Reproductive health impacts of structural gendered racism: moving from measurement to action

Intersecting systems of oppression, such as structural racism and sexism, have long been identified as fundamental causes of health inequities by activists and scholars. However, the field of epidemiology has only recently increased attention towards measuring systems of oppression and power in order to inform strategies to advance health equity. Racialized inequities in adverse birth outcomes persist despite decades of health care improvements, indicating the necessity of interrogating structural determinants rather than individual factors. This dissertation integrates unique data sources to advance the study of multilevel measures that capture how inequitable social contexts (re)produce adverse birth outcomes in order to challenge the laws, policies, and practices that uphold these systems. We examine the reproductive health impacts of structural gendered racism – the totality of interconnectedness between structural racism and sexism – and the role of community care in counteracting these structural harms. First, we develop a novel latent class measure of structural gendered racism at the state level that captures the multidimensionality of these intersecting systems of oppression and how they influence preterm birth inequities across the United States. Second, we explore how policing, as a product of intersecting systems of oppression, acts as a neighborhood-level racialized gendered stressor leading to preterm birth. Third, moving beyond measurement, we look towards community-based doulas as a strategy to provide community care in the context of structural gendered racism. Findings from these studies reinforce the importance of addressing context-specific structural determinants of health inequities and the need to fund community-led, non-carceral strategies that address the interconnected root causes of these inequities. Taken together, these studies advance the epidemiological conceptualization and measurement of intersecting systems of oppression, amplify calls for the field of epidemiology to critique policing practices as a population health issue, and embrace collective care as a radically hopeful response to systemic oppression.