Socially Assigned Race and the Health of Racialized Women and Their Infants

Abstract

Introduction: While historically most public health research has relied upon self-identified race as a proxy for experiencing racism, a growing literature recognizes that socially assigned race may more closely align with racialized lived experiences that influence health outcomes. We aim to understand how women's health behaviors, health outcomes, and infant health outcomes differ for women socially assigned as nonwhite when compared with women socially assigned as white in Massachusetts. Methods: Using data from the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) Reactions to Race module, we documented the associations between socially assigned race (white vs. nonwhite) and women's health behaviors (e.g., initiation of prenatal care, breastfeeding), women's health outcomes (e.g., gestational diabetes, depression before pregnancy), and infant health outcomes (e.g., preterm birth, low birth weight [LBW]). Multivariable models adjusted for age, marital status, education level, nativity, receipt of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance during pregnancy, infant sex, plurality, and gestational age. Additional models adjusted for treatment by race, how often one thinks about race, and nativity. Results: Women socially assigned as nonwhite had higher odds of breastfeeding (adjusted odds ratio [AOR]: 1.86, 95% confidence interval [CI]: 1.54 to 2.25), lower odds of consuming alcohol (AOR: 0.27, 95% CI: 0.24 to 0.31), and lower odds of smoking (AOR: 0.30, 95% CI: 0.24 to 0.38) compared with those socially assigned as white. However, women socially assigned as nonwhite had higher odds of reporting gestational diabetes (AOR: 1.97, 95% CI: 1.49 to 2.61). Mothers socially assigned as nonwhite also had higher odds of giving birth to an LBW (AOR: 1.66, 95% CI: 1.29 to 2.14) and small-for-gestational age (AOR: 1.46, 95% CI: 1.19 to 1.80) infant compared with women socially assigned as white. Discussion: In comparison with women socially assigned as white, we observed poorer health outcomes for women who were socially assigned nonwhite despite engaging in more beneficial pregnancy-related health behaviors. Socially assigned race can provide an important context for women's experiences that can influence their health and the health of their infants.

Maternal and Perinatal Health Disparities Among Middle Eastern and North African Women and Children in the United States

“…The studies found that the prevalence of smoking among pregnant MENA women ranged from < 1-6% compared to 12-16% among pregnant White women (Abuelezam et al, 2020;El Reda et al, 2007;Johnson et al, 2005;Kulwicki et al, 2007). One study found that prevalence estimates of smoking during or within three months before pregnancy were 6-10% among MENA women (Abuelezam et al, 2022). However, this study did not make any comparisons in smoking to White women.…”

“…There is a growing body of literature focused on outcomes among MENA women and children (Abuelezam et al, 2022;. Yet, the existing MCH literature among MENA women and children fails to address national objectives and performance measures (Berge et al, 2018).…”

Maternal and perinatal health disparities among Middle Eastern and North African women and children in the United States

“…Research by Abuelezam and colleagues (2022) used data from the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) to evaluate the health of MENA mothers and their children based on socially assigned race. The study evaluated several women's health behaviors, including initiating prenatal care during the rst trimester, breastfeeding in the hospital, and abstaining from alcohol three months prior and during pregnancy (Abuelezam et al, 2022). However, the study did not assess whether women saw a dentist in the last six months.…”

Funding for Refugee Health Research From the National Institutes of Health Between 2000 and 2020

“…Conducting refugee health research is particularly challenging because few public health systems collect data on migration history and experiences. Refugee populations are often studied within their racial and ethnic groups without inquiry into their displacement history or considering race as a social construct . Designing novel health interventions to address health disparities in the minoritized refugee population requires a deep understanding of various contextual factors such as wars or other trauma exposure in the country of origin, experiences during migration, resettlement community politics and capacities, education level, and social support systems, among others.…”

“…Refugee populations are often studied within their racial and ethnic groups without inquiry into their displacement history or considering race as a social construct. 19 , 20 , 21 , 22 Designing novel health interventions to address health disparities in the minoritized refugee population requires a deep understanding of various contextual factors such as wars or other trauma exposure in the country of origin, experiences during migration, resettlement community politics and capacities, education level, and social support systems, among others. Refugee health research is needed to assess these interplaying factors and formulate evidence-based recommendations allowing for achieving optimal health over the life course.…”