Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 16;25(1):577.
doi: 10.1186/s12884-025-07693-y.

The impact of social determinants of health on infant and maternal health using a reproductive justice lens

Kathryn J Malin  1 , Ashelee J Vance  2 , Stephanie E Moser  3 , Jessica Zemlak  4 , Cherise Edwards  4 , Rosemary White-Traut  5 , Rebecca Koerner  6 , Jacqueline McGrath  7 , Kelly McGlothen-Bell  7
Affiliations

The impact of social determinants of health on infant and maternal health using a reproductive justice lens

Kathryn J Malin et al. BMC Pregnancy Childbirth. .

Abstract

Background: Rates of preterm birth, low birth weight, and Neonatal Intensive Care Unit (NICU) admissions continue to rise in the United States (US). Social determinants of health (SDOH) are recognized as significant contributors to infant and maternal health, underscoring the need for use of research frameworks that incorporate SDOH concepts. The Restoring Our Own Through Transformation (ROOTT) theoretical framework is rooted in reproductive justice (i.e. reproductive rights and social justice-based framework) and emphasizes both structural and social determinants as root causes of health inequities. The impact of SDOH on maternal and infant mortality and morbidity can often be traced to structural determinants unique to the US, including slavery, Jim Crow laws, redlining, and the GI Bill.

Aims: Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 8 database, we aimed to evaluate relationships between SDOH (as guided by the ROOTT Framework) and maternal and infant health outcomes.

Methods: Data were analyzed from 11 states that included the SDOH supplement in their PRAMS 8 data collection. We used bivariate analyses to examine relationships between SDOH measures guided by the ROOTT framework (e.g. abuse during pregnancy, access to prenatal care, housing stability and education) and maternal morbidity (i.e., gestational hypertension and gestational diabetes) and infant outcomes (i.e., preterm birth, NICU admission, breastfeeding). Pre-identified covariates were controlled for in the logistic and linear regression models.

Results: Preterm birth, NICU admission, breastfeeding, and maternal morbidities were significantly associated with SDOH measures linked to structural determinants in the US. Abuse during pregnancy, access to prenatal care, housing, and education were all significantly associated with poorer infant health outcomes in the final regression models. Women who received prenatal care beginning in the 3rd trimester were twice as likely to develop gestational hypertension.

Conclusions: SDOHs rooted in structural determinants are important predictors of poorer maternal and infant health outcomes. Evaluating health outcomes using a reproductive justice framework reveals modifiable risk factors, including access to stable healthcare, safety, and housing. Comprehensive healthcare provision must ensure early and consistent access to healthcare and resources for safety and housing stability to support maternal and infant health.

Keywords: Access; Maternal health; PRAMS; Perinatal health; Pregnancy; Social determinants of health; Structural determinants of health.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study received an exemption from the Marquette University Institutional Review Board. Approval for use of the PRAMS Automated Research File Portal and data from the CDC was received in March 2024. The general PRAMS methodology and protocol have been reviewed and approved by the Centers for Disease Control and Prevention’s institutional review board and informed consent documents are included within each survey packet explaining the participant’s rights. No written consent is required, and consent is implied if the survey is completed [13]. Consent for publication: The Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System team has been notified of intention to publish these results, our team has not received a response. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The modified Web of Causation as Guided by the ROOTT framework with associated PRAMS variables (in italics) that were operationalized to measure the social determinants of health
Fig. 2
Fig. 2
The results of the final trimmed model, displaying relationships between infant and maternal health outcomes and social determinants of health
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129(Suppl 2):19–31. 10.1177/00333549141291S206. - PMC - PubMed
    1. McKee K, Admon LK, Winkelman TNA, Muzik M, Hall S, Dalton VK, et al. Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006–2015. BMC Womens Health. 2020;20(1):150. 10.1186/s12905-020-00996-6. - PMC - PubMed
    1. Roach JM. ROOTT’s theoretical framework of the web of causation between structural and social determinants of health and wellness-2016. Restoring Our Own Through Transformation; 2016. Available from: https://www.roottrj.org/web-causation. Cited 2025 Feb 17.
    1. Chen Y, Shiels MS, Uribe-Leitz T, Molina RL, Lawrence WR, Freedman ND, et al. Pregnancy-related deaths in the US, 2018–2022. JAMA Netw Open. 2025;8(4):e254325. 10.1001/jamanetworkopen.2025.4325. - PMC - PubMed
    1. Daw JR, Winkelman TNA, Dalton VK, Kozhimannil KB, Admon LK. Medicaid expansion improved perinatal insurance continuity for low-income women. Health Aff (Millwood). 2020;39(9):1531–9. 10.1377/hlthaff.2019.01835. - PubMed

LinkOut - more resources