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The longstanding toll of police violence on Black communities came into sharp relief last year with the murder of George Floyd. Now, a research team from Minneapolis, a city traumatized by the police killings of Floyd and other unarmed Black men, has published a study showing that the impact of even routine policing extends deeply and pervasively into communities, and may adversely affect the health of pregnant women and their babies.

In a study being published Wednesday in JAMA Network Open, scientists examined rates of preterm birth, a problem Black people are nearly twice as likely to experience as white people, and found that people living in neighborhoods with a high number of police contacts were twice as likely to experience a preterm birth.

The findings applied to both white and Black people living in heavily policed neighborhoods, but because more people of color live in these neighborhoods, the stress felt by encountering even routine day-to-day policing and vigilance is higher for mothers who are Black, the researchers said.

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“Certainly we have shocks of acute stress from incidents of police violence in communities, but the day-to-day common stress of leaving home and always seeing police on your block or seeing people pulled over has an impact too,” said Rachel R. Hardeman, the founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health and one of the study’s lead authors.

To conduct the research, Hardeman’s team relied on publicly released data from the City of Minneapolis Police Incident Report, which includes information on the date, time, and location for all incidents reported by officers, to determine how frequent per capita police contact was in each of the city’s census tracts. They then examined how birth outcomes compared in the different tracts. The researchers controlled for factors such as maternal age, marital status, insurance status, and socioeconomic factors such as income to show that police presence was associated with low birth weights, Hardeman said.

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The study doesn’t prove a causal connection between policing and premature births. But it provides more evidence that racism and policing affect maternal health, said Fleda Mask Jackson, the president of the Atlanta-based health equity research firm and think tank Majaica, and creator of the Save 100 Babies campaign. “It points to the fact that there’s something very unique to being Black in America. The effect of racism in America is generational and triggered by police violence.”

Other studies have shown adverse birth outcomes in Muslim American women after the terrorist attacks of 9/11; in Latina women after major immigration raids; and in Black women after police shootings. “This study dives a little deeper into the nuance of how anti-Black racism affects birth outcomes,” said Jackson, who has conducted research showing that pregnant Black women can be so anxious about police violence they anticipate their unborn children facing, they can experience depression. “Even in the womb, there is stress around the anticipation of police violence.”

The work helps shed light on what might be causing longstanding racial maternal health disparities. Despite improved prenatal care in recent decades for women of all colors, Black women remain twice as likely as white people to give birth prematurely, something that can have lifelong health consequences for the child and is likely one cause of “the stubbornly persistent and shameful increased infant mortality rates in Black infants,” Bernard P. Dreyer, a former president of the American Academy of Pediatrics, wrote in a commentary accompanying the new research.

Black infants are 2.3 times more likely to die than white infants during their first year of life and maternal complications, including death, are 3.4 times more likely to occur for Black mothers. “This study exposes a number of pathways from structural racism to poorer health outcomes in Black communities,” Dreyer wrote. In 2018, the American Public Health Association declared law enforcement violence to be a public health issue.

Jackson said she found it intriguing that pregnant white women were nearly as adversely affected by police contacts as Black women. “That shows it’s important because it affects everyone,” she said. Jackson said she would like to see similar studies in other geographic areas such as the southern and midwestern U.S., which may have different patterns of racial and ethnic mixing in neighborhoods than Minneapolis.

The researchers found that women in one population — Black people not born in the U.S. — were far less likely to experience preterm birth despite living in heavily policed areas. The finding adds to the “immigrant paradox” of recent immigrants to the U.S. being healthier than more-established immigrants or non-immigrants despite hardships or socioeconomic status.

Hardeman’s team said the findings suggest that while Black people from countries such as Somalia, Liberia, or Eritrea experience anti-Black racism, they are shielded from the “cumulative and intergenerational” exposure to stress related to racism and heavy policing. This long-term stress, which some call “weathering,” may be a critical factor in poor health outcomes. The different outcomes for U.S.-born and non-U.S.-born Black people, she said, “further reinforces the case that race is a social construct and not a biological one.”

Hardeman said the team did not control for medical conditions like hypertension and diabetes, which are also linked to preterm birth, because those stress-related factors were likely mediators in the association between police contact and preterm birth. She said the issue of how to control for comorbidities linked to racism was a critical issue not just in her study, but in all work on health disparities, including higher Covid-19 death rates in minoritized communities. “If we’re not looking at what’s causing the hypertension to begin with, we’re missing the point,” she said.

The research project started shortly after the July 2016 death of Philando Castile, a 32-year old Black man fatally shot during a routine traffic stop in the Minneapolis-St. Paul area. It emerged after his death that Castile had been pulled over by police 49 times in 13 years, an average of one traffic stop every three months. Concerns about the safety of Black men and boys going about their daily lives were things Hardeman heard repeatedly as she conducted research with Black families at the Roots Community Birth Center in Minneapolis.

“One of the themes that kept coming up for families was that they didn’t want to know the sex of the baby they were having,” Hardeman said. “There was a lot of fear and stress and concern around having a Black baby boy.”

Hardeman said she hopes the paper can contribute to the ongoing debate about policing in her city, where voters last month rejected a plan to replace the police department with a public-health oriented department of public safety, and also nationwide. “This is bigger than any individual or family that may be harmed,” she said of the effects of police violence and presence. “Babies born too early are set on a life course immediately at risk for poor outcomes, and that starts the cycle all over again.”

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