Study Shows Ties Between Segregation, Severe Pregnancy Complications | Healthiest Communities Health News

New research finds minority women living in highly segregated, heavily Black communities are at greater risk of experiencing severe health problems related to pregnancy compared with those who reside in areas with low segregation.

The analysis published Thursday in JAMA Network Open encompassed data on more than 166,000 births to women who lived in South Carolina, with the births occurring either before the COVID-19 pandemic – from January 2018 to February 2020 – or during it, from March 2020 to June 2021. Researchers also used a county-level measure of residential segregation reflecting the probability Black residents would interact with white residents and vice versa, with a score of 60% or greater representing a high rate of isolation and a score below 40% representing a greater likelihood of “Black vs. white exposure.”

The study showed that across the minority racial and ethnic groups studied – Black, Hispanic and “other,” a category including groups such as Asians and American Indians – women who lived in high-segregation communities had a higher risk of experiencing severe maternal morbidity accompanied by a blood transfusion compared with women of the same group who lived in a low-segregation area. Severe maternal morbidity refers to a range of pregnancy complications that can include heart failure, eclampsia and renal failure.

Over both time frames, Black women had rates of severe maternal morbidity that were consistently higher than white women, regardless of residential segregation. In low-segregation communities, Black women faced nearly 1.5 times the risk of severe pregnancy complications than white women – a disparity that widened in highly segregated areas.

Both Black and Hispanic women living in high-segregation areas experienced an increase in unadjusted rates of severe maternal morbidity during the pandemic compared with before the pandemic, with Hispanic women living in low-segregation communities experiencing a rise as well.

The chances of experiencing severe maternal morbidity with a transfusion also were lower among Hispanic women than among white women in low-segregation communities, but rose to be nearly two times higher compared with white women in high-segregation areas.

Lead study author Peiyin Hung, an assistant professor in the Department of Health Services Policy and Management in the Arnold School of Public Health at the University of South Carolina, says the disparities in outcomes are connected to the poorer socioeconomic conditions coupled with less access to health care services that are often found within predominantly Black communities.

“Everything goes back to the social determinants of health,” Hung says. “Residential neighborhoods have a major impact on access to resources like access to job markets, transportation, to health care, safety and food.”

Hung adds that heavily segregated Black communities also tend to have fewer health care options, in terms of both physical facilities as well as less access to virtual health platforms due to a dearth in availability of high-speed internet.

“A lot of women of color did not feel comfortable going into hospital settings during the early pandemic period,” Hung says. “And those communities are pretty underinvested in terms of broadband infrastructure to receive appropriate care.”

The study authors also point to structural racism as fueling large disparities in maternal health outcomes between white women and women of color, noting that an association between severe maternal morbidity and segregation exists for people of color even after adjusting for individual factors such as education, insurance and obesity.

“The residents living in Black segregated communities had worse maternal morbidity outcomes, which might be a totality of historical and structural racism, rather than individual socioeconomic burdens,” the study states. “Cumulative and mutually reinforcing discrimination of housing, education, employment, criminal justice, economic opportunities, and health care put these racial minority populations at higher risk of adverse maternal outcomes.”

The JAMA study’s findings are similar to those of an analysis published in 2021 that found women living in majority-Black communities in Philadelphia were experiencing higher rates of severe pregnancy-related health issues than women living in predominantly white neighborhoods.

And they come as an analysis published this week by the Government Accountability Office reported that the maternal mortality rate for Black or African American women soared from 44.0 per 100,000 live births in 2019 to 68.9 in 2021, with the rate for Hispanic women increasing from 12.6 per 100,000 to 27.5 over the same period. The rate for white women, meanwhile, increased from 17.9 per 100,000 to 26.1.

The new study additionally points to a woman’s immigration status potentially affecting her care and outcomes in South Carolina, stating that “only lawfully residing pregnant women would be provided with medical coverage.”

Hung says both federal and state policymakers can help to reduce the maternal risks associated with segregation by increasing economic and employment stability in the most vulnerable communities.

“We have to really bring all the parties together to address these contributing factors that are associated with historically racial residential segregation,” Hung says.