Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States
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 abor...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-021-07165-x |
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| author | Sara K. Redd Whitney S. Rice Monica S. Aswani Sarah Blake Zoë Julian Bisakha Sen Martha Wingate Kelli Stidham Hall |
| author_facet | Sara K. Redd Whitney S. Rice Monica S. Aswani Sarah Blake Zoë Julian Bisakha Sen Martha Wingate Kelli Stidham Hall |
| author_sort | Sara K. Redd |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-24T03:48:19Z |
| format | Article |
| id | doaj.art-0fa15a206d134a1db91a6002462466be |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-24T03:48:19Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-0fa15a206d134a1db91a6002462466be2022-12-21T17:16:38ZengBMCBMC Health Services Research1472-69632021-10-0121111510.1186/s12913-021-07165-xRacial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United StatesSara K. Redd0Whitney S. Rice1Monica S. Aswani2Sarah Blake3Zoë Julian4Bisakha Sen5Martha Wingate6Kelli Stidham Hall7Department of Health Policy and Management, Rollins School of Public Health, Emory UniversityCenter for Reproductive Health Research in the Southeast (RISE), Emory UniversityDepartment of Health Services Administration, School of Health Professions, University of Alabama at BirminghamDepartment of Health Policy and Management, Rollins School of Public Health, Emory UniversityIndependent Clinician ScholarDepartment of Health Care Organization and Policy, School of Public Health, University of Alabama at BirminghamDepartment of Health Care Organization and Policy, School of Public Health, University of Alabama at BirminghamCenter for Reproductive Health Research in the Southeast (RISE), Emory UniversityAbstract 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.https://doi.org/10.1186/s12913-021-07165-xAbortionHealth policyHealth services researchReproductive health servicesAdverse birth outcomesUS state laws |
| spellingShingle | Sara K. Redd Whitney S. Rice Monica S. Aswani Sarah Blake Zoë Julian Bisakha Sen Martha Wingate Kelli Stidham Hall Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States BMC Health Services Research Abortion Health policy Health services research Reproductive health services Adverse birth outcomes US state laws |
| title | Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States |
| title_full | Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States |
| title_fullStr | Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States |
| title_full_unstemmed | Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States |
| title_short | Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States |
| title_sort | racial ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the united states |
| topic | Abortion Health policy Health services research Reproductive health services Adverse birth outcomes US state laws |
| url | https://doi.org/10.1186/s12913-021-07165-x |
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