Abstract
BackgroundTo examine racial/ethnic and educational inequities in the relationship between state-level restrictive abortion policies and adverse birth outcomes from 2005 to 2015 in the United States.MethodsUsing a state-level abortion restrictiveness index comprised of 18 restrictive abortion policies, we conducted a retrospective longitudinal analysis examining whether race/ethnicity and education level moderated the relationship between the restrictiveness index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW). Data were obtained from the 2005–2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files and analyzed with linear probability models adjusted for individual- and state-level characteristics and state and year fixed-effects.ResultsAmong 2,250,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average, states had approximately seven restrictive abortion policies enacted from 2005 to 2015. Black individuals experienced increased probability of PTB with additional exposure to restrictive abortion policies compared to non-Black individuals. Similarly, those with less than a college degree experienced increased probability of LBW with additional exposure to restrictive abortion policies compared to college graduates. For all analyses, inequities worsened as state environments grew increasingly restrictive.ConclusionFindings demonstrate that Black individuals at all educational levels and those with fewer years of education disproportionately experienced adverse birth outcomes associated with restrictive abortion policies. Restrictive abortion policies may compound existing racial/ethnic, socioeconomic, and intersecting racial/ethnic and socioeconomic perinatal and infant health inequities.
Highlights
To examine racial/ethnic and educational inequities in the relationship between state-level restrictive abortion policies and adverse birth outcomes from 2005 to 2015 in the United States
Black individuals lived in states with the most enacted restrictive abortion policies (7.4), while American/Pacific Islander (AAPI) and Hispanic/Latinx individuals lived in states with the fewest enacted restrictive abortion policies (4.6 and 5.3, respectively)
In terms of adverse birth outcomes, Black individuals had the highest rates of preterm birth (PTB) (17.2%) and low birthweight (LBW) (13.5%), while AAPI and White individuals had the lowest rates of PTB (10.4 and 10.8%, respectively) and Hispanic/Latinx, White, and American Indian/Alaska Native (AIAN) individuals had the lowest rates of LBW (7.0, 7.2, and 7.3%, respectively)
Summary
To examine racial/ethnic and educational inequities in the relationship between state-level restrictive abortion policies and adverse birth outcomes from 2005 to 2015 in the United States. As structural determinants of health [35] that shape who and via what means pregnant people can access abortion, pregnant people living in restrictive sociopolitical environments who are unable to access abortion services may end up continuing their pregnancy [5], resulting in adverse birth outcomes via a number of potential mechanisms. States with legal environments that restrict abortion access often lack supportive policies promoting the health and safety of pregnant people, their children, and their families – such as Medicaid expansion, expansive family/medical leave, and comprehensive sex education [41, 42] – which may result in reduced access to supportive services and contribute to adverse birth outcomes [33, 34, 42, 43]. Variation in Restrictive Abortion Policies and Adverse Birth Outcomes in the United States from 2005 to 2015, in press)
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