Beyond poverty and education: measuring structural racism in neighborhoods to understand racialized birth outcome disparities

Neighborhood context is a root cause of poor health and racial health disparities, including disparities in adverse birth outcomes. In a recent article, XXXX et al. leveraged a multi-generationally linked dataset of South Carolina birth certificates to construct life course trajectories of census tract-level neighborhood affluence and disadvantage (Am J Epidemiol 2025;XXX(XX):XXX-XXX). This innovative study contributes to the literature on neighborhood context and perinatal health by highlighting the relevance of a life course approach, interrogating the role of neighborhood affluence and disadvantage on racial disparities, and extending this research to the U.S. South. In this commentary, we reiterate and expand on these points. First, we argue for the importance of explicitly integrating life course theory into neighborhoods and reproductive health research and assessing neighborhood context at several time points. Second, we encourage future studies to develop exposure measures that have a clear point of intervention and address the complex process of structural racism, rather than focusing on neighborhood composition. Finally, we emphasize the importance of considering the life course of neighborhoods themselves. Future research should interrogate historical and contemporary practices of neighborhood-level marginalization to create clear calls to action on how we can intervene to improve perinatal outcomes.