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Geographic Variation in Reproductive Health Among the Black Population in the US: An Analysis of Nativity, Region of Origin, and Division of Residence

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Abstract

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.

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Notes

  1. 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.

  2. 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.

  3. 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.

  4. 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.

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Authors and Affiliations

  1. Department of Sociology, Washington University in St. Louis, St. Louis, MO, USA

    Savannah Larimore & Hedwig Lee

  2. Department of Afro American Studies, University of Wisconsin, Madison, WI, USA

    Mosi Ifatunji

  3. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    Jane Rafferty, James Jackson & Margaret T. Hicken

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  1. Savannah Larimore
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  2. Mosi Ifatunji
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Correspondence to Savannah Larimore.

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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.

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Appendix

Appendix

See Table 2 and Figs. 5, 6, 7, 8 and 9.

Table 2 Foreign-born sample and sub-groups by division of residence
Full size table
Fig. 5
figure 5

Odds of infant health outcomes among US- and foreign-born Black birthing people. Results of the fully adjusted, stratified regression models are shown. Foreign-born sub-groups are ordered from smallest to largest and division is order by the size of the foreign-born Black population. Estimates at the national level are shown in black. US-born Blacks, represented by the vertical dashed line, are the always the reference group and 95% confidence intervals are displayed for each estimate

Full size image
Fig. 6
figure 6

Odds of pregnancy-related health outcomes among US- and foreign-born Black birthing people. Results of the fully adjusted, stratified regression models are shown. Foreign-born sub-groups are ordered from smallest to largest and division is order by the size of the foreign-born Black population. Estimates at the national level are shown in black. US-born Blacks, represented by the vertical dashed line, are the always the reference group and 95% confidence intervals are displayed for each estimate

Full size image
Fig. 7
figure 7

Probability of reproductive health outcomes among US- and foreign-born Black birthing people. Results of the fully adjusted, stratified regression models are shown. Division is order by the size of the foreign-born Black population. Estimates at the national level are shown in black. 95% confidence intervals are displayed for each probability

Full size image
Fig. 8
figure 8

Probability of infant health outcomes among US- and foreign-born Black birthing people. Results of the fully adjusted, stratified regression models are shown. Foreign-born sub-groups are ordered from smallest to largest and division is order by the size of the foreign-born Black population. Estimates at the national level are shown in black. 95% confidence intervals are displayed for each probability

Full size image
Fig. 9
figure 9

Probability of pregnancy-related health outcomes among US- and Foreign-born Black birthing people. Results of the fully adjusted, stratified regression models are shown. Foreign-born sub-groups are ordered from smallest to largest and division is order by the size of the foreign-born Black population. Estimates at the national level are shown in black. 95% confidence intervals are displayed for each probability

Full size image

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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

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