Racism within the criminal legal system may be a driver of racial and ethnic inequities in severe maternal morbidity

Racial and ethnic inequities in the criminal legal system are an important manifestation of structural racism. These inequities not only harm incarcerated people and their families, but also impact the health of the entire community.

To date, there has been little research on how these inequities may influence the risk of severe maternal morbidity—a set of life-threatening complications occurring during childbirth and postpartum. In the United States, Black people who give birth are two to three times more likely to experience severe maternal morbidity than White people who give birth. The difference in maternal mortality is even more stark: The United States has the highest rates of maternal mortality among high-resource nations, with Black people who give birth facing a three- to four-fold higher risk than their White counterparts.

A team of scientists led by a postdoctoral scholar at UC Berkeley School of Public Health has been working to fill that knowledge gap.

In a study published in JAMA Network Open, Elleni Hailu, PhD, MPH, and her team found that Black and Hispanic or Latinx people who give birth who reside in counties with high Black-White jail incarceration inequity had higher odds of severe maternal morbidity compared with those residing in low-inequity counties.

“Mass incarceration is known to have ill health effects that permeate communities,” the authors write. “Mass incarceration is conceptualized to influence population health inequities through depleted community socioeconomic and psychosocial resources, severed social ties, and heightened stress.”

“Consequently, residing in neighborhoods affected by mass incarceration has been shown to increase the risk of various adverse mental and physical health outcomes.”

This population-based cross-sectional study used statewide data from California on all live hospital births from 1997 through 2018. The data were obtained from hospital discharge and vital statistics records, which were linked with publicly available county-level data.

Mahasin Mujahid, PhD, MS, who is Lillian E. I. and Dudley J. Aldous Chair at Berkeley Public Health and the paper’s senior author, said the research sheds light on the critical intersection of structural racism within the criminal-legal system and its profound impact on maternal health outcomes.

“Our findings underscore the urgent need for a transformative approach to address racial and ethnic disparities in pregnancy-related complications and a call to action to dismantle inequitable institutions,” Mujahid said. “This will require reevaluating policies within the criminal-legal system and the development of bold new approaches to community-based alternatives to punitive practices to safeguard maternal health and promote equity for all.”


Additional authors include: Corinne A. Riddell, PhD, MS; Patrick T. Bradshaw, PhD, MS; and Jennifer Ahern, PhD, MPH; UC Berkeley School of Public Health; and Suzan L. Carmichael, PhD, MS, Stanford University.

This work was supported by a grant from the National Institute of Nursing Research.

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