Examining the association between historical redlining and adverse birth outcomes in mothers residing in areas of high risk, as outlined by HOLC, in Virginia.

Despite being one of the wealthiest nations, disparities in adverse birth outcomes persist across racial and ethnic lines in the United States. There is evidence that historic redlining is related to current neighborhood characteristics, including increased minority presence, higher prevalence of poverty and greater social vulnerability. Redlining was the practice of racially discriminatory grading of neighborhoods’ mortgage credit-worthiness, implemented via the federally sponsored Home Owners’ Loan Corporation (HOLC) color-coded maps, which US government used from 1933 to 1977, effectively isolating Black people in areas that would suffer lower levels of investment than their white counterparts. Today, those same neighborhoods suffer not only from reduced wealth and greater poverty, but from lower life expectancy, higher incidence of chronic diseases and poorer health outcomes in general. The main objective of this work was to assess if historical redlining is associated with contemporary risk of preterm birth (< 37 weeks gestation), low birth weight (LBW), and small-for-gestational age (SGA). We used Birth certificate data for all live births occurring between 2015 and 2019 from the following Virginia localities: Richmond, Lynchburg, Roanoke, and Virginia Beach-Norfolk-Newport News area. The prevalence of adverse birth outcomes tended to be higher in worse HOLC grades. Overall odds of adverse birth outcomes increased as HOLC grade worsened. In congruence with prior studies on redlining, we found that worsening HOLC grade was associated with adverse birth outcomes.
Policies geared toward racially segregating neighborhoods in the US were widespread, pervasive, and well-documented in US history. Effects of such policies can persist long past their existence and may continue to contribute to health disparities even after their discontinuation. The analysis of historical redlining and health outcomes can raise important questions on government accountability. It also reveals how using the lens of structural racism, particularly when it is informed by our own history, can inspire follow-up research to strengthen evidence on how we could understand, rectify, and prevent health inequities.