Association between state mandate of contraceptive insurance coverage and infant mortality in the United States, 2001

Abstract

Purpose Previous research has demonstrated that more liberal abortion policies are associated with fewer unintended births and lower neonatal mortality rates. Studies also report a link between unintended pregnancies and adverse birth outcomes such as low birth weight, a strong predictor of infant mortality. This study seeks to examine the effect of state legislative policies mandating health insurance coverage for contraceptives and its association with infant mortality. Methods National Center for Health Statistics data of 2001 neonatal mortality rates (NMR), infant mortality rates (IMR), and percent births of low birth weight (LBW) were compiled for U.S. states. State policies mandating insurance coverage for contraceptives were ranked as “none, limited, or comprehensive” by the Kaiser Family Foundation. Analyses regressed “any-coverage-mandate” with infant health indicators, adjusting for potential confounders. Stratification for race adjusted for race-respective covariates. Results In 2001, 26 states possessed a mandate for contraceptive coverage. In crude analyses, any-coverage-mandate was associated with overall lower NMR (β = −0.63, P = 0.04) and lower IMR (β = −1.25, P = 0.003). In multivariate analyses, though negative regression coefficients for LBW and NMR were not significant, marginally lower IMR (β = −0.73, P = 0.06) was found among states with any-coverage-mandates. When stratified by race, no associations were found among whites between coverage-mandate and LBW, NMR, and IMR. Among blacks, however, coverage-mandate was significantly associated with lower LBW percentage (β = −0.78, P = 0.04), lower NMR (β = −2.78, P = 0.01), and lower IMR (β = −3.76, P = 0.02). Conclusion State policies mandating contraceptive insurance coverage appear correlated with fewer adverse birth outcomes, especially among blacks. This corroborates the hypothesis that state policy mandating insurance coverage for contraceptives may help prevent unintended births and lower subsequent infant mortality rates by facilitating greater access of contraceptives to women of lower SES.