Sociopolitical stress and Muslim immigrant health: County-level analyses of birth outcomes in the Trump era

• In Event: Immigrant Health - Changing Contexts, Heterogeneity, Resilience, and Selectivity

Abstract

Sociopolitical stress can stem from exclusionary immigration policies, encroachment on religious freedoms, authoritarianism, and/or legalized structural racism. Immigrant women who are not protected by the political status quo tend to experience worsened birth outcomes in periods of heightened sociopolitical stress. The 2016 U.S. Presidential election and ensuing Trump presidency was a period of intense anti-immigrant and prejudicial rhetoric. Anti-Muslim racism was a central theme in the election cycle, including the promise and passage of Execute Order 13769 (the Muslim Ban). Public discourse, laws, and policy at the national level can contribute to heightened maternal stress and impact health across the life course, though the local contexts of individual lives may exacerbate or mitigate national-level structural effects on health. At the same time, the effects of residing in hostile local sociopolitical contexts on birth outcomes among Muslim immigrant mothers are not well known. In this paper, I draw on an innovative methodological approach to identify likely Muslim immigrants in population-level birth certificate data from the National Center for Health Statistics. I operationalize a unique form of sociopolitical stress – residing in a county that pivoted from voting Democratic in the 2012 elections to voting for a divisive and prejudiced Republican candidate in 2016. I examine the potential health consequences of this local climate through the prevalence of low birthweight births and preterm births before (2013-2016) and after (2017-2019) the 2016 U.S. Presidential election among Muslim immigrant mothers residing in Pivot Counties (2012: Democrat; 2016: Republican) compared to Non-Pivot Counties (2012: Democrat; 2016: Republican). I use race-stratified multilevel linear models and a difference-in-differences analysis to examine changes in adverse birth outcomes among Muslim immigrant mothers living in pivot counties by ethnoracial categorization (White/MENA, South Asian, Black) before and after the 2016 U.S. Presidential election versus changes in birth outcomes for Muslim immigrant mothers residing in reliably Democratic non-pivot counties. MENA and South Asian Muslim immigrant women living in pivot counties are at increased risk for PTB after the Trump election compared to their counterparts in reliably Democrat counties. The rate of PTB increased most severely for South Asian Muslim immigrant mothers. Implications are discussed.

Author

• Nafeesa Andrabi, University of Michigan-Ann Arbor