Reproductive Health in an Era of Cascading Inequity: The “Double Jeopardy” of Environmental Stressors and Gaps in the Social Safety Net

The environment has a profound effect on human health, especially sensitive reproductive outcomes. Prior epidemiological evidence supports the "double jeopardy" hypothesis -- the notion that co-exposure to environmental and social stressors (e.g. perceived stress, financial strain, or experience of discrimination) could jointly affect reproductive health. In this commentary, we posit an extension to this framework, where we hypothesize that bolstering social safety net policies could help to alleviate the adverse effects of environmental stressors on reproductive health. We use publicly available data on social resources (health insurance coverage, food security, and hospital-based obstetric care) and environmental exposures (air pollution, lead, and heat waves) to illustrate the overlap of environmental stressors and social resources in the United States to support this hypothesis. Building upon these data, we provide recommendations for future research to rigorously evaluate our proposed extension of the "double jeopardy" hypothesis.