Inequities And Disparities In Reproductive Health Reproductive Epidemiology PDF Download

In this dissertation, I use reproduction as a site of inquiry to investigate forms of inequality in the United States, including inequalities in gender, race, and class. Across the three independent but interrelated studies, I investigate how discourse, context, and norms structure the experience of reproduction by focusing on the ways that relations of power-whether discursive or institutional-constrain or expand the conditions for reproductive justice over time and space. In the first study, I conduct an analysis of transcripts of congressional hearings on welfare reform. I investigate how policymakers co-constitute pregnancy and welfare as "problems" related to social degradation and child harm, where proposed solutions are alternatively preventative or punitive. I describe how construction of this problem is gendered and racialized. The language of cultural racism is invoked to describe young, single, mothers as responsible for a decline in morality and young fathers as lacking accountability. The results demonstrate specific rhetorical strategies that actors in the policymaking process of reforming welfare relied on to construct welfare pregnancies as "problems" against a normative construction of a White, middle-class, heterosexual, consumption-based family unit. In the second study, I use restricted birth data from the National Vital Statistics System and meteorologic data from the National Oceanic and Atmospheric Administration to examine how racial and socioeconomic variation in exposure to climate change contribute to inequities in birth outcomes-markers of early-life health that appear consequential for health and wellbeing into adulthood. Using econometric tools, I find that exposure to extreme relative heat in the first trimester worsens most birth outcomes for most race-SES-exposure groups, while exposure to relative heat in the third trimester has some beneficial and equalizing effects on birth outcomes. In the third study, I use data from in-depth interviews conducted during the COVID-19 pandemic lockdown, defined as March to October 2020, to examine social schemas participants used to understand and interpret their partnership and childbearing experiences and desires. In the context of the pandemic lockdown, a profound event that shaped much about peoples' everyday realities, respondents drew heavily on existing narratives that reinforced heterosexual, social, and medicalized hierarchies to make sense of reproductive experiences. In this way, respondents aligned reproduction with behavioral and socialization frameworks that counter the "planful" paradigm of reproductive decision-making widely used in demographic scholarship.