Neighborhood context and reproductive health

https://doi.org/10.1016/j.ajog.2005.01.071Get rights and content

Racial and social class differences in rates of preterm birth and other adverse outcomes are among the most widely recognized and least well-understood phenomena in the study of reproductive health. Individual-level characteristics have failed to account for such gradients. Recently, researchers have begun to argue that health in general and reproductive outcomes specifically are rooted in social inequalities. One area of such inequality may be residential segregation and the associated race/ethnic differences in exposure to adverse neighborhood conditions. We review the empiric data that examine the association between neighborhood conditions and reproductive health. We also review the major challenges that researchers face when trying to incorporate neighborhood-level variables into studies of health outcomes. Our goal is to stimulate further research that simultaneously considers social, economic, and biologic determinants of reproductive health.

Section snippets

Neighborhood context

It has been suggested that the identification of plausible mechanisms through which neighborhood context influences health outcomes is perhaps the most pressing issue in the advancement of our understanding of how residential context translates into either good or bad health.11 In the Figure, drawing on previous studies, we outline a conceptual framework that links neighborhood context to adverse reproductive events highlighting important intervening variables along this pathway.10, 11, 12, 13,

Comment

The notion that community-level conditions can produce profound effects on host susceptibility to disease derives in part from the long-standing existence of strong social class and race/ethnic gradients in health and death and the inability of individual-level characteristics to account for such gradients.75 The emphasis on community context has a long history in public health. Initially, the field of public health was dominated by concerns with neighborhood variation in health outcomes and

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    Supported by grants HD36462 from the National Institute of Child Health and Human Development, and TS-626 from the Centers of Disease Control and Prevention.

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