Life Course Contexts and Racial Birth Outcome Disparities
Laura Freeman Cenegy
This dissertation investigates one of the most heavily researched, yet poorly understood, manifestations of racial health inequality in the U.S., the black-white gap in infant health at birth. I examine the ways in which life course family and contextual circumstances come together to produce far reaching negative influences on African American women’s reproductive health and the life chances of their children. In three separate, but related chapters, I pose different questions about how the contextual environments in which African American women grow up contributes to their infants’ disproportionate risk of poor health, as indicated by their weight at birth (< 5 ½ lbs.). The history and present day realities of racial residential segregation mean that, by and large, African American and white women have grown up in different neighborhoods with different resources and advantages in ways that have not been accounted for in the research to date. To address this, I use longitudinal data from the Panel Study of Income Dynamics linked with tract-level data from the U.S. Census Bureau to examine the life course contextual precursors to this important intergenerational health problem. The results indicate that the two-fold excess incidence of low birth weight among African Americans is largely attributable to their cumulative life course exposure to high poverty and majority black neighborhoods. Poor neighborhoods pose similar risks to white mothers’ infant birth weight outcomes, but their overall exposure to neighborhood poverty is quite limited compared to African American mothers. In fact, one important insight from this research is that white women coming of age from the 1970s to the present have had very little exposure to neighborhoods that were not overwhelming white and nonpoor, whereas black women’s experiences prior to childbearing have been far more diverse and characterized by a range of exposures to different racial and poverty contexts. These findings collectively underscore the need to longitudinally examine the lifecourse origins of maternal and infant health and racial inequalities in health more broadly.