Reproductive health outcomes are indicators of larger social processes and researchers have long documented inequalities in these outcomes among Blacks and Whites in the United States. However, we do not fully understand the underlying mechanisms responsible for these inequalities. We believe that this is partially due to the treatment of the Black population as a monolith, which masks underlying variation in health risks and outcomes. By examining the variation that exists beneath the average, we can begin to develop a better understanding of the potential sources of health inequalities between Blacks and other racialized populations. We provide an application of this perspective through a geographic examination of reproductive health outcomes within the Black population. Using national birth records data from 2013 to 2016, we examine differences in low birth weight, preterm birth, gestational hypertension, and gestational diabetes by nativity (i.e., US- or foreign-born), region of origin (e.g., Sub-Saharan Africa, the Caribbean), and current US division of residence (e.g., Middle Atlantic, South Atlantic) within the Black population. While foreign-born Blacks are at a lower risk for low birth weight, preterm birth, and gestational hypertension, they are at an elevated risk for gestational diabetes compared to US-born Blacks. Moreover, we find substantial variation in this general pattern across region of origin and division of residence in the US. These findings demonstrate the potential role of migration, context, and selectivity in the health of foreign-born Blacks and demonstrate that national averages mask geographic variation, limiting our understanding of the contributions of these and other social processes to the health of racialized groups in the US.

生殖健康结局是更大的社会进程的指标，研究人员长期以来在美国黑人和白人中记录了这些结局的不平等现象。但是，我们不完全理解造成这些不平等的潜在机制。我们认为，这部分是由于将黑人人口当作一个整体对待，掩盖了健康风险和结果的潜在差异。通过研究低于平均值的差异，我们可以开始更好地理解黑人与其他种族人口之间健康不平等的潜在根源。我们通过对黑人人口中生殖健康结局的地理检查来提供这种观点的应用。使用2013年至2016年的国家出生记录数据，我们通过出生率（即美国出生或外国出生），起源地区（例如撒哈拉以南非洲，加勒比海地区）和美国目前的出生地划分，检查了低出生体重，早产，妊娠高血压和妊娠糖尿病的差异黑人人口中的居住地（例如，中大西洋，南大西洋）。虽然外国出生的黑人患低出生体重，早产和妊娠高血压的风险较低，但与美国出生的黑人相比，她们患妊娠糖尿病的风险较高。此外，我们发现这种一般模式在美国原籍和居住地区之间存在很大差异。这些发现证明了迁移，环境和选择性在外国出生的黑人健康中的潜在作用，并证明了全国平均值掩盖了地理差异，