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Racism damages black pregnant women’s mental health, Covid-19 made it even worse.

This scientist is figuring out how to avoid their children also suffering the consequences.

A growing body of research suggests that structural and interpersonal racism compound to wreak havoc on the mental health of black people in America. When the Covid-19 pandemic struck, those effects were further exacerbated.

Wanjiku F.M. Njoroge, the Medical Director of the Young Child Clinic at Children's Hospital of Philadelphia, wanted to understand what this unique, stressful time looked like for black women. Specifically, for those who were experiencing pregnancy. She’s adamant that learning more about their experiences — what worked and what didn't — can arm us with much better knowledge to grow healthier, happier children in the future.

I’m a science journalist, and had the pleasure of chatting with Njoroge for my ITM column, where I unpack the behind-the-scenes of science changing the way we think about the world. Together, we plunged into the details of her work, and the history that has carved out the patterns she’s trying to break.

A collage of images made by Sofia Quaglia

Why are you interested in that intersection between maternal and infant health, and the effects that racism has on it?

I'm an infant preschool psychiatrist, and I'm a health equity researcher. I have long been interested in the intersection of race and racism, culture and ethnicity, and psychopathology. My interest is in those first five years of life — that’s because 90% of the brain develops, as you may well know, in the first five years of life. So, it is a critically important time when we're thinking about ensuring children and families are supported and trying to protect or mitigate against experiences that may have later associations with psychopathology.

Why was Covid-19 a unique moment to look into how racism and health converge?

When the pandemic hit the United States, simultaneously, we were wrestling with police brutality. Data was also coming out that communities of color, specifically African American, Latino, native and indigenous populations, were being hit harder and disproportionately impacted by the pandemic than other communities across the United States.

With a group of multidisciplinary colleagues from the institutions I work with, we started imagining what it might be like to be a pregnant woman. We created a questionnaire that we sent out to all the women who were currently pregnant, and in any of the Pennsylvania Hospital Health Systems.

We asked how they were doing, and what their concerns about the pandemic were. We asked about their concerns about deliveries, their pregnancies, and their mood — trying to gauge depression and anxiety. We were also interested in where these women lived, so we looked at zip codes and addresses.

And what were the results of this initial feedback?

We recognized that while all pregnant women were concerned and stressed, black women were more concerned, and they had different worries.

For example, we know that there are disparities in morbidity and mortality for women of colour, with black women dying about 2.3 times more than non-Latinx white women in the United States. We don’t know whether this reinforced black women’s growing concerns, but there clearly was more worry about delivery among this segment of the population.

Similarly, black women were more concerned about what the pandemic might mean for their jobs, for financial and housing situations. We know that black women get paid less than white women on average, in any job across the United States. So again, the disparities that already existed, were reflected in the concerns. The differences seem to speak to these larger disparities.

In the subsequent surveys, we've added more questions to try to unpack these differences, and we’re speaking to these women one on one to find out if there are themes that exist across black women, or if there are some differences based on a variety of other factors.

The surveys also looked at the geographical data of where these women were living, only to find a pattern of differences in their mental health outcomes and worries. Does this have something to do with America’s history of segregation?

Yes, it’s called redlining. Back in the 1930s and 40s, there was a group that was mandated by the Feds called the HLC, the Homeowners Loan Corporation, which was tasked with trying to determine neighbourhoods for future investments. They were in over 230 cities in the United States and were colour-coding their maps into four different colours: red, yellow, green, and blue. The blue neighbourhoods were the best neighbourhoods, the neighbourhoods that were better for investment. The green neighbourhoods were growing, similar to the blues. The yellow neighbourhoods were hazardous and the red neighbourhoods were declining.

Guess what: the areas that were deemed the red neighbourhoods had the largest amounts of Black Folk. Because those neighbourhoods were redlined there was disinvestment: they did not build any new stores or parks or museums. If you had a house in that neighbourhood, your house was worth less than if you were in a blue or green neighbourhood.

If you imagine intergenerational wealth, Black folks are already being paid significantly less than white people, and their neighbourhoods are now deemed as declining and hazardous. If you passed that on to your future generations, you were already starting off at a deficit. And because of segregation, you could only buy into these neighbourhoods, or only live and rent in these neighbourhoods that had been red lines. So, you were again, at a deficit.

But why is this segregation still relevant today, and how does it tie in with people’s physical and mental health?

Redlining has had all kinds of ramifications. For Philly, for example, you can take the 1934 maps and overlay it onto the 2020 map. The areas that had been redlined in the 30s are the same areas where the Covid-19 pandemic was most impacting communities. When we overlaid the black women in our survey study on these old historical redlining maps, the majority of the black women were living in these historically redlined neighborhoods.

This goes to show that in the United States, there are these systems and structures that were specifically built and created to segregate Americans and they have had this long-lasting and enduring impact on the health of Americans. That’s also why the pandemic was very much hitting communities on a mental health level.

Does this add to the everyday racism that people of colour experience?

Yes. When we started including questions about everyday discrimination in our surveys, we did find in our cohort that black women reported higher rates of racism. This can also trickle down to their children. There's been some interesting research that talks about how interpersonal racism can really impact black women's health while they're pregnant, and that that can be reflected in their child's development early in infancy — with the children appearing more anxious, having more difficulty separating, and more.

How much do we know of how much in turn, then this affects the development of children?

That's the question! We’ve been working with these women since they were pregnant, and we follow them and their babies through the first four years of life — the babies are now two. We have data from when they were pregnant, at delivery, and from six to 15 weeks postpartum. We're still asking moms questions about depression, anxiety, trust, and their medical team at the time of delivery. Now we're asking the fathers or secondary caregivers the same. We’re also doing interactive exercises with the moms and the babies, where we send toys to their homes and observe different tasks.

From all this data, we can hopefully start to glean what the impacts of racism and the pandemic are on the developmental health of children.

What is your hypothesis so far and what can we do with this initial data?

What we know is that people in the United States experience multiple forms of racism concurrently. And yet, many black people are doing well, despite all of the deck being stacked against us. There clearly is resilience. Looking at our data, we can start to think about what kinds of things families may have that have helped their children to thrive despite all the challenges.

Then again, babies, like adults, all have different temperaments, so that can be an important factor at play.

When we're thinking about prevention and early intervention, we want to be as precise as possible. There may not be an intervention for all. If we're thinking about trying to help parents with bringing children to the future, then having a more specific sense of what factors are the most determinative. Can we erase some of those boxes? Or can we build things around them?

Our goal is to do as much as we can for stages of life when the brain is building itself to be as protected as possible for the rest of childhood, adolescence, and adulthood.


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