{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T07:41:19Z","timestamp":1776930079077,"version":"3.51.2"},"reference-count":94,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["K01MD015291"],"award-info":[{"award-number":["K01MD015291"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J. Racial and Ethnic Health Disparities"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Addressing the grave racial inequities in maternal health requires a new generation of research that better operationalizes root causes of these outcomes. Recent frameworks improving the conceptualization of structural racism have illuminated the need for better conceptual clarity when investigating neighborhoods as a site of structural marginalization for Black birthing populations as well. In particular, better conceptualization of dynamic feedback in how neighborhoods are constructed and experienced, especially as they embed vicious cycles of place-based racialization, is integral to producing conceptually relevant and translatable evidence to address inequities in Black maternal health. This study presents a newly developed framework that integrates dynamic insight on neighborhood contexts from multiple disciplines to better conceptualize how it operates during the childbearing window to drive inequitable maternal morbidity rates among Black birthing people. I also compare and contrast this framework with existing frameworks based on how they represent key domains of social and structural determinants, neighborhood context, and dynamic feedback. Illustrating the strengths and weaknesses of each framework can improve researchers\u2019 ability to leverage these frameworks when developing project-specific conceptual models on structural racism, neighborhood context, and Black maternal health. Building a comparative repository of frameworks, in conjunction with developing new frameworks, will improve the field\u2019s capacity to follow best practices of rooting research in conceptually explicit models that improve operationalization and translation of evidence to eventually eliminate racial inequities in maternal health.<\/jats:p>","DOI":"10.1007\/s40615-025-02345-5","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T10:02:10Z","timestamp":1740996130000},"page":"1434-1451","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Structural Racism, Geographies of Opportunity, and Maternal Health Inequities: A Dynamic Conceptual Framework"],"prefix":"10.1007","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3728-4652","authenticated-orcid":false,"given":"Irene","family":"Headen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"key":"2345_CR1","doi-asserted-by":"publisher","first-page":"394","DOI":"10.3390\/children9030394","volume":"9","author":"RK Dagher","year":"2022","unstructured":"Dagher RK, Linares DE. A critical review on the complex interplay between social determinants of health and maternal and infant mortality. Children. 2022;9:394.","journal-title":"Children"},{"issue":"2","key":"2345_CR2","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/GRF.0000000000000349","volume":"61","author":"EA Howell","year":"2018","unstructured":"Howell EA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynaecol. 2018;61(2):387\u201399.","journal-title":"Clin Obstet Gynaecol"},{"key":"2345_CR3","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1001\/jama.2023.9043","volume":"330","author":"LG Fleszar","year":"2023","unstructured":"Fleszar LG, Bryant AS, Johnson CO, Blacker BF, Aravkin A, Baumann M, et al. Trends in state-level maternal mortality by racial and ethnic group in the United States. JAMA. 2023;330:52.","journal-title":"JAMA"},{"key":"2345_CR4","doi-asserted-by":"crossref","unstructured":"Hoyert DL. Health E-stat: maternal mortality rates in the United States, 2022 [Internet]. Hyattsville, MD: National Center for Health Statistics (U.S.); 2024. Available from: https:\/\/stacks.cdc.gov\/view\/cdc\/152992. Accessed 20 Dec 2024.","DOI":"10.15620\/cdc\/152992"},{"key":"2345_CR5","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1097\/AOG.0000000000004057","volume":"136","author":"CC Brown","year":"2020","unstructured":"Brown CC, Adams CE, George KE, Moore JE. Associations between comorbidities and severe maternal morbidity. Obstet Gynecol. 2020;136:892\u2013901.","journal-title":"Obstet Gynecol"},{"key":"2345_CR6","unstructured":"Declercq E, Zephyrin L. Severe maternal morbidity in the United States: a primer. 2021;28."},{"key":"2345_CR7","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1097\/AOG.0000000000003647","volume":"135","author":"KB Kozhimannil","year":"2020","unstructured":"Kozhimannil KB, Interrante JD, Tofte AN, Admon LK. Severe maternal morbidity and mortality among indigenous women in the United States. Obstet Gynecol. 2020;135:294\u2013300.","journal-title":"Obstet Gynecol"},{"key":"2345_CR8","doi-asserted-by":"publisher","first-page":"19297","DOI":"10.1038\/s41598-024-70130-1","volume":"14","author":"MD Claridy","year":"2024","unstructured":"Claridy MD, Hernandez-Green N, Rathbun SL, Cordero JF. Community level factors and racial inequities in delivery hospitalizations involving severe maternal morbidity in the United States, 2016\u20132019. Sci Rep. 2024;14:19297.","journal-title":"Sci Rep"},{"key":"2345_CR9","doi-asserted-by":"publisher","first-page":"e2317641","DOI":"10.1001\/jamanetworkopen.2023.17641","volume":"6","author":"DA Fink","year":"2023","unstructured":"Fink DA, Kilday D, Cao Z, Larson K, Smith A, Lipkin C, et al. Trends in maternal mortality and severe maternal morbidity during delivery-related hospitalizations in the United States, 2008 to 2021. JAMA Netw Open. 2023;6:e2317641.","journal-title":"JAMA Netw Open"},{"key":"2345_CR10","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1007\/s40615-020-00825-4","volume":"8","author":"S Noursi","year":"2021","unstructured":"Noursi S, Saluja B, Richey L. Using the ecological systems theory to understand Black\/White disparities in maternal morbidity and mortality in the United States. J Racial and Ethnic Health Disparities. 2021;8:661\u20139.","journal-title":"J Racial and Ethnic Health Disparities"},{"key":"2345_CR11","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1097\/AOG.0000000000003762","volume":"135","author":"E Wang","year":"2020","unstructured":"Wang E, Glazer KB, Howell EA, Janevic TM. Social determinants of pregnancy-related mortality and morbidity in the United States: a systematic review. Obstet Gynecol. 2020;135:896\u2013915.","journal-title":"Obstet Gynecol"},{"key":"2345_CR12","doi-asserted-by":"publisher","first-page":"B8","DOI":"10.1016\/j.ajog.2016.06.048","volume":"215","author":"JL Bailit","year":"2016","unstructured":"Bailit JL, Gregory KD, Srinivas S, Westover T, Grobman WA, Saade GR. Society for maternal-fetal medicine (SMFM) special report: current approaches to measuring quality of care in obstetrics. Am J Obstet Gynecol. 2016;215:B8-16.","journal-title":"Am J Obstet Gynecol"},{"key":"2345_CR13","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1089\/jwh.2020.8877","volume":"30","author":"MC Lu","year":"2021","unstructured":"Lu MC, Noursi S. Summary and conclusion: framing a new research agenda on maternal morbidities and mortality in the United States. J Women\u2019s Health. 2021;30:280\u20134.","journal-title":"J Women\u2019s Health"},{"key":"2345_CR14","unstructured":"Office of Disease Prevention and Health Promotion. Healthy People 2030: pregnancy and childbirth [Internet]. [cited 2024 Aug 26]. Available from: https:\/\/health.gov\/healthypeople\/objectives-and-data\/browse-objectives\/pregnancy-and-childbirth. Accessed 31 Aug 2023."},{"key":"2345_CR15","first-page":"393","volume":"14","author":"AD Aina","year":"2019","unstructured":"Aina AD, Asiodu IV, Castillo P, Denson J, Drayton C, Aka-James R, et al. Black maternal health research re-envisioned: best practices for the conduct of research with, for, and by Black mamas. Harv L & Pol\u2019y Rev. 2019;14:393.","journal-title":"Harv L & Pol\u2019y Rev"},{"key":"2345_CR16","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1111\/1468-0009.12390","volume":"97","author":"H Alderwick","year":"2019","unstructured":"Alderwick H, Gottlieb LM. Meanings and misunderstandings: a social determinants of health lexicon for health care systems. Milbank Q. 2019;97:407\u201319.","journal-title":"Milbank Q"},{"key":"2345_CR17","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1093\/aje\/kwab239","volume":"191","author":"PB Adkins-Jackson","year":"2022","unstructured":"Adkins-Jackson PB, Chantarat T, Bailey ZD, Ponce NA. Measuring structural racism: a guide for epidemiologists and other health researchers. Am J Epidemiol. 2022;191:539\u201347.","journal-title":"Am J Epidemiol"},{"key":"2345_CR18","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1089\/heq.2020.0081","volume":"5","author":"JG Alson","year":"2021","unstructured":"Alson JG, Robinson WR, Pittman L, Doll KM. Incorporating measures of structural racism into population studies of reproductive health in the United States: a narrative review. Health Equity. 2021;5:49\u201358.","journal-title":"Health Equity"},{"key":"2345_CR19","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1111\/1468-0009.12641","volume":"101","author":"TH Brown","year":"2023","unstructured":"Brown TH, Homan P. The future of social determinants of health: looking upstream to structural drivers. Milbank Q. 2023;101:36\u201360.","journal-title":"Milbank Q"},{"key":"2345_CR20","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1089\/jwh.2020.8882","volume":"30","author":"J Crear-Perry","year":"2021","unstructured":"Crear-Perry J, Correa-de-Araujo R, Lewis Johnson T, McLemore MR, Neilson E, Wallace M. Social and structural determinants of health inequities in maternal health. J Women\u2019s Health. 2021;30:230\u20135.","journal-title":"J Women\u2019s Health"},{"key":"2345_CR21","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.ajog.2022.05.033","volume":"227","author":"IE Headen","year":"2022","unstructured":"Headen IE, Elovitz MA, Battarbee AN, Lo JO, Debbink MP. Racism and perinatal health inequities research: where we have been and where we should go. Am J Obstet Gynecol. 2022;227:560\u201370.","journal-title":"Am J Obstet Gynecol"},{"key":"2345_CR22","unstructured":"powell JA. Structural racism: building upon the insights of John Calmore. North Carolina law review. 2008;86:791."},{"key":"2345_CR23","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1146\/annurev-soc-071811-145508","volume":"38","author":"B Reskin","year":"2012","unstructured":"Reskin B. The race discrimination system. Annu Rev Sociol. 2012;38:17\u201335.","journal-title":"Annu Rev Sociol"},{"key":"2345_CR24","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1177\/00221465231222924","volume":"65","author":"TH Brown","year":"2024","unstructured":"Brown TH, Homan P. Structural racism and health stratification: connecting theory to measurement. J Health Soc Behav. 2024;65:141\u201360.","journal-title":"J Health Soc Behav"},{"key":"2345_CR25","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1016\/j.healthplace.2010.07.002","volume":"16","author":"TL Osypuk","year":"2010","unstructured":"Osypuk TL, Acevedo-Garcia D. Beyond individual neighborhoods: a geography of opportunity perspective for understanding racial\/ethnic health disparities. Health Place. 2010;16:1113\u201323.","journal-title":"Health Place"},{"key":"2345_CR26","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1177\/2332649215626936","volume":"2","author":"AA Sewell","year":"2016","unstructured":"Sewell AA. The racism-race reification process: a mesolevel political economic framework for understanding racial health disparities. Sociol Race Ethnicity. 2016;2:402\u201332.","journal-title":"Sociol Race Ethnicity"},{"issue":"2","key":"2345_CR27","first-page":"13","volume":"11","author":"M Groos","year":"2018","unstructured":"Groos M, Wallace M, Hardeman R, Theall KP. Measuring inequity: a systematic review of methods used to quantify structural racism. J Health Dispar Res Pract. 2018;11(2):13.","journal-title":"J Health Dispar Res Pract"},{"key":"2345_CR28","doi-asserted-by":"publisher","first-page":"102923","DOI":"10.1016\/j.healthplace.2022.102923","volume":"78","author":"EM Hailu","year":"2022","unstructured":"Hailu EM, Maddali SR, Snowden JM, Carmichael SL, Mujahid MS. Structural racism and adverse maternal health outcomes: a systematic review. Health Place. 2022;78:102923.","journal-title":"Health Place"},{"key":"2345_CR29","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1007\/s40615-017-0378-5","volume":"5","author":"AR Riley","year":"2018","unstructured":"Riley AR. Neighborhood disadvantage, residential segregation, and beyond\u2014lessons for studying structural racism and health. J Racial and Ethnic Health Disparities. 2018;5:357\u201365.","journal-title":"J Racial and Ethnic Health Disparities"},{"key":"2345_CR30","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1093\/aje\/kwad129","volume":"192","author":"X Gao","year":"2023","unstructured":"Gao X, Berkowitz RL, Michaels EK, Mujahid MS. Traveling together: a road map for researching neighborhood effects on population health and health inequities. Am J Epidemiol. 2023;192:1731\u201342.","journal-title":"Am J Epidemiol"},{"key":"2345_CR31","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.2105\/AJPH.2011.300149","volume":"101","author":"AV Diez Roux","year":"2011","unstructured":"Diez Roux AV. Complex systems thinking and current impasses in health disparities research. Am J Public Health. 2011;101:1627\u201334.","journal-title":"Am J Public Health"},{"issue":"1","key":"2345_CR32","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1146\/annurev-publhealth-060220-042648","volume":"43","author":"AV Diez Roux","year":"2022","unstructured":"Diez Roux AV. Social epidemiology: past, present, and future. Annu Rev Public Health. 2022;43(1):79\u201398.","journal-title":"Annu Rev Public Health"},{"key":"2345_CR33","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.socscimed.2017.09.018","volume":"191","author":"R Mehra","year":"2017","unstructured":"Mehra R, Boyd LM, Ickovics JR. Racial residential segregation and adverse birth outcomes: a systematic review and meta-analysis. Soc Sci Med. 2017;191:237\u201350.","journal-title":"Soc Sci Med"},{"key":"2345_CR34","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.socscimed.2016.02.014","volume":"153","author":"CN Ncube","year":"2016","unstructured":"Ncube CN, Enquobahrie DA, Albert SM, Herrick AL, Burke JG. Association of neighborhood context with offspring risk of preterm birth and low birthweight: a systematic review and meta-analysis of population-based studies. Soc Sci Med. 2016;153:156\u201364.","journal-title":"Soc Sci Med"},{"key":"2345_CR35","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.annepidem.2021.09.005","volume":"64","author":"KK Stanhope","year":"2021","unstructured":"Stanhope KK, Adeyemi DI, Li T, Johnson T, Boulet SL. The relationship between the neighborhood built and social environment and hypertensive disorders of pregnancy: a scoping review. Ann Epidemiol. 2021;64:67\u201375.","journal-title":"Ann Epidemiol"},{"key":"2345_CR36","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1111\/aogs.12430","volume":"93","author":"AA Vos","year":"2014","unstructured":"Vos AA, Posthumus AG, Bonsel GJ, Steegers EAP, Denkta\u015f S. Deprived neighborhoods and adverse perinatal outcome: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2014;93:727\u201340.","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2345_CR37","doi-asserted-by":"publisher","first-page":"16592","DOI":"10.3390\/ijerph192416592","volume":"19","author":"V Simoncic","year":"2022","unstructured":"Simoncic V, Deguen S, Enaux C, Vandentorren S, Kihal-Talantikite W. A comprehensive review on social inequalities and pregnancy outcome\u2014identification of relevant pathways and mechanisms. IJERPH. 2022;19:16592.","journal-title":"IJERPH"},{"key":"2345_CR38","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1007\/s13669-022-00339-2","volume":"11","author":"B Butler","year":"2022","unstructured":"Butler B, Gripper A, Linos N. Built and social environments, environmental justice, and maternal pregnancy complications. Curr Obstet Gynecol Rep. 2022;11:169\u201379.","journal-title":"Curr Obstet Gynecol Rep"},{"key":"2345_CR39","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.healthplace.2018.05.007","volume":"52","author":"I Headen","year":"2018","unstructured":"Headen I, Mujahid M, Deardorff J, Rehkopf DH, Abrams B. Associations between cumulative neighborhood deprivation, long-term mobility trajectories, and gestational weight gain. Health Place. 2018;52:101\u20139.","journal-title":"Health Place"},{"key":"2345_CR40","doi-asserted-by":"publisher","first-page":"1673","DOI":"10.1007\/s10995-016-1966-4","volume":"20","author":"C Young","year":"2016","unstructured":"Young C, Laurent O, Chung JH, Wu J. Geographic distribution of healthy resources and adverse pregnancy outcomes. Matern Child Health J. 2016;20:1673\u20139.","journal-title":"Matern Child Health J"},{"key":"2345_CR41","doi-asserted-by":"publisher","first-page":"100192","DOI":"10.1016\/j.ssmmh.2023.100192","volume":"3","author":"ME McGovern","year":"2023","unstructured":"McGovern ME, Rokicki S, Von Jaglinsky A, Reichman NE. Neighborhood-level housing affordability and maternal depression. SSM - Mental Health. 2023;3:100192.","journal-title":"SSM - Mental Health"},{"key":"2345_CR42","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1002\/oby.22356","volume":"27","author":"I Headen","year":"2019","unstructured":"Headen I, Laraia B, Coleman-Phox K, Vieten C, Adler N, Epel E. Neighborhood typology and cardiometabolic pregnancy outcomes in the maternal adiposity metabolism and stress study. Obesity. 2019;27:166\u201373.","journal-title":"Obesity"},{"key":"2345_CR43","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1097\/AOG.0000000000004343","volume":"137","author":"JR Meeker","year":"2021","unstructured":"Meeker JR, Canel\u00f3n SP, Bai R, Levine LD, Boland MR. Individual-level and neighborhood-level risk factors for severe maternal morbidity. Obstet Gynecol. 2021;137:847\u201354.","journal-title":"Obstet Gynecol"},{"key":"2345_CR44","doi-asserted-by":"publisher","first-page":"100916","DOI":"10.1016\/j.ajogmf.2023.100916","volume":"5","author":"MS Mujahid","year":"2023","unstructured":"Mujahid MS, Wall-Wieler E, Hailu EM, Berkowitz RL, Gao X, Morris CM, et al. Neighborhood disinvestment and severe maternal morbidity in the state of California. Am J Obst Gynecol MFM. 2023;5:100916.","journal-title":"Am J Obst Gynecol MFM"},{"key":"2345_CR45","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/0309132515618104","volume":"41","author":"MC Lens","year":"2017","unstructured":"Lens MC. Measuring the geography of opportunity. Prog Hum Geogr. 2017;41:3\u201325.","journal-title":"Prog Hum Geogr"},{"key":"2345_CR46","doi-asserted-by":"publisher","first-page":"115622","DOI":"10.1016\/j.socscimed.2022.115622","volume":"317","author":"NK Jeffers","year":"2023","unstructured":"Jeffers NK, Berger BO, Marea CX, Gemmill A. Investigating the impact of structural racism on black birthing people - associations between racialized economic segregation, incarceration inequality, and severe maternal morbidity. Soc Sci Med. 2023;317:115622.","journal-title":"Soc Sci Med"},{"key":"2345_CR47","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1111\/1475-6773.13978","volume":"57","author":"TH Brown","year":"2022","unstructured":"Brown TH, Homan PA. Frontiers in measuring structural racism and its health effects. Health Serv Res. 2022;57:443\u20137.","journal-title":"Health Serv Res"},{"key":"2345_CR48","doi-asserted-by":"publisher","first-page":"103082","DOI":"10.1016\/j.healthplace.2023.103082","volume":"83","author":"N Siddika","year":"2023","unstructured":"Siddika N, Song S, Margerison CE, Kramer MR, Luo Z. The impact of place-based contextual social and environmental determinants on preterm birth: a systematic review of the empirical evidence. Health Place. 2023;83:103082.","journal-title":"Health Place"},{"key":"2345_CR49","doi-asserted-by":"publisher","first-page":"10110","DOI":"10.1080\/14767058.2022.2118045","volume":"35","author":"C Freeman","year":"2024","unstructured":"Freeman C, Stanhope KK, Wichmann H, Jamieson DJ, Boulet SL. Neighborhood deprivation and severe maternal morbidity in a medicaid-Insured population in Georgia. J Matern Fetal Neonatal Med. 2024;35:10110\u20135.","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2345_CR50","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1111\/ppe.12935","volume":"37","author":"X Gao","year":"2023","unstructured":"Gao X, Snowden JM, Tucker CM, Allen A, Morello-Frosch R, Abrams B, et al. Remapping racial and ethnic inequities in severe maternal morbidity: the legacy of redlining in California. Paediatric Perinatal Epid. 2023;37:379\u201389.","journal-title":"Paediatric Perinatal Epid"},{"key":"2345_CR51","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1007\/s10995-018-2596-9","volume":"23","author":"J Guglielminotti","year":"2019","unstructured":"Guglielminotti J, Landau R, Wong CA, Li G. Patient-, hospital-, and neighborhood-level factors associated with severe maternal morbidity during childbirth: a cross-sectional study in New York state 2013\u20132014. Matern Child Health J. 2019;23:82\u201391.","journal-title":"Matern Child Health J"},{"key":"2345_CR52","doi-asserted-by":"publisher","first-page":"e2237711","DOI":"10.1001\/jamanetworkopen.2022.37711","volume":"5","author":"P Hung","year":"2022","unstructured":"Hung P, Liu J, Norregaard C, Shih Y, Liang C, Zhang J, et al. Analysis of residential segregation and racial and ethnic disparities in severe maternal morbidity before and during the COVID-19 pandemic. JAMA Netw Open. 2022;5:e2237711.","journal-title":"JAMA Netw Open"},{"key":"2345_CR53","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1377\/hlthaff.2019.00735","volume":"39","author":"T Janevic","year":"2020","unstructured":"Janevic T, Zeitlin J, Egorova N, Hebert PL, Balbierz A, Howell EA. Neighborhood racial and economic polarization, hospital of delivery, and severe maternal morbidity: an examination of whether racial and economic neighborhood polarization is associated with severe maternal morbidity rates and whether the delivery hospital partially explains the association. Health Aff. 2020;39:768\u201376.","journal-title":"Health Aff"},{"key":"2345_CR54","doi-asserted-by":"publisher","first-page":"1179562X1985477","DOI":"10.1177\/1179562X19854778","volume":"12","author":"SY Liu","year":"2019","unstructured":"Liu SY, Fiorentini C, Bailey Z, Huynh M, McVeigh K, Kaplan D. Structural racism and severe maternal morbidity in New York state. Clin Med Insights Womens Health. 2019;12:1179562X19854778.","journal-title":"Clin Med Insights Womens Health"},{"key":"2345_CR55","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1093\/jurban\/jtg064","volume":"80","author":"ME Northridge","year":"2003","unstructured":"Northridge ME. Sorting out the connections between the built environment and health: a conceptual framework for navigating pathways and planning healthy cities. J Urban Health: Bull New York Acad Med. 2003;80:556\u201368.","journal-title":"J Urban Health: Bull New York Acad Med"},{"key":"2345_CR56","doi-asserted-by":"crossref","unstructured":"Sewell AA. Opening the Black Box of Segregation. In: Brown A, Smith V, editors. Race and real estate [Internet]. Oxford University Press; 2015 [cited 2023 Jun 15]. p. 87\u2013105. Available from: https:\/\/academic.oup.com\/book\/10403\/chapter\/158219063. Accessed 28 Jan 2023.","DOI":"10.1093\/acprof:oso\/9780199977260.003.0006"},{"key":"2345_CR57","unstructured":"Weissbourd R, Bodini R, He M. Dynamic neighborhoods: new tools for community and economic development. Living Cities: The National Development Initiative. Chicago, IL: RW Ventures; 2009."},{"key":"2345_CR58","doi-asserted-by":"publisher","unstructured":"Hovmand P. Community based system dynamics. Springer New York; 2014.\u00a0https:\/\/doi.org\/10.1007\/978-1-4614-8763-0.","DOI":"10.1007\/978-1-4614-8763-0"},{"key":"2345_CR59","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1086\/507856","volume":"112","author":"EE Bruch","year":"2006","unstructured":"Bruch EE, Mare RD. Neighborhood choice and neighborhood change. Am J Sociol. 2006;112:667\u2013709.","journal-title":"Am J Sociol"},{"key":"2345_CR60","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s11213-016-9382-7","volume":"29","author":"A Kidwai","year":"2016","unstructured":"Kidwai A, Saraph A. Use of archetypal structures in urban dynamics. Syst Pract Action Res. 2016;29:583\u201395.","journal-title":"Syst Pract Action Res"},{"key":"2345_CR61","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.socscimed.2014.09.026","volume":"120","author":"T Janevic","year":"2014","unstructured":"Janevic T, Borrell LN, Savitz DA, Echeverria SE, Rundle A. Ethnic enclaves and gestational diabetes among immigrant women in New York City. Soc Sci Med. 2014;120:180\u20139.","journal-title":"Soc Sci Med"},{"key":"2345_CR62","doi-asserted-by":"publisher","first-page":"151658","DOI":"10.1016\/j.semperi.2022.151658","volume":"46","author":"D Montoya-Williams","year":"2022","unstructured":"Montoya-Williams D, Barreto A, Fuentes-Afflick E, Collins JW. Nativity and perinatal outcome disparities in the United States: beyond the immigrant paradox. Semin Perinatol. 2022;46:151658.","journal-title":"Semin Perinatol"},{"key":"2345_CR63","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.socscimed.2009.10.034","volume":"70","author":"TL Osypuk","year":"2010","unstructured":"Osypuk TL, Bates LM, Acevedo-Garcia D. Another Mexican birthweight paradox? The role of residential enclaves and neighborhood poverty in the birthweight of Mexican-origin infants. Soc Sci Med. 2010;70:550\u201360.","journal-title":"Soc Sci Med"},{"key":"2345_CR64","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1007\/s40615-019-00650-4","volume":"7","author":"AD Williams","year":"2020","unstructured":"Williams AD, Messer LC, Kanner J, Ha S, Grantz KL, Mendola P. Ethnic enclaves and pregnancy and behavior outcomes among Asian\/Pacific Islanders in the USA. J Racial and Ethnic Health Disparities. 2020;7:224\u201333.","journal-title":"J Racial and Ethnic Health Disparities"},{"key":"2345_CR65","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1742-7622-9-1","volume":"9","author":"M Joffe","year":"2012","unstructured":"Joffe M, Gambhir M, Chadeau-Hyam M, Vineis P. Causal diagrams in systems epidemiology. Emerg Themes Epidemiol. 2012;9:1.","journal-title":"Emerg Themes Epidemiol"},{"key":"2345_CR66","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.whi.2021.11.006","volume":"32","author":"SL Carmichael","year":"2022","unstructured":"Carmichael SL, Abrams B, El Ayadi A, Lee HC, Liu C, Lyell DJ, et al. Ways forward in preventing severe maternal morbidity and maternal health inequities: conceptual frameworks, definitions, and data, from a population health perspective. Women\u2019s Health Issues. 2022;32:213\u20138.","journal-title":"Women\u2019s Health Issues"},{"key":"2345_CR67","doi-asserted-by":"publisher","first-page":"101225","DOI":"10.1016\/j.ssmph.2022.101225","volume":"19","author":"AL Sonderlund","year":"2022","unstructured":"Sonderlund AL, Charifson M, Ortiz R, Khan M, Schoenthaler A, Williams NJ. A comprehensive framework for operationalizing structural racism in health research: The association between mass incarceration of Black people in the US and adverse birth outcomes. SSM-Popul Health. 2022;19:101225.","journal-title":"SSM-Popul Health"},{"key":"2345_CR68","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1007\/s10995-020-03074-3","volume":"25","author":"BD Chambers","year":"2021","unstructured":"Chambers BD, Arega HA, Arabia SE, Taylor B, Barron RG, Gates B, et al. Black women\u2019s perspectives on structural racism across the reproductive lifespan: a conceptual framework for measurement development. Matern Child Health J. 2021;25:402\u201313.","journal-title":"Matern Child Health J"},{"key":"2345_CR69","doi-asserted-by":"publisher","first-page":"S22","DOI":"10.1016\/j.ajog.2005.01.071","volume":"192","author":"JF Culhane","year":"2005","unstructured":"Culhane JF, Elo IT. Neighborhood context and reproductive health. Am J Obstet Gynecol. 2005;192:S22\u20139.","journal-title":"Am J Obstet Gynecol"},{"key":"2345_CR70","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s10995-010-0712-6","volume":"16","author":"EM Davis","year":"2012","unstructured":"Davis EM, Stange KC, Horwitz RI. Childbearing, stress and obesity disparities in women: a public health perspective. Matern Child Health J. 2012;16:109\u201318.","journal-title":"Matern Child Health J"},{"key":"2345_CR71","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1353\/dem.2008.0012","volume":"45","author":"RJ Sampson","year":"2008","unstructured":"Sampson RJ, Sharkey P. Neighborhood selection and the social reproduction of concentrated racial inequality. Demography. 2008;45:1\u201329.","journal-title":"Demography"},{"key":"2345_CR72","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1111\/1468-0009.00019","volume":"80","author":"N Halfon","year":"2002","unstructured":"Halfon N, Hochstein M. Life course health development: an integrated framework for developing health, policy, and research. Milbank Q. 2002;80:433\u201379.","journal-title":"Milbank Q"},{"key":"2345_CR73","first-page":"207","volume":"3","author":"AT Geronimus","year":"1992","unstructured":"Geronimus AT. The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethn Dis. 1992;3:207\u201321.","journal-title":"Ethn Dis"},{"key":"2345_CR74","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1037\/0033-2909.131.5.662","volume":"131","author":"CL Giscomb\u00e9","year":"2005","unstructured":"Giscomb\u00e9 CL, Lobel M. Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy. Psychol Bull. 2005;131:662\u201383.","journal-title":"Psychol Bull"},{"key":"2345_CR75","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ogc.2016.10.002","volume":"44","author":"EA Howell","year":"2017","unstructured":"Howell EA, Zeitlin J. Quality of care and disparities in obstetrics. Obstet Gynecol Clin North Am. 2017;44:13\u201325.","journal-title":"Obstet Gynecol Clin North Am"},{"key":"2345_CR76","doi-asserted-by":"crossref","unstructured":"Filippi V, Chou D, Barreix M, Say L, the WHO Maternal Morbidity Working Group (MMWG). A new conceptual framework for maternal morbidity. Int J Gynecol Obstet. 2018; 141:4\u20139.","DOI":"10.1002\/ijgo.12463"},{"key":"2345_CR77","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1089\/jwh.2015.5637","volume":"25","author":"C Prather","year":"2016","unstructured":"Prather C, Fuller TR, Marshall KJ, Jeffries WL. The impact of racism on the sexual and reproductive health of African American women. J Women\u2019s Health. 2016;25:664\u201371.","journal-title":"J Women\u2019s Health"},{"key":"2345_CR78","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1177\/1073110520958875","volume":"48","author":"JK Taylor","year":"2020","unstructured":"Taylor JK. Structural racism and maternal health among Black women. J Law Med Ethics. 2020;48:506\u201317.","journal-title":"J Law Med Ethics"},{"key":"2345_CR79","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1089\/jwh.2020.8874","volume":"30","author":"B Saluja","year":"2021","unstructured":"Saluja B, Bryant Z. How implicit bias contributes to racial disparities in maternal morbidity and mortality in the United States. J Women\u2019s Health. 2021;30:270\u20133.","journal-title":"J Women\u2019s Health"},{"key":"2345_CR80","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1053\/j.semperi.2017.07.005","volume":"41","author":"KB Kozhimannil","year":"2017","unstructured":"Kozhimannil KB, Hardeman RR, Henning-Smith C. Maternity care access, quality, and outcomes: a systems-level perspective on research, clinical, and policy needs. Semin Perinatol. 2017;41:367\u201374.","journal-title":"Semin Perinatol"},{"key":"2345_CR81","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1177\/1073110520958876","volume":"48","author":"R Yearby","year":"2020","unstructured":"Yearby R. Structural racism and health disparities: reconfiguring the social determinants of health framework to include the root cause. J Law Med Ethics. 2020;48:518\u201326.","journal-title":"J Law Med Ethics"},{"issue":"4","key":"2345_CR82","first-page":"34","volume":"37","author":"SB Verbiest","year":"2017","unstructured":"Verbiest SB, Tully KP, Stuebe AM. Promoting maternal and infant health in the 4th Trimester. Zero to Three. 2017;37(4):34\u201344.","journal-title":"Zero to Three"},{"key":"2345_CR83","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1186\/s12889-023-16097-6","volume":"23","author":"JC Mah","year":"2023","unstructured":"Mah JC, Penwarden JL, Pott H, Theou O, Andrew MK. Social vulnerability indices: a scoping review. BMC Publ Health. 2023;23:1253.","journal-title":"BMC Publ Health"},{"key":"2345_CR84","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1177\/03091325221139980","volume":"47","author":"J Bernard","year":"2023","unstructured":"Bernard J, Steinf\u00fchrer A, Kl\u00e4rner A, Keim-Kl\u00e4rner S. Regional opportunity structures: a research agenda to link spatial and social inequalities in rural areas. Prog Hum Geogr. 2023;47:103\u201323.","journal-title":"Prog Hum Geogr"},{"key":"2345_CR85","first-page":"757","volume":"50","author":"N Brazil","year":"2023","unstructured":"Brazil N, Wagner J, Ramil R. Measuring and mapping neighborhood opportunity: a comparison of opportunity indices in California. Environ Planning B: Urban Anal City Sci. 2023;50:757\u201375.","journal-title":"Environ Planning B: Urban Anal City Sci"},{"key":"2345_CR86","doi-asserted-by":"publisher","first-page":"505","DOI":"10.2105\/AJPH.2005.066043","volume":"96","author":"JD Sterman","year":"2006","unstructured":"Sterman JD. Learning from evidence in a complex world. Am J Public Health. 2006;96:505\u201314.","journal-title":"Am J Public Health"},{"key":"2345_CR87","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1007\/s10995-022-03376-8","volume":"26","author":"I Guynn","year":"2022","unstructured":"Guynn I, Simon J, Anderson S, Klaman SL, Mullenix A, Cilenti D, et al. Tools for supporting the MCH workforce in addressing complex challenges: a scoping review of system dynamics modeling in maternal and child health. Matern Child Health J. 2022;26:176\u2013203.","journal-title":"Matern Child Health J"},{"key":"2345_CR88","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1007\/s10995-014-1586-9","volume":"18","author":"CD Kroelinger","year":"2014","unstructured":"Kroelinger CD, Rankin KM, Chambers DA, Diez Roux AV, Hughes K, Grigorescu V. Using the principles of complex systems thinking and implementation science to enhance maternal and child health program planning and delivery. Matern Child Health J. 2014;18:1560\u20134.","journal-title":"Matern Child Health J"},{"key":"2345_CR89","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1057\/jos.2014.16","volume":"9","author":"J Brittin","year":"2015","unstructured":"Brittin J, Araz OM, Nam Y, Huang T-K. A system dynamics model to simulate sustainable interventions on chronic disease outcomes in an urban community. J Simul. 2015;9:140\u201355.","journal-title":"J Simul"},{"key":"2345_CR90","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1002\/ajcp.12636","volume":"71","author":"MK Lemke","year":"2023","unstructured":"Lemke MK, Brown KK, Fallah-Fini S, Hall A, Obasanya M. Complex systems and participatory approaches to address maternal health disparities: findings from a system dynamics group model building project in North Texas. Am J of Comm Psychol. 2023;71:303\u201316.","journal-title":"Am J of Comm Psychol"},{"key":"2345_CR91","first-page":"3","volume":"9","author":"L Fraade-Blanar","year":"2022","unstructured":"Fraade-Blanar L, Koo T, Whaley CM. Going to the doctor: rideshare as nonemergency medical transportation. Rand Health Q. 2022;9:3.","journal-title":"Rand Health Q"},{"key":"2345_CR92","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1136\/jech.2005.036913","volume":"59","author":"Y Paradies","year":"2005","unstructured":"Paradies Y. Conceptual diagrams in public health research. J Epidemiol Community Health. 2005;59:1012\u20133.","journal-title":"J Epidemiol Community Health"},{"key":"2345_CR93","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1177\/1524839919890869","volume":"21","author":"SS Brady","year":"2020","unstructured":"Brady SS, Brubaker L, Fok CS, Gahagan S, Lewis CE, Lewis J, et al. Development of conceptual models to guide public health research, practice, and policy: synthesizing traditional and contemporary paradigms. Health Promot Pract. 2020;21:510\u201324.","journal-title":"Health Promot Pract"},{"key":"2345_CR94","doi-asserted-by":"publisher","first-page":"S128","DOI":"10.2105\/AJPH.2018.304874","volume":"109","author":"K Guastaferro","year":"2019","unstructured":"Guastaferro K, Collins LM. Achieving the goals of translational science in public health intervention research: the multiphase optimization strategy (MOST). Am J Public Health. 2019;109:S128\u20139.","journal-title":"Am J Public Health"}],"container-title":["Journal of Racial and Ethnic Health Disparities"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40615-025-02345-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40615-025-02345-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40615-025-02345-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T16:02:00Z","timestamp":1772812920000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40615-025-02345-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,3]]},"references-count":94,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["2345"],"URL":"https:\/\/doi.org\/10.1007\/s40615-025-02345-5","relation":{},"ISSN":["2197-3792","2196-8837"],"issn-type":[{"value":"2197-3792","type":"print"},{"value":"2196-8837","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,3]]},"assertion":[{"value":"8 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 December 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 February 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The author declares no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}}]}}