Reproductive health outcomes are indicators of larger social processes and researchers have long documented inequalities in these outcomes among Blacks and Whites in the United States. However, we do not fully understand the underlying mechanisms responsible for these inequalities. We believe that this is partially due to the treatment of the Black population as a monolith, which masks underlying variation in health risks and outcomes. By examining the variation that exists beneath the average, we can begin to develop a better understanding of the potential sources of health inequalities between Blacks and other racialized populations. We provide an application of this perspective through a geographic examination of reproductive health outcomes within the Black population. Using national birth records data from 2013 to 2016, we examine differences in low birth weight, preterm birth, gestational hypertension, and gestational diabetes by nativity (i.e., US- or foreign-born), region of origin (e.g., Sub-Saharan Africa, the Caribbean), and current US division of residence (e.g., Middle Atlantic, South Atlantic) within the Black population. While foreign-born Blacks are at a lower risk for low birth weight, preterm birth, and gestational hypertension, they are at an elevated risk for gestational diabetes compared to US-born Blacks. Moreover, we find substantial variation in this general pattern across region of origin and division of residence in the US. These findings demonstrate the potential role of migration, context, and selectivity in the health of foreign-born Blacks and demonstrate that national averages mask geographic variation, limiting our understanding of the contributions of these and other social processes to the health of racialized groups in the US.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
We use phrases such as ‘the US-born Black population’ to collectively refer to individuals that were born in the US and self-identify as Black or African American. We acknowledge that this population includes Black people with ancestry in American slavery as well as those whose forbearers might have migrated to the US sometime after slavery (i.e., second- or third-generation immigrants). We use the term ‘the foreign-born Black population’ to refer to individuals that were born outside of the US and identify as Black or African American.
The term “birthing people” collectively refers to individuals who have given birth. It encompasses people who may or may not identify as “woman”, “mother”, or other labels commonly associated with giving birth.
See Table 2 in the Appendix for the number of foreign-born residents by division and results from the Pearson chi-square test for the differences by region of origin.
We selected these values because they are most common in our dataset. Figures 5 and 6 in the Appendix display the estimates used in Figs. 2, 3 and 4 as odds-ratios relative to US-born Blacks along with 95% confidence intervals. In addition, because of the robust association between education and health, we produce predicted probabilities for birthing people with a high school education or less in Appendix Figs. 7, 8 and 9.
Abraído-Lanza, A. F., Armbrister, A. N., Flórez, K. R., & Aguirre, A. N. (2006). Toward a theory-driven model of acculturation in public health research. American Journal of Public Health, 96(8), 1342–1346.
Acevedo-Garcia, D., Soobader, M.-J., & Berkman, L. F. (2007). Low birthweight among US Hispanic/Latino subgroups: The effect of maternal foreign-born status and education. Social Science & Medicine, 65(12), 2503–2516.
Acevedo-Garcia, D., Bates, L. M., Osypuk, T. L., & McArdle, N. (2010). The effect of immigrant generation and duration on self-rated health among US adults 2003–2007. Social Science & Medicine, 71(6), 1161–1172.
Acharya, A., Blackwell, M., & Sen, M. (2016). The political legacy of American slavery. The Journal of Politics, 78(3), 621–641.
Allison, P. D. (1999). Comparing logit and probit coefficients across groups. Sociological Methods & Research, 28(2), 186–208.
Arthur, C. M., & Katkin, E. S. (2006). Making a case for the examination of ethnicity of Blacks in United States health research. Journal of Health Care for the Poor and Underserved, 17(1), 25–36.
Blondel, B., & Kaminski, M. (2002). Trends in the occurrence, determinants, and consequences of multiple births. Seminars in Perinatology, 26(4), 239–249.
Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010). Socioeconomic disparities in health in the United States: What the patterns tell us. American Journal of Public Health, 100(S1), S186–S196.
Breen, R., Karlson, K. B., & Holm, A. (2018). Interpreting and understanding logits, probits, and other nonlinear probability models. Annual Review of Sociology, 44(1), 39–54.
Capps, R., McCabe, K., & Fix, M. (2012). Diverse streams: African migration to the United States. Washington, D.C: Migration Policy Institute.
Center for Disease Control and Prevention. 2019. How does CDC identify severe maternal morbidity? | CDC. Retrieved November 11, 2019. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/severe-morbidity-ICD.htm.
Creanga, A. A., Bateman, B. T., Kuklina, E. V., & Callaghan, W. M. (2014). Racial and ethnic disparities in severe maternal morbidity: A multistate analysis, 2008–2010. American Journal of Obstetrics and Gynecology, 210(5), 435.e1-435.e8.
Creanga, A., Syverson, C., Seed, K., & Callaghan, W. (2017). Pregnancy-related mortality in the United States, 2011–2013. Obstetrics & Gynecology, 130(2), 366–373.
Darity, W. J., & Frank, D. (2003). The economics of reparations. American Economic Review, 93(2), 326–329.
Davis, R. A. (1992). Black ethnicity: A case for conceptual and methodological clarity. Western Journal of Black Studies, 16(3), 147–151.
David, R. J., & Collins, J. W. (1997). Differing birth weight among infants of U.S.-born Blacks, African-born Blacks, and U.S.-born Whites. New England Journal of Medicine, 337(17), 1209–1214.
Derenoncourt, E. (2018). Can you move to opportunity? Evidence from the great migration. Department of Economics & Public Policy, University of California Berkeley, Berkeley, CA. Unpublished Manuscript.
Elo, I. T., Vang, Z., & Culhane, J. F. (2014). Variation in birth outcomes by mother’s country of birth among non-Hispanic Black Women in the United States. Maternal and Child Health Journal, 18(10), 2371–2381.
Feliciano, C. (2005). Educational selectivity in U.S. immigration: How do immigrants compare to those left behind? Demography, 42(1), 131–152.
Goosby, B. J., Cheadle, J. E., & Mitchell, C. (2018). Stress-related biosocial mechanisms of discrimination and African American health inequities. Annual Review of Sociology, 44(1), 319–340.
Grady, S. C., & McLafferty, S. (2007). Reproductive health inequalities for immigrant and native-born Black Women in New York City. Urban Geography, 28(4), 377–397.
Green, T. L. (2012). Black and immigrant: Exploring the effects of ethnicity and foreign-born status on infant health. Migrationpolicy.Org. Retrieved November 8, 2019. https://www.migrationpolicy.org/research/CBI-infant-health.
Hamilton, T. G. (2014). Selection, language heritage, and the earnings trajectories of Black immigrants in the United States. Demography, 51(3), 975–1002.
Hamilton, T. G. (2020). Black immigrants and the changing portrait of Black America. Annual Review of Sociology, 46(1), 295–313.
Hamilton, T. G., & Hummer, R. A. (2011). Immigration and the health of U.S. Black adults: Does country of origin matter? Social Science & Medicine, 73(10), 1551–1560.
Harper, M. A., Espeland, M. A., Dugan, E., Meyer, R., Lane, K., & Williams, S. (2004). Racial disparity in pregnancy-related mortality following a live birth outcome. Annals of Epidemiology, 14(4), 274–279.
Hicken, M. T., Lee, H., Ailshire, J., Burgard, S. A., & Williams, D. R. (2013). ‘Every Shut Eye, Ain’t Sleep’: The role of racism-related vigilance in racial/ethnic disparities in sleep difficulty. Race and Social Problems, 5(2), 100–112.
Hicken, M. T., Lee, H., & Hing, A. K. (2018). The weight of racism: Vigilance and racial inequalities in weight-related measures. Social Science & Medicine, 199, 157–166.
Ifatunji, M. A. (2016). A test of the Afro Caribbean model minority hypothesis: Exploring the role of cultural attributes in labor market disparities between African Americans and Afro Caribbeans. Du Bois Review: Social Science Research on Race, 13(1), 109–138.
Ifatunji, M. A., Wallace, D., & Faustin, Y. (2019). Black nativity and health disparities: A research paradigm for understanding the social determinants of health. University of North Carolina at Chapel Hill, Department of Sociology, Carolina Population Center and School of Public Health. Unpublished Manuscript.
Jackson, J. S., Torres, M., Caldwell, C. H., Neighbors, H. W., Nesse, R. M., Taylor, R. J., et al. (2004). The National Survey of American Life: A study of racial, ethnic and cultural influences on mental disorders and mental health. International Journal of Methods in Psychiatric Research, 13(4), 196–207.
Jackson, J., Hamilton, T., Ifatunji, M., Lacey, K., Lee, H., & Rafferty, J. (2018). Using analytic domains within the Black population to understand disparities in population health. Princeton, New Jersey: Robert Wood Johnson Foundation and Policy Link.
Janevic, T., Zeitlin, J., Egorova, N., Balbierz, A., & Howell, E. A. (2018). The role of obesity in the risk of gestational diabetes among immigrant and U.S.-born women in New York City. Annals of Epidemiology, 28(4), 242–248.
Kramer, M. R., & Hogue, C. R. (2009). Is segregation bad for your health? Epidemiologic Reviews, 31(1), 178–194.
Krieger, N. (2005). Embodiment: A conceptual glossary for epidemiology. Journal of Epidemiology & Community Health, 59(5), 350–355.
LaMacchia, R., Torrieri, N., Davis, J., & Gregory, E. (1994). Geographic areas reference manual. Bureau of the Census. https://www.census.gov/geo/reference/garm.html. Accessed May 8, 2017.
Logan, J. R. (2007). Who are the other African Americans? Contemporary African and Caribbean immigrants in the United States. In Y. Shaw-Taylor & S. A. Tuch (Eds.), The other African Americans: Contemporary African and Caribbean immigrants in the United States (pp. 49–68). Lanham, Boulder, New York, Toronto, and Plymouth: Rowman & Littlefield Publishers Inc.
Logan, J. R., Zhang, W., & Alba, R. D. (2002). Immigrant enclaves and ethnic communities in New York and Los Angeles. American Sociological Review, 67(2), 299–322.
Long, J. S. (2009). Group comparisons in logit and probit using predicted probabilities. Department of Sociology & Statistics, Indiana University, Bloomington, IN. Unpublished Manuscript.
Long, J. S., & Mustillo, S. A. (2018). Using predictions to compare groups in regression models for binary outcomes. Department of Sociology & Statistics, Indiana University, Bloomington, IN. Unpublished Manuscript.
Martin, J. A., Hamilton, B. E., Osterman, M. J. K., Driscoll, A. K., & Drake, P. (2018). Births: final data for 2016. National vital statistics reports (Vol. 67, No. 1). Hyattsville, MD: National Center for Health Statistics.
Matthews, T. J., Ely, D. M., & Driscoll, A. K. (2018). State variations in infant mortality by race and Hispanic origin of mother, 2013–2015. NCHS Data Brief, 1–8.
McLemore, M. R. (2019). To prevent women from dying in childbirth, first stop blaming them. Scientific American. May.
Model, S. (2008). West Indian immigrants: A Black success story? New York: Russell Sage Foundation.
Mustillo, S., Krieger, N., Gunderson, E. P., Sidney, S., McCreath, H., & Kiefe, C. I. (2004). Self-reported experiences of racial discrimination and Black–White differences in preterm and low-birthweight deliveries: The CARDIA study. American Journal of Public Health, 94(12), 2125–2131.
National Center for Health Statistics. 2003. 2003 revisions of the U.S. Standard Certificates of Live Birth and Death and the fetal death report. http://www.cdc.gov/nchs/data/dvs/birth11-03finalACC.pdf.
National Center for Health Statistics. n.d. Natality—All counties data files, 2013–2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
O’Connell, H. A. (2012). The impact of slavery on racial inequality in poverty in the contemporary U.S. South. Social Forces, 90(3), 713–734. https://doi.org/10.1093/sf/sor021.
Owens, D. C., & Fett, S. M. (2019). Black maternal and infant health: Historical legacies of slavery. American Journal of Public Health, 109(10), 1342–1345.
Phelan, J. C., & Link, B. G. (2015). Is racism a fundamental cause of inequalities in health? Annual Review of Sociology, 41, 311–330.
Read, J. G., & Emerson, M. O. (2005). Racial context, Black immigration and the U.S. Black/White health disparity. Social Forces, 84(1), 181–199.
Read, J. G., Emerson, M. O., & Tarlov, A. (2005). Implications of Black immigrant health for US racial disparities in health. Journal of Immigrant Health, 7(3), 205–212.
Reece, R. L. (2019). Whitewashing slavery: Legacy of slavery and White social outcomes. Social Problems, 67(2), 304–323. https://doi.org/10.1093/socpro/spz016.
Reece, R. L., & O’Connell, H. A. (2015). How the legacy of slavery and racial composition shape public school enrollment in the American South. Sociology of Race and Ethnicity, 2(1), 42–57. https://doi.org/10.1177/2332649215582251.
Singh, G. K., & Yu, S. M. (1995). Infant mortality in the United States: Trends, differentials, and projections, 1950 through 2010. American Journal of Public Health, 85(7), 957–964.
Singh, G. K., & Siahpush, M. (2002). Ethnic-immigrant differentials in health behaviors, morbidity, and cause-specific mortality in the United States: An analysis of two national data bases. Human Biology, 74(1), 83–109.
Singh, G. K., Siahpush, M., Liu, L., & Allender, M. (2018). Racial/ethnic, nativity, and sociodemographic disparities in maternal hypertension in the United States, 2014–2015. International Journal of Hypertension. Retrieved November 8, 2019. https://www.hindawi.com/journals/ijhy/2018/7897189/abs/.
Waters, M. C. (1999). Black identities: West Indian immigrant dreams and American realities. New York: Russell Sage Foundation and Cambridge, Harvard University Press.
Walton, E. (2009). Residential segregation and birth weight among racial and ethnic minorities in the United States. Journal of Health and Social Behavior, 50(4), 427–442.
Williams, D. R. (2012). Miles to go before we sleep: Racial inequities in health. Journal of Health and Social Behavior, 53(3), 279–295.
Williams, D. R., & Collins, C. (2001). Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports, 116(5), 404–416.
Williams, D. R., & Mohammed, S. A. (2013). Racism and health I: Pathways and scientific evidence. American Behavioral Scientist, 57(8), 1152–1173.
Zuberi, T. (2000). Deracializing social statistics: Problems in the quantification of race. The ANNALS of the American Academy of Political and Social Science, 568(1), 172–185.
This manuscript is dedicated to our colleague and mentor, Dr. James Jackson. Considering the breadth of his knowledge and expertise, courageous and visionary leadership skills, passion and compassion, boundless levels of energy and generosity, talent for incubating and encouraging networks for collaboration, and tenacity regarding working to create inclusive working environments, few come even close to rivaling James. May he rest in power.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Larimore, S., Ifatunji, M., Lee, H. et al. Geographic Variation in Reproductive Health Among the Black Population in the US: An Analysis of Nativity, Region of Origin, and Division of Residence. Popul Res Policy Rev 40, 33–59 (2021). https://doi.org/10.1007/s11113-020-09629-0
- Reproductive health
- Infant health
- Pregnancy-related morbidity
- Racial health inequalities