Disproportionate Preterm Delivery Among Black Women: a State-Level Analysis

  • Palmira SantosEmail author
  • Gitanjali Joglekar
  • Kristen Faughnan
  • Jennifer Darden
  • Ann Hendrich


Preterm delivery occurs at extraordinarily higher rates among Black women than among women of any other race or ethnicity. For those children who survive, many face a lifetime of health and developmental challenges as well as difficulties in school and life. Previous studies have provided substantive evidence that the preterm delivery disparity experienced by Black women is associated with ongoing distress caused by racism. Our study examines rates of preterm delivery for Black women in the USA to determine the level of risk associated with living in specific states. Using a logistic regression model, we examined the impact of the delivery state, controlling for known clinical, economic, and demographic risk factors. We found that 32 of the 35 states included in our analysis were associated with a statistically significantly increased risk of preterm delivery among Black women, as compared to the state with the lowest preterm delivery rate for Black women. These findings allowed us to organize states into a continuum of preterm delivery risk. Because of the harmful effects of preterm delivery and its disproportionate impact among Black women and infants, we recommend that a measure of preterm delivery be included in any state plan to assess, intervene in, and monitor racial disparities.


Labor and delivery Disparities Preterm delivery Social determinants of health MSC Codes: 92-02: Research exposition (monographs, survey articles), Biology and other natural sciences 



The authors would like to thank the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics for providing the data used in this study.

Author Contribution

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Palmira Santos, Gitanjali Joglekar, and Kristen Faughnan. The first draft of the manuscript was written by Palmira Santos, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

Ethical approval was not required for this retrospective study. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Formal consent is not required for this type of study.

Supplementary material

40615_2019_657_MOESM1_ESM.pdf (250 kb)
Online Resource 1: Deliveries and Preterm Birth Rates by Race and State. Descriptive Caption: Online Resource 1 provides full state-level descriptive results. The leftmost column lists the state name. The second and third columns list, respectively, the total number of deliveries in the state and the percent of those deliveries that were preterm. The fourth and fifth columns list the same information for Black women only, while the sixth and seventh columns list this information for non-Black women. Finally, the eighth column lists the unadjusted risk ratio for preterm birth for Black women relative to non-Black women in the designated state. A footnote indicates that the table includes only singleton live births that had a gestational age of at least 20 weeks, took place in 2016, had complete data for all study variables, occurred in a hospital, and were paid for by either Medicaid or a private insurer. (PDF 250 kb)
40615_2019_657_MOESM2_ESM.pdf (239 kb)
Online Resource 2: State Odds Ratios for Preterm Delivery (Deliveries among Non-Black Women). Descriptive Caption: Online Resource 2 provides state odds ratios for preterm birth among non-Black women. The first column lists the state name. The second column lists the state odds ratio (OR) and 95% confidence interval (CI). A footnote indicates that results are adjusted for maternal age, payer type, maternal hypertension, maternal diabetes, pre-pregnancy obesity, and smoking during pregnancy, and that the reference state is Oregon. (PDF 239 kb)


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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Brandeis UniversityWalthamUSA
  2. 2.AlabasterUSA
  3. 3.St. LouisUSA

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