Low birthweight is a pernicious public health problem that has seen little to no improvement in the United States for over 50 years. Being born low birth weight carries an increased risk of a broad range of adverse health and development outcomes and has been identified as a likely mechanism through which health and socioeconomic inequality is reproduced across generations. Racial disparities in birth weight are particularly stark. However, despite considerable attention to the issue, existing research fails to fully explain the social, institutional, and historical processes that operate to uphold racialized inequality in adverse birth outcomes. In light of recent declines in average birth weight and increases in pre-term births over recent decades, this puzzle is of particular importance to the public health and medical community, as well as to the racially minoritized populations affected by these shifts. The current dissertation approaches the problem from three different angles to better understand how racialized patterns in birth weight inequality are shaped via 1) vast shifts in the timing and level of participation in the institutions of marriage and education over time and the associated implications for racialized age patterns of low birth weight risk; 2) rapid increases in the use of obstetric interventions that have had widespread implications for the distribution of births by gestational age; and 3) the dilution of Black voting power via racialized disenfranchisement. Using standard regression techniques, classic demographic life table methods, and decomposition techniques, this dissertation finds that racialized disparities in educational attainment, exposure to obstetric intervention, and political exclusion all operate to exacerbate and/or maintain long-standing disparities in birth weight risk for racially minoritized populations. Implications of this work for future research and policy call for increased attention to the institutional and historical processes that produce racialized patterns of risk for adverse birth outcomes in Black communities.