PROJECT SUMMARY/ABSTRACT Black women in the US are twice as likely to experience a preterm birth (PTB), a low birth weight (LBW) infant, or the death of a child before age one compared to white women. This profoundly disturbing racialized pattern of adverse reproductive outcomes has endured for as long as data have been available. Decades of medical and public health research have documented the magnitude of racial inequity in maternal and child health, and it persists although the total infant mortality rate has declined and despite efforts aimed at improving access to prenatal care and early childhood initiatives. The intractability of this problem suggests structural racism—the ways in which societies foster discrimination by reinforcing inequitable systems that in turn reinforce discriminatory beliefs, values, and distribution of resources—as a root cause of these racial health inequities. The overall objective of the proposed project is to understand the degree to which acts of police violence—a pervasive form of structural racism—negatively impact reproductive health outcomes among black women and exacerbate inequities in adverse birth outcomes at the population level. This project will test the hypothesis that incidences of racialized police violence have both a direct and an indirect link to negative birth outcomes among black women compared to white women. Understanding the mechanisms through which racialized police violence is a source of psychosocial stress for black women will lead to novel intervention targets that may reduce racial inequities in birth outcomes. The project has three specific aims. Aim 1: Quantify the risk of PTB and LBW related to spatial and social proximity to the killing of a black man by police and the ensuing civil unrest. This population-based cohort study leverages vital records from the Minnesota Department of Health to assess if black women experienced worse birth outcomes following the killing of Philando Castile by police and the subsequent civil unrest. It will also assess if spatial proximity to the site of the incident and civil unrest increased risk for worse birth outcomes among all women. Aim 2: Quantify the impact of police violence on PTB and LBW risk among black women. Using a quasi-experimental causal framework and leveraging 13 years of birth records available from every county in the US, this aim assesses if incidents of police violence across the US are associated with greater risk for PTB and LBW among black women. Aim 3: Illuminate the lived experience of how racialized police violence impacts black women during pregnancy. An online survey administered to black women (n=200) who were pregnant and living in two communities with incidents of high- profile police violence (Twin Cities, MN, and Baton Rouge, LA) will assess psychosocial stress related to police violence, followed by 50 in-depth interviews in each city with women to characterize the impact of police violence on birth outcomes and to identify patterns and mechanisms. The long-term goal of this project is to eliminate inequities in birth outcomes for black women. This timely and urgent project not only aligns with NICHD’s goal of preventing pregnancy- related complications and reducing maternal and infant death, but it will further underscore the negative impact of racialized police violence on society, bolstering arguments for large-scale change in police-community interactions.

PROJECT NARRATIVE Our long-term goal is to eliminate inequities in birth outcomes for black women. This timely and urgent project not only aligns with NICHD’s goal of preventing pregnancy-related complications and reducing maternal and infant death but will further underscore the negative impact of racialized police violence on society, bolstering arguments for large-scale change in police-community interactions. This study also marks an important change in public health framing from one that incorrectly names race—a seemingly immutable characteristic—as a “risk factor” to one that centers racism as a fundamental cause of health inequities.