The Big Picture

Stillbirth remains a pressing public health concern, with persistent racial disparities across the United States. This study examined how racialized economic segregation—measured by the Index of Concentration at the Extremes (ICE)—influences the risk of stillbirth in Harris County, Texas. The analysis revealed that neighborhood privilege benefits some groups but not others, offering critical insights into how structural disparity shapes maternal and infant health outcomes.

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What We Did

Researchers conducted a retrospective cohort study of more than 900,000 live births and nearly 5,000 stillbirths in Harris County, Texas, between 2007 and 2020. They calculated ICE scores for census tracts to capture the joint effects of racial and economic segregation, contrasting high-income non-Hispanic White residents with low-income people of color. Multivariate logistic regression and Blinder-Oaxaca decomposition methods were used to determine how ICE and maternal risk factors contributed to racial disparities in stillbirth.

1

Racial Disparities in Stillbirth Rates:

Non-Hispanic Black mothers had the highest stillbirth rate (9.1 per 1,000), more than double that of non-Hispanic White mothers (3.8 per 1,000), and higher than Hispanic mothers (4.7 per 1,000).

2

Limited Benefit of Privileged Neighborhoods:

Living in the most privileged neighborhoods was associated with lower stillbirth odds for White mothers (OR = 0.82), but not for Black, Hispanic, or other racial/ethnic groups.

3

Segregation Explains Part of the Disparity:

Racialized economic segregation (ICE) accounted for 9.7% of the Black-White stillbirth disparity, while education (12.3%) and obesity (7.2%) were also major contributors. Together, measured factors explained only 21.2% of the disparity.

4

Chronic Stress and Discrimination:

The findings suggest that systemic racism and discrimination may offset the health benefits of economic privilege for non-White mothers, potentially through mechanisms like chronic stress and limited social support.
Understanding how racialized economic segregation shapes stillbirth risk helps to:

1

Illuminate the persistent structural drivers of racial disparities in maternal and infant health.

2

Highlight the need for interventions that go beyond individual behaviors to address systemic inequities.

3

Reinforce that neighborhood privilege is not universally protective and may have differential impacts across racial lines.
To address disparities in stillbirth:

1

Invest in Maternal Health Resources:

Expand access to quality prenatal care in economically and racially marginalized communities.

2

Address Structural Racism:

Implement policies that counteract the effects of historical disinvestment and segregation.

3

Tailor Interventions by Group:

Recognize that the same solutions may not benefit all populations equally; culturally and contextually relevant strategies are needed.

4

Expand Research on Chronic Stress:

Support research into how discrimination-related stress biologically affects pregnancy outcomes.

The takeaway?

Stillbirth disparities are rooted in structural inequality, not individual risk alone. While racialized economic segregation explains a portion of the Black-White disparity, the majority remains unexplained, underscoring the importance of addressing systemic racism and broader social determinants to improve maternal and infant health outcomes for all communities.

About the Study

This research was published in the Journal of Racial and Ethnic Health Disparities in June 2025. The full APA citation is: Rammah, A., Drake, J., Moussa, I., Whitworth, K. W., Henderson, H., Alvarez, J., & Symanski, E. (2025). Racialized economic segregation and disparities in the risk of stillbirth. Journal of Racial and Ethnic Health Disparities., 37(4), 24–30. https://link.springer.com/article/10.1007/s40615-025-02511-9