Stress during pregnancy: the role of institutional racism

Institutional racism, also known as structural racism, can be defined as differential access to resources and opportunities by race as well as policies, laws, and practices that reinforce racial inequity. This study examines how institutional racism in the form of residential redlining (neighbourhood-level racial inequities in mortgage lending) and segregation (geographic separation of groups by race) is associated with self-reported stress among a diverse cohort of pregnant women. Institutional racism was measured by a residential redlining index using Home Mortgage Disclosure Act data and residential segregation using 2000 US Census data. These redlining and segregation indices were linked with data from a pregnancy cohort study (n = 4652), which included individual measures of reported stress. We ran multilevel linear regression models to examine the association between redlining, segregation and reported stress. Hispanic women compared with all other women were slightly more likely to report stress. There was no significant relationship between redlining and stress among this population. However, higher neighbourhood percentage black was inversely associated with stress. This study suggests that some forms of segregation may be associated with reported stress. Future studies should consider how redlining and segregation may provide an understanding of how institutional racism and the neighbourhood context may influence stress and health of populations.