Addresses and Survival: Where Geography Shapes Black Motherhood

For Black mothers across the United States, maternal outcomes depend less on their doctors and more on their address. The five-digit zip code that we define our lives around also quietly shapes access to care, quality of treatment, and maternal outcomes that should never be predetermined. Behind the numbers, Black parents live in neighborhoods designed by redlining, underfunded medical facilities, transportation inaccessibility, and discriminatory policies that turn geography into risk.

Growing up, I have noticed firsthand how your zip code impacts your quality of life. Living in residentially segregated Baltimore City, it was evident how a 5-minute drive into more affluent neighborhoods could increase your life expectancy by 15+ years. Thus, inner city Black residents, like myself, face poorer health outcomes compared to our White counterparts due to different zip codes. Across the United States, a similar pattern has emerged in regards to Black mothers – we are dying at higher rates compared to other racial groups.

Socioeconomic status (SES) can be attributed to higher rates of Black maternal and fetal mortality. Though maternal health is framed as solely a medical issue, for Black women, it is just as much of a neighborhood issue. In a report conducted by the American Medical Association (AMA) and Sinai Urban Health Institute in Chicago, “[i]n recent years, the U.S. has witnessed a mounting awareness of maternal health inequities, unveiling a complex interplay of socio-economic, racial and health care system factors…” (Lubell 2024). Like Black mothers in Chicago, Black mothers in other low-SES zipcodes across America face low maternal care access, resulting in severe maternal morbidity and higher rates of infant deaths, preterm births, and low birth weights.  Low SES zipcodes, representing primarily Black and Brown populations, also highlight a lack of OB/GYN care and facilities available to women of childbearing age. Additionally, structural racism and its intersection with healthcare reveal a legacy of adverse maternal health outcomes among Black mothers in the US. Findings from a retrospective cohort study including 64,804 live births in 17 zip codes conducted in the  Finger Lakes region of New York state from 2005 to 2018 found that historically redlined communities based on criteria from the 1940  Home Owners’ Loan Corporation map (HOLC; also known as the redline map) were associated with an increased risk of preterm birth and periviable birth (Hollenbach et al, 2021).  Similarly, in a study conducted in Texas, compared to women living in high SES neighborhoods, women in low SES communities faced a higher prevalence of maternal and fetal risks such as asthma, obesity, hypertension, preclampsia, and more (Patel et al, 2024). These realities reveal that what appears to be individual health disparities is, in truth, the cumulative impact of policies and places that have long dictated whose lives are protected.

As the AMA President-elect Bobby Mukkamala, MD, stated, “[t]he health of medically disenfranchised patients and the health of their babies suffer when pregnant patients don’t have access to care in their communities” (Lubell 2024). Black mothers should not have to worry about the health and safety of their families based solely on their zip code. Black families should be able to live freely where they please and receive the same level and access to care compared to others in different neighborhoods. To improve Black maternal health outcomes, solutions must extend beyond individual health behavioral changes. We must address the system designed to disproportionately affect Black mothers. Maternal health equity can be achieved when we fix the systems that consistently fail Black bodies. New proposed health policies should invest in healthcare facilities in historically marginalized communities. A “Health in All Policies” approach, policies that address transportation, housing, education, and more, should be considered to fully improve the lives of Black mothers and their babies. For many Black mothers, survival requires navigating a healthcare system shaped by unequal investment and outdated assumptions. We must first acknowledge the uncomfortable truth: in America, a zip code can still decide who lives, who suffers, and who is mourned. No one should have to sacrifice their quality of life because of the neighborhoods they live in. Black mothers matter, Black babies matter, and most importantly, Black neighborhoods matter.

Citations:

Hollenbach, S. J., Thornburg, L. L., Glantz, J. C., & Hill, E. (2021). Associations between historically redlined districts and racial disparities in current obstetric outcomes. JAMA Network Open, 4(9), e2126707. https://doi.org/10.1001/jamanetworkopen.2021.26707

Lubell, J. (2024, August 21). How maternal care access varies by where moms live. American Medical Association. https://www.ama-assn.org/public-health/population-health/how-maternal-care-access-varies-where-moms-live

Patel, V. J., Delano, V., Juttu, A., Adhora, H., Zaheer, A., Vargas, L., & Jacobs, B. (n.d.). The implications of socioeconomic status by zip code on maternal-fetal morbidity and mortality in san antonio, texas. Cureus, 16(2), e54636. https://doi.org/10.7759/cureus.54636