (n = 46), 29% of the Black women born outside the U.S. (n = 56) and 10.6% of the white women lived in the fourth quartile of police contact rates.
Also, 14% of the Black women born in the U.S. (n = 17), 5.7% of the Black women born outside the U.S. (n = 11) and 6.7% of the white women (n = 50) experienced preterm birth, or birth before 37 weeks gestation.
In unadjusted models, Black women born in the U.S. (OR = 1.5; 95% CI, 1.4-1.7) and white women (OR = 2; 95% CI, 1.9-2) in census tracts with very high levels of police contact had higher odds of preterm birth than their counterparts in low-contact census tracts.
Black women born outside the United States (OR = 0.9; 95% CI, 0.8-1) in tracts with very high levels of police contact had lower odds of preterm birth than their counterparts in low-contact census tracts.
In adjusted models, the odds of preterm birth were 100% higher for Black women born in the U.S. (OR = 2; 95% CI, 1.8-2.2), 90% higher for white women (OR = 1.9; 95% CI, 1.9-2) and 10% higher for Black women born outside the U.S. (OR = 1.1; 95% CI, 1-1.2) in census tracts with very high police contact than those in low-contact tracts.
The higher odds of preterm birth among white women suggested that police contact acts as a stressor for everyone, the researchers said. However, the persistent inequity in preterm birth between Black and white women born in the U.S. could be attributed to disproportionate policing of Black neighborhoods compared with white neighborhoods.
Neighborhoods with a greater proportion of Black residents were more likely to be policed than other neighborhoods, the researchers said. The higher incidence of preterm birth among Black mothers compared to white mothers then could be attributed to racialized exposure to police and not to other differences in police contact, the researchers continued.
Policy and its effects
“Structural racism is multidimensional, so there are multidimensional factors in racial health inequities,” Hardeman said. “The cumulative impact of racism wether on the bodies of Black people over the course of their lives, which is why we see such noticeable differences in health outcomes for U.S.-born and non-U.S.-born Black birthing people.”
This is why the researchers maintain that racism and not race is the cause of health inequities, Hardeman said.
“If racial health inequities were purely biological, we would see the same rates of preterm birth regardless of whether Black people were born in the U.S. or born in a different country. However, a Black person who was born and grew up in Somalia or Liberia does not face the systemic white supremacy of the U.S., so they have better birth outcomes,” she said.
Also, she continued, Black immigrants may benefit from living in “immigrant enclaves,” or areas with a high proportion of immigrant populations from the same country of origin, which provide support and protection against the effect of racism.
According to Hardeman, her research with the Roots Community Birth Center in Minneapolis has shown that centering culture and relationships in prenatal care can improve birth outcomes for Black women and their babies.
“Health professionals should consider understanding the historic and contemporary impacts of structural racism to be a core professional competency. If health professionals center the full racial, ethnic and cultural identities and experiences of Black birthing people, including stressors of structural racism like over-policing and police violence, they can improve health outcomes,” she said.
Calling racism a fundamental cause of health inequity, Hardeman said anti-racism needs to be applied to institutions that affect the fundamentals of people’s lives and communities.
“Minneapolis policymakers need to center at the margins when developing policy and implementing reform, which means focusing on community health and on the needs of Black birthing people. This also means including and empowering community members to drive the changes,” Hardeman said.
This study is the first to report this kind of relationship between police contact and preterm birth, Hardeman said, but she does not want it to be the only one.
“We would love other researchers from other urban areas with a high proportion of Black immigrants that have a history of police brutality, such as New York City, to validate our findings and to see if this is a Minneapolis problem or something more universal,” she said.
“In Minneapolis and other cities, we want to investigate how neighborhood changes, like gentrification, further exacerbate this problem. We also want to explore policing in relation with other forms of structural racism and how these may reinforce one another to drive racial inequities,” she said.
For more information:
Rachel R. Hardeman, PhD, MPH, can be reached at hard0222@umn.edu.
Reference:
Perspective
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As a maternal and child health researcher, I find this study by Dr. Rachel Hardeman and colleagues incredibly important. Structural racism adversely affects all aspects of the health of Black pregnant people, including increased exposure to social and health risk factors, unequal access to resources and lower access to and quality of maternal health care.
In this study, the authors found that greater police presence during pregnancy increases risks for preterm birth. There are several striking aspects of their findings.
First, Black pregnant people disproportionately live in high police contact areas compared with white pregnant people, and this police presence significantly increases the risk of preterm birth.
Second, while Black people born in the U.S. had more than twice the rate of preterm birth as white people, Black people born outside the U.S. had the lowest rates of preterm birth, which further reinforces the fact that race is a social construct, not a biological one.
The findings shine light on the intergenerational trauma of structural racism and the ways it contributes to the widening racial disparities in health. They also align with a large body of research on the impacts of neighborhoods on people’s health and wellbeing. We know that the neighborhood a person lives in matters in a variety of important ways for their physical and psychological health.
For example, in a study I worked on examining racial disparities in COVID-19 mortality, my co-authors and I found that counties with greater levels of adverse social determinants, like low education, high rates of uninsurance and reduced access to internet connections, had higher rates of COVID-19 mortality, even after adjusting for age, obesity and other health-related risk factors. The findings by Hardeman provide further evidence on the importance of neighborhood context, specifically high levels of police contact, and this is the first study to link neighborhood police contact to preterm birth.
Policymakers around the country have been grappling with how to address racial bias in policing, reduce segregation and promote health equity. It will take multisectoral transformational change to address these issues, which are some of the most pressing issues of our time.
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