Living in a neighborhood with high eviction rates over time is associated with higher rates of psychological distress among pregnant Black women compared to those who live in areas with lower eviction rates, a new study has found.
The research highlights the impact of the housing crisis on pregnant women, even on those who haven’t personally been evicted, and the importance of neighborhood conditions to Black maternal health, said lead author Shawnita Sealy-Jefferson, associate professor of epidemiology at The Ohio State University College of Public Health.
“Black mothers are at least three times more likely than white mothers to die during or in the year after pregnancy, and we are not talking enough about the neighborhoods that people are living in as a predictor of poor maternal mental health,” Sealy-Jefferson said.
She and her colleagues examined trajectories of neighborhood evictions over time, and odds of moderate and serious psychological distress among more than 800 Metro-Detroit Black women during pregnancy. Higher rates of eviction filings and judgments in a woman’s neighborhood before and during pregnancy were associated with two-fold to four-fold higher odds of psychological distress. The study appears today in the American Journal of Epidemiology.
Overall, 68% of the women in the study reported psychological distress during pregnancy, with 8% of them reporting serious psychological distress — the type of health struggles that constitute a diagnosable mental illness. Recent estimates suggest that 3.4% of the U.S adult population has serious psychological distress.
Mental health conditions, including suicide and overdoses related to substance use disorder, are the leading cause of maternal death.
“It is stressful, even when you’re not the one being evicted, seeing your neighbors’ and friends’ stuff on the curb — baby beds, toys — and knowing they might have nowhere to go, and that you might be next,” Sealy-Jefferson said.
The estimates in the study inevitably underestimate the true impact of eviction because they don’t reflect illegal evictions — those that don’t go through the courts, Sealy-Jefferson said. Previous research estimates that 40-50% of evictions are illegal.
Sealy-Jefferson, a Detroit native who has been studying the impact of neighborhoods on Black women’s birth and maternal outcomes for more than a decade, said the results confirmed what her observations have been telling her for years: “Neighborhoods matter. Nobody has connected these violent experiences over time to poor maternal mental health. A lot of the discourse is: ‘Black people have higher rates of everything, what are these people doing wrong that increases their risk?’ But what we’re showing is that the problem is literally the way this society is organized.
“Neighborhoods with a disproportionate burden of eviction rates stem from historical federal government sponsored redlining, and contemporary racism and sexism.”
Redlining refers to systemic disinvestment in neighborhoods with predominantly Black residents.
Beyond policy-level changes that protect tenants and increase funding for affordable housing, a logical next step is to identify modifiable risk factors for psychological distress during pregnancy so that social service and health care providers can use culturally appropriate and relevant interventions for harm reduction, Sealy-Jefferson said.
“The root cause of inequities in Black maternal health has to be acknowledged and addressed or these inequities are going to continue to worsen over time,” she said.
Study co-authors include Benita Jackson of Smith College, and Brittney Francis of Harvard.
Support for this research was provided by the Robert Wood Johnson Foundation.
