Black Babies Matter: An Intersectional Analysis of Preterm Birth Risk Among Black Mothers

Prematurity, or birth before 37 weeks of gestation, is associated with increased multisystem health risks for infants and poor mental health outcomes for mothers. Black mothers experience higher likelihoods of preterm birth compared with other racialized groups. Black mothers, however, are a heterogeneous social group who differ on factors such as racialized identity, ethnicity, and nativity, and ignoring these interconnected factors can lead to an incomplete assessment of within-racial group differences in preterm birth risk. Our study applies intersectionality's intracategorical methodological approach to explore heterogeneity in preterm birth risk among Black mothers.

Using birth certificate data from the 2023 U.S. National Vital Statistics System (N = 552,708), binary logistic regression models were used to analyze whether the likelihood of preterm birth for Black mothers differed across categories of racialized identity (single-race vs. multiracial), and nativity (U.S. born vs. foreign-born).

Results revealed multiracial (adjusted odds ratio [aOR] 0.82; 95% confidence interval [CI], 0.80-0.85), Hispanic (aOR, 0.90; 95% CI, 0.87-0.93), and foreign-born (aOR, 0.65; 95% CI, 0.63-0.66) Black mothers had lower odds of preterm birth compared with their single-race, non-Hispanic, and U.S.-born counterparts, respectively. When all aspects of social location were measured conjointly, single-race, non-Hispanic, U.S.-born Black mothers had the highest percentage of preterm births (12.4%), whereas multiracial, Hispanic, foreign-born Black mothers had the lowest percentage of preterm births (8.2%).

Our study contributes to research on preterm birth disparities and broader conversations surrounding the importance of utilizing intersectional frameworks to articulate within-racial group differences in Black maternal outcomes.