Early Elective Delivery Disparities between Non-Hispanic Black and White Women after Statewide Policy Implementation

Abstract

BackgroundIn 2011, Oregon implemented a policy that reduced the state's rate of early (before 39 weeks' gestation) elective (without medical need) births. ObjectiveThis analysis measured differential policy effects by race, examining whether Oregon's policy was associated with changes in non-Hispanic Black–White disparities in early elective cesarean and labor induction. MethodsWe used Oregon birth certificate data, defining prepolicy (2008–2010) and postpolicy (2012–2014) periods, including non-Hispanic Black and White women who gave birth during these periods (n = 121,272). We used longitudinal spline models to assess policy impacts by race and probability models to measure policy-associated changes in Black–White disparities. ResultsWe found that the prepolicy Black–White differences in early elective cesarean (6.1% vs. 4.3%) were eliminated after policy implementation (2.8% vs. 2.5%); adjusted models show decreases in the odds of elective early cesarean among Black women after the policy change (adjusted odds ratio, 0.47; 95% confidence interval, 0.22–1.00; p = .050) and among White women (adjusted odds ratio, 0.79; 95% confidence interval, 0.67–0.93; p = .006). Adjusted probability models indicated that policy implementation resulted in a 1.75-percentage point narrowing (p = .011) in the Black–White disparity in early elective cesarean. Early elective induction also decreased, from 4.9% and 4.7% for non-Hispanic Black and non-Hispanic White women to 3.8% and 2.5%, respectively; the policy was not associated with a statistically significant change in disparities. ConclusionsA statewide policy reduced racial disparities in early elective cesarean, but not early elective induction. Attention to differential policy effects by race may reveal changes in disparities, even when that is not the intended focus of the policy.