The Muslim Ban and preterm birth: Analysis of U.S. vital statistics data from 2009 to 2018.

Anti-immigrant stigma or xenophobia is increasingly pervasive globally. Racism is a determinant of adverse health outcomes, but the epidemiological implications of the recent wave of xenophobic policies have not been well studied. The 2017 travel ban on individuals from Muslim majority countries is an example of such policy efforts in the United States. Using the 2009-2018 National Center for Health Statistics period linked infant birth-death data, we used time series methods to compare the monthly odds of preterm births to women from travel ban countries (Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen) after the January 2017 travel ban to the number expected had the ban not been implemented. We estimated our counterfactual from the history of preterm birth among women born in countries included in the ban as well as trends in preterm birth among native-born non-Hispanic (NH) White women. Among the 18,945,795 singleton live births included in our study period (including 191,121 born to women from banned countries), the average monthly rate of births that were preterm birth was 8.5% (range: 6.8%, 10.6%) among women born in the countries affected by the ban and 8.6% (range: 7.7%, 9.8%) among native-born NH White women. Our results show an increase in the odds of preterm birth among infants born to women from travel ban countries in September 2017 and persisting through the cohort born in August 2018. The coefficient for exposed infants born in these months suggests that the odds of preterm birth increased by 6.8% among women from banned countries (p < 0.001). Our results suggest that the first U.S. Executive Order (#13769) of the travel ban targeting individuals from Muslim majority countries may be associated with preterm births. We therefore conclude that structurally xenophobic and racist policies in the U.S. may have a harmful effect on birth outcomes and early life indicators of life-long health outcomes.