Perhaps unsurprisingly, preterm birth rates in the U.S. are disproportionately high in the Black community. In 2006, preterm birth rates for Black mothers were 18.5%; conversely, preterm birth rates for white mothers in 2006 were 11.7% [4]. Moreover, while Black babies account for just 15% of all births, they account for 35% of births before 28 weeks of pregnancy, meaning that they are three times more likely than white babies to be born before 28 weeks [1]. 

While the disparity in preterm births along racial lines is obvious, there has been little explanation as to why this disparity exists. For example, while smoking is associated with an increased risk of preterm birth, pregnant Black women smoke at lower rates than pregnant white women, but they still face higher preterm birth rates [2]. Additionally, when factors such as socioeconomic status and access to healthcare are held constant for white and Black mothers, the racial disparity in preterm birth persists [1].

According to two separate papers, the leading explanation is that housing environments may cause the racial disparities seen in preterm birth rates due to heightened environmental exposure. One study notes that Black women live in more disadvantaged areas, which is associated with higher preterm birth rates [2]. Another paper states that increased exposure to lead and other industrial toxins may contribute to higher preterm birth rates. This paper also highlights that Black women face higher exposure to these toxic chemicals, which may explain higher rates of preterm births [1]. This fact is not surprising: because of decades of institutional racism manifested in housing policy, minority communities have been developed in closer proximity to factories, industrial waste sites, and highways.

Solutions to the preterm birth gap, therefore, must address the deep-rooted nature of its underlying causes. Consequently, progressive social policies that address systemic racism may help to mitigate the preterm birth rate disparity. One example is the Inflation Reduction Act (IRA) — a landmark law passed in the summer of 2022. This law is not just an environmental policy; rather, the policy outline addresses the concept of environmental racism — the “disproportionate impact of environmental hazards on people of color” [3]. The IRA aims to reinvent infrastructure such as public transit to promote green and mitigate the impacts of environmental racism. It also helps to impose environmental regulations that limit environmental hazards — such as lead in drinking water, as seen in Flint. Still, more action is needed to desegregate housing and distance minority populations from direct environmental risks.

Another potential explanation for preterm birth is related to diet and body size: thinner women have lower occurrences of preterm birth. Body size and diet track are racially disproportionate, but this can again be traced back to racial inequities. The presence of food deserts and deference to less healthy diets because of time and cost constraints is an incessant issue for minority communities. These time and cost constraints are related to disadvantaged socioeconomic status — for example, impoverished women working multiple jobs may be compelled to choose fast food over healthier options because of these constraints. Disadvantaged socioeconomic status is inextricably connected to systemic racism [5].

Overall, it is vital to advance structural solutions to improve the health of Black mothers and their infants. Healthcare systems must create strategic plans to identify, monitor, assess, and address their patients’ social needs. Moreover, government attention should focus on developing policies and practices that address the social drivers of health to help reduce these health inequities.