During the New Deal Era of the 1930s, the discriminatory practice of redlining was introduced in the United States. Neighborhoods with immigrants and people of color 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 its ban over fifty years ago, redlining policies from the last century continue to affect these communities today, especially Black populations residing in inner-city communities. Over time, this disinvestment 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 affected by redlining continue to show increased risk of preterm birth rates in Black mothers. Historic and continued housing instability in these once redlined communities 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. In other words, 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, therefore increasing the risks for Black maternal health and birthing outcomes.
Housing instability can also create an environment ripe for gentrification, where rising housing and rent prices force longtime residents out of their homes to make room for wealthier, and more-often-than not, Whiter residents. This may foster high-stress environments, which also increases the chances of a premature birth, among other things.
Premature births are associated with numerous negative health conditions including both short- and long-term cardiovascular issues and social and behavioral issues. While the United States healthcare system continues to fail Black communities, it becomes difficult to escape this cycle of health inequity.
While the future of Black maternal health in the United States may feel uncertain and there is much work to be done, we have made progress. In 1977, the Community Reinvestment Act (CRA) was designed to combat the effects of redlining by encouraging investments in underserved communities. However, historically the investments have not been explicitly aimed at improving the fate of Black maternal health, or health equity in general.
To counter the decades of disinvestment and address Black maternal health outcomes in the United States, hospitals and health systems should continue to partner with banks under the Community Reinvestment Act to foster low-income and minority group health equity. By increasing investment in maternal healthcare centers, neonatal care units, and other vital health services, banks would be making a vital move to 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.
Samantha Autar is a health equity intern at NCRC.