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Racialized economic segregation in relation to fecundability in a preconception cohort study.

Sharonda M Lovett1, Erin J Campbell2,3, Andrea S Richardson4

  • 1Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA. slovett1@bu.edu.

Journal of Urban Health : Bulletin of the New York Academy of Medicine
|December 20, 2025
PubMed
Summary

Racialized economic segregation, measured by the Index of Concentration at the Extremes (ICE), was linked to lower fecundability (the probability of conception). Disadvantaged neighborhoods showed a moderate decrease in conception rates.

Keywords:
FecundabilityFertilityIndex of Concentration at the ExtremesNeighborhood characteristicsResidential segregationSocioeconomic factorStructural racism

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Area of Science:

  • Reproductive Epidemiology
  • Social Determinants of Health
  • Environmental Health

Background:

  • Racialized economic segregation is a known determinant of health disparities.
  • Previous research linked segregation to adverse pregnancy outcomes.
  • No studies had examined the association between segregation and fecundability.

Purpose of the Study:

  • To investigate the association between residential segregation and fecundability.
  • To assess the impact of economic, racial, and racialized economic segregation on the per-cycle probability of conception.

Main Methods:

  • Analysis of 10,438 U.S. participants from the Pregnancy Study Online cohort (2013-2022).
  • Calculation of Index of Concentration at the Extremes (ICE) for economic, racial, and racialized economic segregation using residential addresses.
  • Use of proportional probabilities regression models to estimate fecundability ratios (FRs), adjusting for relevant variables.

Main Results:

  • A monotonic inverse association was observed between increasing quintiles of economic segregation (ICEincome) and racialized economic segregation (ICEincome + white/black) with fecundability.
  • Living in the most disadvantaged neighborhoods (quintile 1) for racialized economic segregation was associated with a moderate decrease in fecundability (FR = 0.79).
  • Less evidence of association was found between racial segregation (ICEwhite/black) and fecundability.

Conclusions:

  • Neighborhood racialized economic segregation is associated with reduced fecundability.
  • These findings highlight the impact of social and economic environmental factors on conception.
  • Further research is needed to understand the mechanisms underlying this association.