Premature birth is associated with a range of negative long-term health outcomes. Now, a new study by researchers at the University of Rochester is linking the historical practice of redlining to these dangerous births.

The study, which used historical and modern data from the City of Rochester and County Monroe, shows dramatic increases in preterm birth rates between areas deemed most and least desirable by lenders over 80 years old.

The modern racial disparity in premature births and infant mortality in the United States is well documented. According to the Centers for Disease Control and Prevention, in 2020, the rate of premature births (before 37 weeks) to black mothers in the United States was nearly 50% higher than that of white or Hispanic women. In Monroe County, babies are born with low birth weight, a leading killer of children, two and a half times more common in black women than in white women.

The practice of redlining began in the 1930s when the Home Owners Loan Corporation rated neighborhoods based on various criteria, including the number of immigrant and black families. Neighborhoods with the most non-white residents were deemed “unsafe” for lenders, and the maps were used to demarcate areas where mortgages could and could not be insured. These areas, marked in red on HOLC maps, are said to see decades of disinvestment, with poverty concentrated in specific areas of the city center and residents unable to obtain mortgages to purchase their homes. Research interest in the practice of redlining and its sustainable socio-economic, environmental and health impacts has grown in recent years, and the new study is the first to directly link the practice of redlining to preterm birth.

Researchers from the departments of Obstetrics and Gynecology and Public Health Sciences at the UR examined birth data for Monroe County from 2005 to 2018 and compared the occurrences of preterm birth to the HOLC map of Rochester. Their analysis revealed a 60% increase in the rate of preterm births between postal codes designated as “desirable” and those designated “unsafe” on the 1938 map. Births before 28 weeks increased by 250%. Additionally, when comparing secondary outcomes, there was also a significant increase in severe maternal depression and lower breastfeeding rates between these areas.

“This is further evidence of the influence of a legacy of structural racism on the disproportionate burden of adverse pregnancy outcomes for black women in the United States,” says Stefanie Hollenbach MD, assistant professor in the Department of Obstetrics and of Gynecology from URMC and co-author. of the study. “The fact that the racially discriminatory mortgage loan models of the 1940s are associated with contemporary premature birth rates may inform us that the legacy of government sanctioned discrimination persists to this day. “

The results highlight a growing body of research on the links between the racism that is fundamental in many institutions and the disparities seen in modern society. The researchers also suggest that their findings could lead to more studies on associations between a variety of social or environmental factors and preterm birth.

“In our study, historical redlining was associated with worse pregnancy and childbirth outcomes experienced by black women today,” said Elaine Hill, study co-author and economist in the Department of Science. the public health of the URMC.

A future study could examine the roles of income, access to insurance and life stressors on the occurrence of preterm births and other negative outcomes for mother and infant.

“These findings suggest the potential influences of a system of deep structural inequity that spills over over time, with impacts that extend beyond measurable socio-economic inequalities,” Hill said.

Roblyn Powley is a student at St. John Fisher College.

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