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 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.

Post‐Roe emergency medicine: Policy, clinical, training, and individual implications for emergency clinicians

“…23 Black women are also more likely to experience adverse birth outcomes associated with abortion restrictions. 10 Additionally, the socioeconomic impact of giving birth is significant and forced pregnancy and birth will magnify preexisting disparities. Not only are low-income women more likely to have difficulty accessing abortion care, those who do not terminate undesired pregnancies are more likely to experience adverse economic consequences.…”

“…Racism is a driver of reproductive injustice 7 and, as a result, Black, Hispanic, Indigenous people–in particular those of lower socioeconomic status and living in rural areas—continue to experience disproportionate barriers to accessing reproductive health care 8 . Black women are more likely to experience barriers to accessing contraception and have the highest rate of unintended pregnancy of any racial group, while Hispanic women report the highest rate of unintended birth 9,10 . As a result, women from historically minoritized racial groups are more likely to require abortion care: Black women are four times more likely to have abortions as compared to non‐Hispanic White women and about twice as likely compared to Hispanic women 11 .…”

“…A study in Texas found that restrictive abortion laws were associated with a disproportionate reduction in the abortion rate among Hispanic women, particularly among those living in a county with a closed clinic and those who had to travel over 100 miles for abortion care 23 . Black women are also more likely to experience adverse birth outcomes associated with abortion restrictions 10 …”

Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era

“…74 Abortion restrictions predominantly affect minorities, people affected by poverty, those with mental health diagnoses and lack of health care, [75][76][77][78] and may worsen their economic outcomes. 79 The recent changes in abortion legislation will compound existing racial, ethnic, and socioeconomic inequities, 76 and the politicization of mifepristone will overwhelmingly affect those populations, given that in 2014, 75% of abortions occurred in poor or low-income women. 80 The current climate of abortion restrictions only promises to worsen an already spiraling challenge and will accentuate and widen disparities and inequities, at a time when preventing them should be a nationwide priority in health care and beyond.…”

Community-led research for reproductive justice: Exploring the SisterLove Georgia Medication Abortion project

“…The Supreme Court of the United States is posed to overturn Roe v. Wade this month, thus eliminating federal abortion protection and allowing states to regulate or outlaw abortion (6,7). Since Roe v. Wade in 1973, federal (e.g., the Hyde Amendment that prohibits federal funding to cover abortion for public insurance patients) and state-level (e.g., gestational age limits) policies have restricted access, particularly for people of color, low-income communities, and young people (8,9). This creates treacherous double binds, particularly for Black and low-income people, who have the highest risk of maternal mortality and highest rates of abortion demand (due to poverty and lower access to contraception), but the worst barriers to safe abortion care (10).…”