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

• Published in: BMC health services research Vol. 21; no. 1; pp. 1 - 1139
• Main Authors: Redd, Sara K, Rice, Whitney S, Aswani, Monica S, Blake, Sarah, Julian, Zoë, Sen, Bisakha, Wingate, Martha, Hall, Kelli Stidham
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 22-10-2021; BioMed Central; BMC
• Subjects: Abortion; Adverse birth outcomes; Bans; Birth weight; Education; Health aspects; Health care disparities; Health policy; Health services; Health services research; Insurance coverage; Minority & ethnic groups; Obstetrics; Political aspects; Pregnancy; Premature birth; Reproductive health; Reproductive health services; Social aspects; Socially handicapped; Sociodemographics; Sociopolitical factors; State employees; US state laws; United States; United States > US
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-021-07165-x

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.