Birthing Minnesota: The Associations of Structural Racism and Neighborhood Characteristics with the Health of Minnesota’s Birthing Population, Pregnancy through Postpartum

Abstract

Structural racism in Minnesota communities may be associated with adverse birth outcomes such as preterm birth, low birthweight, severe maternal morbidity, and death for birthing people. This dissertation provides a comprehensive report on the birthing outcomes of Minnesota people who gave birth 2011-2019 including the rates of prenatal risks (e.g. inadequate prenatal care, diabetes, and hypertension), adverse pregnancy outcomes (e.g. premature birth, low birthweight, fetal death), maternal morbidity (e.g. transfusion, unplanned hysterectomy, admission to ICU), and death (e.g. pregnancy-related, pregnancy-associated, all-cause after the first year). The relationship between structural racism in Minnesota and the health outcomes experienced by birthing people, specifically Black and American Indian people, during the perinatal period and in the years following childbirth is examined using the Index of Concentration at the Extremes (ICE) in a treatment effects model. In areas with the highest exposure to structural racism (according to ICE measures), neighborhood characteristics (e.g. access to healthy food, presence of green spaces, available quality education) may be associated with better than expected outcomes when the quality and number of resources are high. A logistic model was used to detail the association of increasing neighborhood resources to birth outcomes for individuals exposed to high levels of structural racism.