INVESTIGATING THE EFFECTS OF CULTURAL AND CONTEXTUAL FACTORS ON BIRTH WEIGHT OUTCOMES FOR BLACK AMERICAN MOTHERS

Abstract

This dissertation investigates whether current government interventions positively and significantly affect birth weight for Black American Mothers (BAM) when controlling for political, social, and cultural factors. Hierarchical linear modeling is used to evaluate the effect that federal reforms and program services geared towards health equity, such as adult Medicaid expansion and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Programs and Administrative Services, have on birth weight from 2010 to 2018. Using a three-paper format, the first study tests whether state and local health policy factors, such as state adult Medicaid expansion status and bureaucratic factors, such as WIC Program and Administration (P&A) cost, respectively, impact county-level birth weight for BAM. The second study examines whether state-level interquartile measures (IQM) of Racism and Religiosity in Google search trends impacted county-level birth weight for BAM. The last study examines interactions between socioeconomic factors, bureaucratic factors such as WIC P&A cost, and policy factors such as adult Medicaid expansion status. The findings across the three papers suggest that regional characteristics have a significant effect on increasing adverse outcomes for pregnant Black mothers. Birth weight outcomes are the worst in the Southern of the United States. As the natality data does not include individual factors such as marital status and live birth order, I could not control differences in birth weight for single mothers, first-time mothers, or other factors that may affect birth weight. Future research should supplement this data by partnering with hospitals and with local agencies to address birth weight disparities. This would facilitate testing the impact of public and nonprofit services on birth weight outcomes in health systems in various regions across the United States.