Historical Neighborhood Redlining and Fertility in a Cohort of US Black Women.

BACKGROUND

Structural racism can manifest in contemporary neighborhoods via historical policies or programs. For example, the Home Owners' Loan Corporation, a government-backed program from the 1930s, systematically diverted wealth away from Black neighborhoods. The reproductive health consequences of this racist program remain understudied. We evaluated associations between residence in a historically redlined neighborhood and fecundability, the per-cycle probability of conception.

METHODS

We used data from the Black Women's Health Study, a US cohort of Black women who were aged 21-69 years in 1995 and were followed up with biannual questionnaires. Experiences of infertility (i.e., tried for ≥12 months to conceive without success) were captured on several questionnaires. A 2011 supplemental module collected pregnancy histories between 1995 and 2011, including planning status and time to conception. We linked geocoded addresses to historical Home Owners' Loan Corporation grades (A ["best"] to D ["hazardous," i.e., redlined]). Using proportional probabilities regression models with generalized estimating equations, we estimated fecundability ratios and 95% confidence intervals (CIs).

RESULTS

Our analysis included 818 planned pregnancy attempts from 674 participants (mean age = 33.9 years). Relative to participants residing in neighborhoods with the highest grades (A or B), adjusted models showed reduced fecundability among participants who resided in lower graded neighborhoods (C: 0.91, 95% CI: 0.77, 1.09; D: 0.82, 95% CI: 0.68, 0.99).

CONCLUSIONS

In this cohort of US Black women, contemporary residence in a historically redlined neighborhood was associated with reduced fecundability. Our findings highlight the importance of exploring how historical neighborhood disinvestment affects reproductive health.