Abstract
BACKGROUND: Most studies capturing the health effects of police violence focus on directly impacted individuals, but a burgeoning field of study is capturing the indirect, community-level health effects of policing. Few empirical studies have examined neighbourhood-level policing, a contextual and racialised gendered stressor, in relation to preterm birth risk among Black and other racially minoritised people. METHODS: We spatially linked individual birth records (2017-2019) in Seattle, Washington (n=25 909) with geocoded data on police stops for three exposure windows: year before pregnancy, first and second trimester. We fit race-stratified multilevel modified Poisson regression models predicting preterm birth (<37 gestational weeks) across tertiles of neighbourhood stop rates controlling for individual and neighbourhood-level covariates. For the second trimester exposure window, birth was operationalised as a time-to-event outcome using multilevel Cox proportional hazard models. RESULTS: Neighbourhood stop rates of Black residents was higher compared with White residents, and Black and Asian pregnant people were exposed to the highest median neighbourhood-level stop rates. Black birthing people living in neighbourhoods with more frequent police stops had increased risk of preterm birth across all exposure windows including the year before pregnancy (adjusted risk ratio (aRR): 1.38, 95% CI 1.02 to 1.85), first trimester (aRR:1.74, 95% CI 1.17 to 2.57) and second trimester (aHR: 1.66, 95% CI 1.14 to 2.42). We found null or inverse associations among Asian, Hispanic and White people. CONCLUSION: Our study adds to the growing evidence documenting associations of higher risk of preterm birth with neighbourhood police stops among Black birthing people. These findings suggest that routine police practices are one aspect of structural racism contributing to racialised perinatal health inequities.