Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States

• Type of Material: Article
• Authors: Sara Redd, Emory University; Whitney Rice, Emory University; Monica S Aswani, University of Alabama Birmingham; Sarah Blake, Emory University; Zoë Julian, Independent Clinician Scholar, Atlanta; Bisakha Sen, University of Alabama Birmingham; Martha Wingate, University of Alabama Birmingham; Kelli Hall, Emory University
• Language: English
• Date: 2021-10-22
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12913-021-07165-x
• Title of Journal or Parent Work: BMC HEALTH SERVICES RESEARCH
• Volume: 21
• Issue: 1
• Start Page: 1139
• End Page: 1139
• Grant/Funding Information: This research was supported by a predoctoral fellowship from the Center for Reproductive Health Research in the Southeast (RISE) and in part with grant support from the Society of Family Planning Research Fund (SFPRF11–18). The views and opinions expressed are those of the authors, and do not necessarily represent the views and opinions of SFPRF. Neither funding body played a role in the design of the study, collection, analysis, and interpretation of data, or in writing the manuscript.
• Keywords: RACIAL DISPARITIES; IMPACT; Science & Technology; MANDATORY DELAY LAW; Health Care Sciences & Services; SOCIOECONOMIC DISPARITIES; Reproductive health services; RACE; US state laws; RATES; MENTAL-HEALTH; Health services research; INFANT-MORTALITY; Health disparities; Race; WOMENS REPRODUCTIVE RIGHTS; Life Sciences & Biomedicine; Health inequities; ethnicity; Abortion; Adverse birth outcomes; SERVICES; Education; Health policy
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Background: 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. Methods: Using 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. Results: Among 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. Conclusion: Findings 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.