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The prevalence of low birthweight varies with ethnicity and socioeconomic status, as shown in Figure 3.10. In 2016, non-Hispanic Black infants were more than twice as likely to be born low birthweight (11%) as non-Hispanic White and Hispanic infants (5% and 6%, respectively) (Womack, Rossen, & Martin, 2018). Contextual influences, such as neighborhood and socioeconomic factors, interact in complex ways to influence low birthweight. For example, neighborhood disadvantage and the stressors that accompany it are associated with an increased risk for low birthweight (Ncube, Enquobahrie, Albert, Herrick, & Burke, 2016). In one study, low birthweight rates were higher in non-Hispanic Black mothers than non-Hispanic White mothers, but the racial difference declined (but did not disappear) when the researchers took into account financial and relationship stresses (Almeida, Bécares, Erbetta, Bettegowda, & Ahluwalia, 2018). These findings suggest that contextual factors, such as differences in experienced stress, may influence some of the racial differences in low birthweight.

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Figure 3.10 Very Low and Low Birthweight Rates, by Maternal Race/Ethnicity, 2015

Source: Centers for Disease Control and Prevention (2018c).

Socioeconomic disadvantage interacts with race and ethnicity in complex ways to influence low birthweight. For example, in one study of over 10,000 Californian women, the most economically disadvantaged Black and White women showed similar low-birthweight rates, regardless of race (Braveman et al., 2015). Rates of low birthweight declined with a rise in income for all women, but the racial disparity in low birthweight grew such that greater socioeconomic advantage was more strongly associated with lower low-birthweight rates among White but not Black women.

In the United States, socioeconomic status is associated not simply with income but also with access to social services such as health care. The socioeconomic inequalities that influence women’s ability to seek early prenatal care also influence birth outcomes. A comparison of U.S., U.K., Canadian, and Australian births illustrates the role of SES in predicting low birthweight. Although the most disadvantaged women were more likely to give birth to low-birthweight infants in all four countries, SES was most strongly linked with low birthweight in the United States (Martinson & Reichman, 2016). In contrast with the privatization of health care in the United States, health care and other social services are readily available to all individuals in the United Kingdom, Canada, and Australia. Access to health care is an important influence on low birthweight. A recent comparison among five North American cities (Baltimore, Boston, Chicago, Philadelphia, and Toronto, Canada) illustrates the role of contextual factors in low birthweight (De Maio, Ansell, & Shah, 2018). In this study, unemployment and living in a racial or ethnically segregated community were not associated with low birthweight in Toronto, but they were strongly associated with low birthweight across communities in the four U.S. cities in the analysis. Unfortunately, poor access to health care can prevent low-birthweight infants from getting the help that they need to overcome the formidable challenges ahead of them.