Place-Based Structural Disadvantage, Lethal Police Violence, and Adverse Birth Outcomes Among Black Birthing People

Structural racism and lethal police violence shape community environments, particularly in urban and urban-adjacent contexts, and may influence reproductive health. While disparities in birth outcomes among Black populations are well documented, fewer studies have examined how these structural and state-linked exposures jointly pattern risk for adverse birth outcomes. Using 2020 National Center for Health Statistics natality data and Mapping Police Violence data (2015-2019), we analyzed associations between county-level lethal police violence, a multidomain. Structural Racism Exposure Index (SREI), and low birth weight (LBW) and preterm birth (PTB) among non-Hispanic Black birthing people in the United States (N = 407,840). Incidence rate ratios (IRRs) were estimated using. Poisson and multilevel Poisson models, adjusting for maternal sociodemographic characteristics, with multiple sensitivity analyses assessing robustness. Higher levels of structural disadvantage were consistently associated with greater rates of LBW and PTB. Associations between lethal police violence and adverse outcomes were smaller and varied across model specifications. One interaction suggested a possible elevation in PTB in counties with both high police violence and medium structural disadvantage, though interaction findings were limited and should be interpreted cautiously. Findings provide suggestive evidence that structural disadvantage and policing are contextual factors linked with birth outcomes among Black birthing people. Results highlight the importance of examining structural and place-based conditions when assessing reproductive inequities and underscore the need for further research on how these contextual exposures shape Black reproductive well-being.