Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Epidemiology and Population Health

Degree Program

Public Health Sciences with a specialization in Epidemiology, PhD

Committee Chair

Wallis, Anne

Committee Co-Chair (if applicable)

Taylor, Kira

Committee Member

Taylor, Kira

Committee Member

Guinn, Brian

Committee Member

Harris, Muriel

Committee Member

Brown, Aishia

Author's Keywords

Nativity; perceived racial discrimination; preterm birth; small for gestational age; foreign-born black women, US-born black women


Birth outcomes for Black women in the United States (US) are disproportionately worse in comparison to non-Black women, even when controlling for potential confounders. Existing studies suggest foreign-born (FB) Black women present better birth outcomes in comparison to US-born (USB) Black women. Also, the longer FB Black women live in the US, the more their perinatal health advantage diminishes. Racial discrimination has been hypothesized as a potential reason for this decline. This dissertation investigates the relationship between nativity and adverse birth outcomes while also exploring how the reporting of racial discrimination impacts birth outcomes among FB and USB Black mothers who participate in Des Moines Healthy Start.Secondary data (N= 1233, USB = 904, FB =329) from the Healthy Start database from 2000 to 2021 was used to examine the association between nativity, preterm birth (PTB) and small for gestational age (SGA). Primary data (N= 31, USB =4, FB = 27) was captured using a survey that measured three domains: perceived racial discrimination, perceived stress, and acculturation. Perceived Racial Discrimination was measured using the Racial Microaggression Scale (RMAS). Mothers of singleton live births and self-identified as Black or African American were included in the study. USB Black women presented higher odds of PTB (OR:1.65, 95% CI 1.13-2.40) and SGA (OR: 1.47, 95%CI .92-2.35) in comparison to their FB counterparts, yet after adjustment for covariates, this effect attenuated, and no significant differences were observed. Also, USB Black women reported higher scores on the RMAS. Among FB Black women, higher reports were observed among those who resided in the US for more than 5 years or migrated prior to 18 years of age. Additionally, the odds of having an adverse birth outcome increased for each additional experience of racial discrimination among FB Black women. The findings of our study suggest though FB Blacks mothers present a perinatal advantage, exposure to racial discrimination, contingent on the age of migration and the duration of residency, aids in the decline of their birth outcomes. This study provides a basis for future research in the areas of nativity, racial discrimination, and acculturation.