Social
From redlining to reproduction: Examining the influence of historical neighborhood disinvestment on fertility Sharonda M. Lovett* Sharonda M. Lovett Lauren A. Wise Andrea S. Richardson Collette N. Ncube Erin J. Campbell Kipruto Kirwa Kenneth J. Rothman Amelia K. Wesselink Mary D. Willis
Background: Redlining, a historic racist practice that systematically diverted wealth away from Black and Hispanic into White neighborhoods, has been associated with adverse birth outcomes. However, redlining’s influence on fertility is not known. Our objective was to estimate the association between historical redlining and fecundability, the per-cycle probability of conception.
Methods: We analyzed data from 1,358 female participants aged 21-45 in Pregnancy Study Online (PRESTO; 2013-2023), an online preconception cohort study of couples attempting spontaneous conception without fertility treatment. Participants completed a baseline questionnaire on sociodemographic and reproductive factors, and bimonthly follow-up questionnaires for up to 12 months to ascertain pregnancy status. We linked participants’ geocoded addresses to neighborhoods graded by the U.S. Home Owners’ Loan Corporation (HOLC) during the 1930s for perceived riskiness of mortgage lending: A+B (best or still desirable), C (declining), and D (hazardous; i.e., redlined). We used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% confidence intervals (CI), adjusting for age and calendar year of enrollment.
Results: Most participants resided in neighborhoods with higher-risk HOLC grades: 41% grade C and 21% grade D. Black and Hispanic participants were less likely to live in grade A+B neighborhoods compared to non-Hispanic White participants. FRs were 0.84 (95% CI 0.73-0.97) and 0.77 (95% CI 0.65-0.92) for neighborhoods graded C and D, respectively, compared with neighborhoods graded A+B. Associations persisted among nulliparous females and those with <3 cycles of pregnancy attempt time at enrollment.
Discussion: In this preconception cohort study, residence in historically redlined neighborhoods was associated with reduced fecundability. Historical redlining may have reinforced neighborhood processes that yielded persistent place-based inequities in fecundability.
