Birthplace, perinatal loss, and the parity-post-reproductive mortality relationship: Evidence from the Jim Crow-era American South.

Early studies of the parity-mortality relationship expected high parity to elevate mortality risk, but studies increasingly find that childless and high-parity women have higher post-reproductive mortality risk than moderate-parity women (U-shaped pattern). We investigate race-related differences in completed parity and parity-mortality associations, including attention to childlessness. We use a non-Hispanic Black and White sample of U.S. women born between 1920 and 1941 drawn from the REasons for Geographic And Racial Differences in Stroke (REGARDS, 2003-2007) dataset (N = 6542). Black women born in this period, compared to White women, reached higher parity (5+ children) and were more likely childless due, respectively, to greater exposure to southern Jim Crow-era agricultural arrangements (sharecropping) and poorer health. Identification of women's birthplaces in REGARDS allows us to link county-level measures from U.S. Plantation Censuses to women's records. We use count regressions to model completed parity and shared-frailty proportional hazards regressions to model all-cause mortality. We find Black but not White women's high-parity status associated with contextual exposure to plantation agricultural arrangements, and Black but not White women's childlessness primarily associated with perinatal child loss(es). We also find U-shaped parity-post-reproductive mortality patterns among all women, but especially among high-parity Black women born in plantation-holding counties. In the historical context of our study, women's childbearing careers and subsequent mortality risk reflected complex reproductive health histories (especially among the childless) and fertility control practices, which, in turn, reflected differential exposure to geographic, social, and political-economic contexts.