“Black pregnant people in the United States experience preterm birth (PTB; a birth before 37 weeks’ gestation) at rates approximately 2 times that of White pregnant people.” And that is a problem because “Black pregnant people are also twice as likely to experience the death of an infant younger than 1 year, a disparity primarily associated with preterm-related causes of death.” This new study has a lot for us to unpack.
The Study
The researchers studied the association of police contact and PTB in Minneapolis. Why Minneapolis? Because it has a high rate of residential segregation, a large ethnically diverse Black population, a “stark disparity in PTB rates for Black and White pregnant people [1] and infant mortality, and George Floyd was murdered there.
How could we link police contact with PTB? Residential segregation disproportionately places Black people in areas of crime, violence, and poverty. Black pregnant women living in these areas are more likely to have PTB.
"In lieu of policy solutions to address these issues, greater police presence has been the answer in many communities—a practice known as proactive policing.”
Proactive policing can go by many names, e.g., stop and frisk, all related to the broken-windows theory. Overpolicing - "disproportionate targeting of Black communities by law enforcement that does not correlate to the incidence of crime within neighborhoods but rather reflects racist beliefs about Black deviance" has been shown to produce stress in Black men. Could it also be affecting pregnant Blacks?
The researchers looked at live births in 2016 broken down by census tracts in Minneapolis. 745 (70%) White, 121 US-born Black (11.5%), and 193 Black born outside of the US (18%) pregnancies.
Police contacts were broken down by census tracks, based upon filed police reports from 2012 to 2016 and then standardized to the population size of the census tracts. The graphic shows the breakdown in police contacts, although contacts that did not result in written reports make the numbers under-reported. (I would think that police investigating these types of crime would always file a report, but who knows?) With police contacts categorized for each census tract, the study focused on the PTB in the lower three quartiles, and highest quartile (25%) of tracts.
- US-born Black individuals were younger and less likely to be married than White or non-US born Blacks
- Non-US born Blacks had more similar socio-demographics to White individuals than US-born Blacks except for needing public insurance
- Regardless of their birth origin, Black individuals were more likely to live within census tracts with higher (3rd and 4th quartiles) police contact than White individuals.
- PTB were 6.7% for White individuals, 14.1% for US-born Blacks, and 5.7 for non-US born Blacks
Here are the results when adjusted for low versus high police contact.
Police contact is associated with a doubling of PTB in both White and US-born Black pregnancies but has no effect on Black pregnancies among people born outside the US. They concluded,
- “Our analyses suggest that high police contact may affect not only Black but also White pregnant people.
- The fact that we observed higher odds of PTB among White individuals further suggests that police contact acts as a stressor for everyone.
- …the persistent inequity in PTB between US-born Black and White pregnant people in Minneapolis could be attributable to the disproportionate policing of Black neighborhoods compared with White neighborhoods.
- Although both foreign- and US-born individuals occupy the same racial category (Black), the lived experience of anti-Black racism was associated with increased risk of PTB. Our findings suggest that the biological degradation associated with sustained exposure to the anti-Black racial hierarchy of the United States—which often includes cumulative and intergenerational exposures to stress-inducing experiences of overpolicing—contributes significantly to the risk of PTB.”
The study’s limitations include, most notably, that the police contact data was based on populations. There was no information on whether pregnant women did or did not have contact with the police. They also point out that not all police contact "carry the same stress-inducing effects.
"In conclusion, we found that police contact was associated with increased risk of PTB among White pregnant people, US-born Black pregnant people, and Black pregnant people who were born outside the US. However, because neighborhoods with a greater proportion of Black residents were more likely to be policed, the higher incidence of PTB among Black pregnant people than White pregnant people may be attributed to racialized exposure rather than a differential effect of police contact between racial groups. These findings suggest that racialized police patterns borne from a history of structural racism in the United States may contribute to racial disparity in PTB."
The Bias
I do not doubt that the number of PTBs increased as the researchers described. The bias that I find in the study begins with equating police contact as the stressor of interest rather than crimes committed. The study could easily have been narrated as those census tracts with the highest crime levels, as measured by police contact, had the highest incidence of PTB. Which is the most significant stressor because if you want to reduce PTB, we should address those factors with the biggest impact first – don’t you think? Can any of us see a reason not to call for police contact in the face of theft, burglary, robbery, rape, domestic violence, assault, murder, homicide, or police assault?
To be fair, stop and frisk was in place in Minneapolis during the study period, and Blacks were twice as likely to be stopped as Whites. But non-US-born Blacks had the lowest rates of PTB, and from a patrol car, one cannot tell an individual’s origin of birth. The researchers suggest that this disparity lies in the history of structural racism in the US and its intergenerational effects. But that too is a convenient narrative. It leaves out why the non-US-born Blacks, which in Minneapolis are frequently Somalis (it has the largest population in the US), arrived, to begin with – civil unrest. Does the city of Mogadishu ring any bells? The New York Times has written about the disparities of police contacts with Somalis, and they seem remarkedly similar to the experiences of US-born Blacks. Is it evidence-based to say that one group faced more intergenerational stress than another?
Words matter. I am surprised that researchers who carefully choose to describe pregnant people rather than pregnant women would be so injudicious to use police contact, which they admit they cannot fully measure for the population or the pregnant people, in place of the burden of crime. The study is meant to influence the redesign of “public safety policies” to reduce racial health inequality – should we believe that lowering police contact will reduce PTB. Or should we look to find ways to reduce crime?
[1] The researchers use the term, pregnant people. I am a bit older, and I find the phrase jarring, having grown up with the term pregnant women, which I will use for the rest of the article with no disrespect towards those whose gender identity differs from the gender “assigned at birth.” I will use the term pregnant people in direct quotes. I find the phrase “we are pregnant” equally jarring as my wife bore the entire pregnancy, and I just helped out – the labor room quickly removes any belief around the idea that “we” are in labor.
Source: Association of Residence in High–Police Contact Neighborhoods With Preterm Birth Among Black and White Individuals in Minneapolis JAMA Network Open DOI: 10.1001/jamanetworkopen.2021.30290
