Redd Sara K, Hall Kelli Stidham, Aswani Monica S, Sen Bisakha, Wingate Martha, Rice Whitney S
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia.
Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia; Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York; Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Womens Health Issues. 2022 Mar-Apr;32(2):103-113. doi: 10.1016/j.whi.2021.10.006. Epub 2021 Nov 18.
Since 2011, U.S. states have enacted more than 400 policies restricting abortion access. As structural determinants, abortion policies have the potential to influence maternal and child health access, outcomes, and equity through multiple mechanisms. Limited research has examined their implications for birth outcomes.
We created a state-level abortion restrictiveness index composed of 18 restrictive abortion policies and evaluated the association between this index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW) within the United States and by Census Region, using data from the 2005-2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files. We used logistic multivariable regression modeling, adjusting for individual- and state-level factors and state and year fixed effects.
Among 2,500,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average from 2005 to 2015, states had approximately seven restrictive abortion policies enacted, with more policies enacted in the Midwest and South. Nationally, relationships between state restrictiveness indices and adverse birth outcomes were insignificant. Regional analyses revealed that a 1 standard deviation increase in a state's restrictiveness index was associated with a 2% increase in PTB in the Midwest (marginal effect [ME], 0.25; 95% confidence interval [CI], 0.04-0.45; p < .01), a 15% increase in LBW in the Northeast (ME, 1.24; 95% CI, 0.12-2.35; p < .05), and a 2% increase in LBW in the West (ME, 0.12; 95% CI, 0.01-0.25; p < .05).
Variation in restrictive abortion policy environments may have downstream implications for birth outcomes, and increases in abortion restrictions were associated with adverse birth outcomes in three out of four Census Regions.
自2011年以来，美国各州已颁布400多项限制堕胎的政策。作为结构性决定因素，堕胎政策有可能通过多种机制影响母婴健康服务的可及性、结果和公平性。针对这些政策对出生结局影响的研究有限。
我们创建了一个由18项限制堕胎政策组成的州级堕胎限制指数，并利用2005 - 2015年国家卫生统计中心时期关联出生-婴儿死亡档案的数据，评估该指数与美国全国以及按人口普查区域划分的早产（PTB）和低出生体重（LBW）个体水平概率之间的关联。我们使用逻辑多变量回归模型，对个体和州层面的因素以及州和年份固定效应进行了调整。
在250万例活产中，269,253例（12.0%）为早产，182,960例（8.1%）为低出生体重。2005年至2015年期间，各州平均颁布了约7项限制堕胎政策，中西部和南部颁布的政策更多。在全国范围内，州限制指数与不良出生结局之间的关系不显著。区域分析显示，州限制指数每增加1个标准差，中西部的早产发生率增加2%（边际效应[ME]，0.25；95%置信区间[CI]，0.04 - 0.45；p <.01），东北部的低出生体重发生率增加15%（ME，1.24；95% CI，0.12 - 2.35；p <.05），西部的低出生体重发生率增加2%（ME，0.12；95% CI，0.01 - 0.25；p <.05）。
限制堕胎政策环境的差异可能对出生结局产生下游影响，并且在四个普查区域中的三个区域，堕胎限制的增加与不良出生结局相关。
