WHEN NO PLACE IS HOME: The Impact of Residential Segregation on Racial Disparities in Maternal Mortality among non-Hispanic Black and non-Hispanic White Women

Abstract

Black mothers in the United States are dying at higher rates than their White counterparts. With greater attention being given to the issue over the past several years, researchers have increasingly tried to understand what is driving these racial disparities in maternal mortality.

Initial studies focused largely on individual-level risk factors associated with worse maternal outcomes, but more recently the focus has shifted toward identifying the contributions of contextual factors on racial disparities in maternal mortality. This thesis looks to contribute to this literature by examining the impact of racial residential segregation on differences in maternal mortality rates among non-Hispanic Black and non-Hispanic White women. Previous studies have explored the relationship between residential segregation and racial differences in various health outcomes, but this is the first study to examine its effects on maternal mortality specifically.

This thesis hypothesizes that residential segregation has an independent effect on disparities in maternal mortality among non-Hispanic Black and White women. This thesis employs a mixed-methods approach to evaluate the association between residential segregation and Black-White maternal mortality differences across three decades and four metropolitan categories. In the quantitative analysis, it finds that increases in residential segregation, as measured by the index of dissimilarity, is associated with significant increases in differences in Black-White maternal mortality rates, even when controlling for a variety of demographic, health, hospital, and policy-level factors.

Findings in the quantitative analysis are supplemented by qualitative interviews with key stakeholders to better understand what might be driving this relationship and the policy actions that can be taken to reduce it. This study concludes that broad system changes in the U.S. healthcare and residential systems are necessary to completely combat disparities in maternal mortality. However, in the meantime there are a variety of policy solutions that can and must be taken promptly before more Black mothers unnecessarily lose their lives.