PROJECT SUMMARY/ABSTRACT This urgent competitive revision will address how two public health emergencies—COVID-19 and racism—have impacted Black maternal health. The overall objective of the parent project is to elucidate the association between a pervasive form of structural racism—racialized police violence—and adverse reproductive health outcomes. This time sensitive request has significant potential to further revolutionize our understanding of the impact of racism on Black maternal health by exploring how the dual pandemics of COVID-19 and structural racism laid bare by George Floyd’s death while in police custody have impacted Black maternal health. The proposed urgent revision enhances the current R01 by adding two aims to address the implications of the events of 2020—the COVID-19 pandemic and the death of George Floyd while in the custody of Minneapolis Police and the ensuing civil unrest—for Black maternal health. Aim 1 (a) quantify the impact of George Floyd’s death on trends in preterm birth (PTB) and low birth weight (LBW); (b) quantify the risk of PTB and LBW related to spatial proximity to the death of George Floyd by Minneapolis police and the ensuing civil unrest; and (c) explore if the COVID-19 pandemic moderates the relationship between the death of George Floyd and risk of PTB and LBW. Preterm birth (<37 weeks gestation) is a critical marker that is sensitive to the well-being of a community—in regard to racism and measures of stress. Thus, PTB can reveal a lot about how the traumatic death of George Floyd and the stress of COVID-19 have played out in the lives of pregnant Black women. Aim 2: Illuminate the lived experience of how the dual pandemics of COVID-19 and structural racism (laid bare by George Floyd’s death) have impacted Black women who were pregnant in 2020. The revision will enhance the scope and sample size of the parent grant online survey of Black women who were pregnant and living in the two communities that are the focus of the parent R01 (Minnesota and Louisiana) to assess psychosocial stress related to George Floyd’s death, the COVID-19 pandemic, and structural racism. We will also conduct 25 in-depth interviews with Black women in Minnesota who complete the survey to illuminate Black maternal health outcomes for women living in the community where George Floyd died. This timely and urgent revision proposal is directly responsive to Area 2 of NOSI NOT-OD-21-071: Investigate the impact of structural racism in the context of the COVID-19 pandemic on the health and well-being of persons during pregnancy and up to one year postpartum. The proposed aims extend in significant and innovative ways the overarching goal of the parent R01; the timing and severity of the COVID-19 pandemic and the death of George Floyd could not have been anticipated at the time of the original proposal. Both the funded project and revision request mark an important change in public health framing from one that incorrectly names race—a seemingly immutable characteristic—as a “risk factor” to one that identifies racism as a fundamental cause of health inequities.

NARRARTIVE The objective of the proposed competitive revision is to understand how the dual pandemics of COVID-19 and structural racism have impacted Black maternal health. Both the funded project and the revision request mark an important change in public health framing from one that incorrectly names race—a seemingly immutable characteristic—as a “risk factor” to one that identifies racism as a fundamental cause of health inequities. Only by understanding the mechanisms through which structural racism operates and how it affects maternal health can we begin to address this root cause of maternal health disparities.