# Structural Racism and Adverse Birth Outcomes in the US South: A Multigenerational Perspective

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2022 · $636,206

## Abstract

Project Summary Abstract
Chronic material deprivation and the ‘wear and tear’ of everyday discrimination are key social factors thought
to contribute to Black women’s poor birth outcomes. These processes are embedded within structural racism,
which is the larger system of policies, practices, ideologies, and institutions that reinforces racial inequality by
creating differential access to resources and opportunities. To date, however, most research on structural
racism and poor birth outcomes considers maternal exposure to only one or two dimensions of structural
racism, at a single point in time, thereby underestimating its contribution to Black women’s birth outcomes. The
goal of this project is to examine the effects of multigenerational exposure to structural racism on birth
outcomes among Black women in the US South. We will measure exposure to multiple dimensions of
structural racism for South Carolina Black grandmothers and mothers in the same family, and determine their
relationship to children’s adverse birth outcomes (low birth weight, preterm birth, small for gestational age). We
will generate a unique, integrative dataset of births between 1989-2020 that are linked along the maternal line
and merged with multiple administrative data sources measuring different dimensions of structural racism. The
proposed project will: (1) quantify Black women’s exposure to four dimensions of structural racism; (2) examine
the association between the four dimensions of structural racism and adverse birth outcomes both within and
across generations of Black mothers; and (3) assess the contribution of structural racism to the Black/White
disparity in adverse birth outcomes. The proposed study will move the field beyond individual-level
interventions focused on modifiable risk factors, which have not been sufficient to improve Black women’s birth
outcomes. Because Black women face structural barriers to accessing goods, services, and opportunities, the
focus must shift upstream. By systematically examining multiple dimensions of structural racism across
generations, we will gain important insight into the factors that disproportionately affect Black women’s birth
outcomes over time. Knowledge gained from this study will guide policy-makers’ decisions regarding possible
sectors (e.g., criminal justice, education) in which to intervene to improve birth outcomes for Black mothers.

## Key facts

- **NIH application ID:** 10496540
- **Project number:** 5R01MD016046-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Nancy Fleischer
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $636,206
- **Award type:** 5
- **Project period:** 2021-09-27 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10496540

## Citation

> US National Institutes of Health, RePORTER application 10496540, Structural Racism and Adverse Birth Outcomes in the US South: A Multigenerational Perspective (5R01MD016046-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10496540. Licensed CC0.

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