Structural Racism, Geographies of Opportunity, and Maternal Health Inequities: A Dynamic Conceptual Framework.

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' 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's 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.