Neighborhood Safety and Race Disparities in Birthweight
There are profound race disparities in birthweight, with Black women much more likely to give birth to low birthweight babies. Because low birthweight is associated with infant mortality, poor health, and development, even into adulthood, it is imperative that we understand and intervene to ameliorate race disparities in birthweight. Neighborhood social conditions are associated with a range of birth outcomes. We examine whether perceptions of neighborhood safety are associated with birthweight, and whether neighborhood safety helps explain race disparities in birthweight.
We have the unique opportunity to study neighborhood safety and birthweight in the context of a larger study examining why Black infant mortality and other birth outcomes improved drastically in one Wisconsin county over a ten-year period. Data come from a 2010-11 survey of white and black women who gave birth between 2005 and 2007 in either Dane County (where Black infant mortality rates improved) or in the comparison county, Racine County. Using state birth records, the sampling frame included a random sample of non-Hispanic white women and all Black women who gave birth in Dane or Racine County during this time. The survey assessed maternal attitudes, behaviors, and experiences before, during, and after pregnancy.
Out of 941 survey participants who had singleton births, we include the 902 women who had valid data on birthweight and perceived neighborhood safety. The outcome is birthweight (in grams), as reported by mothers. Perceived neighborhood safety is respondents’ report of how frequently they felt safe in their neighborhood during pregnancy and has a range of 1 to 5. Other demographic, socioeconomic, and health controls are included in final models. We used ordinary least squares regression, rather than multilevel modeling, as there was little neighborhood clustering.
Baseline regression models with only race, county, and the interaction of race and county demonstrate a significant race disparity in low birthweight, with Black women giving birth to babies weighing 284 grams lighter, on average, than white women (b=-283.9, p<.001). Mothers in Racine County had slightly lower average birthweight, though this difference is only marginally significant among whites (b=-75.6, p<.10). There was no significant interaction between race and county. Perceived neighborhood safety had no main effect on birthweight. However, the interaction between race and perceived neighborhood safety was statistically significant, with greater neighborhood safety associated with higher birthweight only among Blacks. In neighborhoods where mothers felt the least safe, the predicted race disparity is 535 grams. Among mothers who felt safest in their neighborhoods, the predicted race disparity is only 220 grams. After including SES, health, and service use controls, the group-specific relationship between neighborhood safety and birthweight persisted.
Neighborhood conditions have an important role in race disparities in birthweight in these Wisconsin counties. Disparities in birthweight are small when women live in neighborhoods they perceive as very safe, and large in neighborhoods perceived as unsafe. Results suggest that interventions targeting neighborhood context could help reduce the birthweight disparity between Blacks and whites, but would not eliminate this pervasive inequality.