1041 State-level reproductive legislative climate and maternal, fetal, and infant mortality

Abstract

As maternal mortality rises and the reproductive health policy landscape shifts, we examine the relationship between abortion legislation and population health, hypothesizing that state laws restricting abortion are associated with higher maternal and infant mortality. Retrospective cohort study examining the association between state-level abortion legislation and maternal, fetal, infant, and all-cause female reproductive-age mortality from 2000-2018. Mortality rates were calculated from CDC WONDER vital statistics. Maternal deaths were defined as females with an obstetric-related cause of death based on ICD-10 codes. States were grouped by legislative climate (supportive, middle-ground, or restrictive of abortion as identified by Guttmacher Institute). Mortality rates were compared using GEE models, adjusting for year and proportion of population in poor health to account for health differences among states. Comparing middle-ground to supportive states, or restrictive to supportive states, there were no differences in maternal, all-cause or infant mortality (Table 1). Fetal mortality was lower in restrictive than supportive states (0.792 deaths per 1000 live births and fetal deaths, 95% CI 0.04-1.54). For each additional restrictive abortion law, there is an associated increase in maternal mortality of 2.048 deaths per 100000 live births (95% CI 0.44-3.65) (Table 2). Laws requiring in-person counseling (6.038 deaths per 100000 live births, 95% CI 0.13-11.95) and laws limiting insurance coverage (5.912 deaths per 100000 live births, 95% CI 1.14-10.69) were associated with increased maternal mortality. Laws requiring parental involvement of minors were associated with decreased maternal mortality (-3.584 deaths per 100000 live births, 95% CI -6.3,-0.86). While there were no differences in maternal or infant mortality by legislative environment, each additional state law restricting abortion was associated with an increase in maternal mortality. Our data inform advocacy efforts regarding which types of reproductive legislation may influence population health.View Large Image Figure ViewerDownload Hi-res image Download (PPT)