Prior research finds that residential racial segregation, or the degree to which racial/ethnic groups are isolated from one another, is associated with worsened infant health outcomes, particularly among non-Hispanic (NH) Black infants. However, because exposure to segregation is non-random, it is unclear whether and to what extent segregation is causally linked to infant health. To overcome this empirical limitation, we leverage exogenous variation in the placement of railroad tracks in the 19th century to predict contemporary segregation, as first introduced in Ananat (2011). As with prior literature, we find that residential segregation has a negative and significant impact on association(s) with Black infants’ birth outcomes. However, after accounting for the endogeneity of segregation, we uncover a more complex story: OLS (ordinary least squares) methods underestimate the negative impacts of segregation on birth weight and fetal growth but overestimate its impacts on prematurity. We fail to detect comparable effects on health outcomes among NH White infants. We explore several key structural mechanisms that could contribute to these patterns, including anti-Black prejudice and housing and food insecurity. Given that poor birth outcomes have adverse effects on adults’ health and wellbeing, our findings suggest that in-utero exposure to residential segregation could be one important pathway that directly and indirectly contributes to Black-White inequities beyond infancy.
Dr. Tiffany Green is an economist and population health scientist and a nationally recognized expert in racial/ethnic and nativity disparities in reproductive health. She is currently Assistant Professor of Population Health Sciences and Obstetrics and Gynecology at the University of Wisconsin-Madison School of Medicine and Public Health. Her research focuses primarily on understanding the individual-, family-, and structural-level determinants of racial disparities in reproductive health. Dr. Green’s mission is to shed light on how and why Black women and birthing people, regardless of socioeconomic status experience among the worst health outcomes of any racial/ethnic group—and what evidence-based solutions might ameliorate these persistent inequities. She recently developed a class for medical students, “Race in American Obstetrics and Gynecology”, one of the first courses to address the role of race in the development of US obstetrics and gynecology. She is currently a Temple Center for Public Health Law Research Fellow and is a University of Wisconsin-Madison School of Medicine and Public Health Centennial Scholar. Finally, Dr. Green serves as Co-Chair of the Black Maternal & Child Health Alliance of Dane County, a coalition committed to centering the voices of Black mothers and birthing people and ensuring that Black children are free to reach their highest potential.