The Legacy Of Redlining On Black Maternal Health
The discriminatory practice of redlining first targeted neighborhoods with immigrants and people of color. These were labeled “red” and designated “hazardous” by the Home Owners’ Loan Corporation, and banks, realtors and public officials used those maps to deny loans and other investments in those neighborhoods.
Despite being outlawed more than fifty years ago, redlining policies continue to affect these communities today, especially Black populations living in inner-city communities. Over time, this disinvestment has led to housing instability and poor health rates in these communities, which, in turn, led to adverse effects on Black maternal health and birthing outcomes, which persist today.
Neighborhoods that were once redlined continue to show increased risk of preterm birth rates in Black mothers. Historic and continued housing instability there have been linked to maternal health complications, including hypertension and other neonatal risks. The JAMA Open Network found that preterm births in once redlined zip codes occurred at a rate 1.5 times greater than elsewhere. The legacy of redlining has contributed to racial health inequality and increased risk of preterm births and other complications for Black mothers.
Redlining’s contribution to housing instability has also led to overrepresentation of Black people among the homeless population, thus significantly increasing the risks for Black maternal health and birthing outcomes.
Housing instability can also precede gentrification, where rising housing and rent prices force residents to vacate their homes to be replaced by wealthier and usually Whiter residents. The attendant tensions may lead to high-stress environments that also increases the chances of a premature birth, among other negative effects.
Premature births are associated with numerous negative health conditions including both short- and long-term cardiovascular issues and social and behavioral issues. Because the US healthcare system continues to not serve Black communities well, health inequities persist over time.
There has been some progress in improving Black maternal health. In 1977, the Community Reinvestment Act (CRA) was designed to combat the effects of redlining by encouraging investments in underserved communities. The reality is that the subsequent funded projects have not appreciably improved Black maternal health, or health equity in general.
To counter the decades of disinvestment and address Black maternal health outcomes, hospitals and health systems should continue to partner with banks under the Community Reinvestment Act to foster low-income and minority group health equity. The increased investment in maternal healthcare centers, neonatal care units, and other vital health services, would hopefully improve health outcomes while also combatting the legacy of redlining. Additionally, modernizing the Community Reinvestment Act to increase support for inclusionary zoning and other affordable housing efforts could potentially promote the reduction of poverty in redlined communities, therefore creating an upstream effect for Black maternal health outcomes.
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