New study looks at how policing affects preterm birth

As Minnesota watches former Brooklyn Center police officer Kimberly Potter on trial for the shooting death of Daunte Wright, a new study published in JAMA Open Network shows that pregnant people are at higher risk of preterm birth in highly policed neighborhoods — neighborhoods that often have more residents of color.

Reporter Catharine Richert spoke with the paper’s author Rachel Hardeman, Blue Cross Endowed Professor of Health and Racial Equity and the founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health.

Where did the idea to look at this question come from?

The idea for this work started long before George Floyd's murder, while there's been a lot of attention paid to this issue around policing and police violence, it's not a new topic. Four or five years ago, I was actually doing research, qualitative work, and some of the mothers that we were interviewing talked about the struggle of finding out the sex of their baby, in the aftermath of Philando Castille’s death at the hands of a [St. Anthony] police officer.

And just the idea that it was stressful for them in that knowing that they were carrying a boy in particular felt really, really stressful. And so I started thinking a lot about what that meant for reproductive health outcomes. I thought, “I wonder if it matters if living in a neighborhood where there's high police contact matters for reproductive health.”

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Minneapolis is a highly segregated city. And so we know that there are neighborhoods that are predominantly Black, we know that there's neighborhoods that are predominantly white. And so thinking about what that means, within the context of this bigger question of how structural racism gets under the skin and impacts health outcomes, was really compelling as well.

This builds on a large body of research that shows that women of color are at higher risk of preterm birth, which is also a risk to their baby. What do we know about this question?

The infant mortality rate has dropped 3 percent in the past couple of years, but it has not dropped that much for Black infants. And it has not dropped much for Indigenous or Native American infants across the United States.

And then here in Minnesota, pretty consistently, for as long as we've collected data, Black and Indigenous infants have been twice as likely as white infants to not celebrate their first birthday, so to not make it to that first birthday. And preterm birth, meaning a birth that happens before 37 weeks gestation is a really important risk factor for infant mortality.

So infants that are born too soon, infants that are born too small, are at greater risk for infant mortality, they're also at greater risk for, if they survive, and for a whole host of health issues across the life course — certainly in childhood, but across the life course as well.

What did you find in your research?

We were really interested in understanding if police contact — so living in communities or neighborhoods where there's high levels of police contact — had an impact on on birth outcomes. Particularly, we looked at preterm birth in this case, and what we find is that for birthing people who live in high police contact neighborhoods, they have a higher odds of preterm birth. And for U.S.-born Black birthing people in particular, the odds of preterm birth are 100 percent higher.

One of the other interesting things about this study is that because we were looking at a sample of people giving birth in Minneapolis, we felt it was really important to understand the context of being a foreign-born Black birthing person versus a U.S.-born Black birthing person, given the Somali and African immigrant communities here, and we actually find that the foreign-born Black population in Minneapolis in this sample had the lowest risk.

Is this more a question of people who would be at higher risk of having preterm birth anyway because of all sorts of other issues in our society, happening to live in these neighborhoods? Or is it the impact of highly policed neighborhoods on these women?

That’s a good question and not actually one we can specifically answer from this study because we can't claim causation here. What we can say is that neighborhoods in Minneapolis are highly segregated by race.

And so what we see is that Black birthing people tend to live in neighborhoods or communities that are highly policed. We understand that structural racism is the complex ways that different types of systems, institutions, ideologies and experiences are impacting health and well-being on all these different levels.

What we can say is that police contact is one of the things that's contributing to what we know, from epidemiological literature is part of that sort of stress pathway that impacts preterm birth.

Take all of this into the real world, into these neighborhoods: What sort of solutions might address part of the problem that you've discovered?

I think the policy initiatives that we're seeing being moved forward at the federal level around diversifying the physician or health care workforce, increasing access to doulas and things like that are incredibly important interventions for addressing preterm birth.

But also what this study and many others show or tell us is that outcomes like preterm birth are so deeply tied to social and structural inequity in our society. And so we do have to be thinking about policing and public safety and how that impacts community and population health.

And I think Minneapolis is the perfect place to start exploring that. We can leverage findings like this that are saying, “Hey, this, this is an issue beyond the individual family.” We’re talking about populations and communities, but also we're talking about infants. We're talking about the chance for infants to live healthy and full and thriving lives.