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Why Causation Matters: Rethinking "Race" as a Risk Factor.

Gabriella Mayne1, Ayisha Buckley, Luwam Ghidei

  • 1Department of Health & Behavioral Sciences, University of Colorado, Denver, Colorado; the Department of Obstetrics and Gynecology and the Department of Maternal Fetal Medicine, Weill Cornell Medicine, New York, New York; and Reproductive Specialists of the Carolinas, Charlotte, North Carolina.

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Using "race" as a risk factor for preterm birth is flawed and harmful. Anti-Black racism, not race itself, causes higher risks through chronic stress and implicit bias, necessitating anti-racist maternity care.

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Area of Science:

  • Public Health
  • Sociology
  • Medical Ethics

Background:

  • The correlation between Black "race" and higher preterm birth rates is often misinterpreted as causal.
  • This misinterpretation is harmful, obscuring the true underlying factors contributing to adverse maternal and infant outcomes.

Purpose of the Study:

  • To critique the flawed logic of using Black "race" as a direct risk factor for preterm birth.
  • To identify anti-Black racism as the root cause of increased vulnerability in Black patients.
  • To highlight treatable pathways—chronic stress and implicit bias—through which racism impacts birth outcomes.

Main Methods:

  • Conceptual analysis and critique of existing risk factor paradigms in maternal health.
  • Examination of the pathways linking racism to adverse birth outcomes.
  • Proposal of a paradigm shift towards anti-racist maternity care.

Main Results:

  • The use of Black "race" as a risk factor is scientifically unsound and actively harmful.
  • Anti-Black racism is the primary driver of disparities in preterm birth and other maternal/infant outcomes for Black patients.
  • Chronic stress and implicit bias are key mechanisms through which racism operates, leading to negative birth outcomes.

Conclusions:

  • Eliminating "race" as a risk factor and naming anti-Black racism is crucial for effective interventions.
  • Addressing chronic stress and implicit bias are essential components of anti-racist maternity care.
  • Shifting the causal paradigm is a critical step toward achieving birth equity and improving Black maternal and infant health outcomes.