Laws Restricting Access to Abortion Services and Infant Mortality Risk in the United States
Abstract
:1. Introduction
2. Methods
3. Measures
3.1. Outcome
3.2. Main Exposure
4. Statistical Analysis
5. Results
Characteristics
6. Discussion
Strengths and Limitations
7. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Medicaid | Mandatory | |||||
---|---|---|---|---|---|---|
Funding | Parental | Mandatory | Waiting | Two-Visit | Total | |
State | Restriction | Involvement | Counseling | Period | Law | Laws |
Alabama | Yes | Yes | Yes | Yes | No | 4 |
Alaska | No | No | Yes | No | No | 1 |
Arizona | No | Yes | No | No | No | 1 |
Arkansas | Yes | Yes | Yes | Yes | No | 4 |
California | No | No | Yes | No | No | 1 |
Colorado | Yes | Yes | No | No | No | 2 |
Connecticut | No | No | Yes | No | No | 1 |
Delaware | Yes | Yes | Yes | No | No | 3 |
Washington DC | Yes | No | No | No | No | 1 |
Florida | Yes | Yes | Yes | No | No | 3 |
Georgia | Yes | Yes | Yes | Yes | No | 4 |
Hawaii | No | No | No | No | No | 0 |
Idaho | Yes | Yes | Yes | Yes | No | 4 |
Illinois | No | No | No | No | No | 0 |
Indiana | Yes | Yes | Yes | Yes | Yes | 5 |
Iowa | Yes | Yes | No | No | No | 2 |
Kansas | Yes | Yes | Yes | Yes | No | 4 |
Kentucky | Yes | Yes | Yes | Yes | No | 4 |
Louisiana | Yes | Yes | Yes | Yes | Yes | 5 |
Maine | Yes | No | Yes | No | No | 2 |
Maryland | No | Yes | No | No | No | 1 |
Massachusetts | No | Yes | No | No | No | 1 |
Michigan | Yes | Yes | Yes | Yes | No | 4 |
Minnesota | No | Yes | Yes | Yes | No | 3 |
Mississippi | Yes | Yes | Yes | Yes | Yes | 5 |
Missouri | Yes | Yes | Yes | Yes | Yes | 5 |
Montana | No | No | No | No | No | 0 |
Nebraska | Yes | Yes | Yes | Yes | No | 4 |
Nevada | Yes | No | Yes | No | No | 2 |
New Hampshire | Yes | No | No | No | No | 1 |
New Jersey | No | No | No | No | No | 0 |
New Mexico | No | No | No | No | No | 0 |
New York | No | No | No | No | No | 0 |
North Carolina | Yes | Yes | No | No | No | 2 |
North Dakota | Yes | Yes | Yes | Yes | No | 4 |
Ohio | Yes | Yes | Yes | Yes | Yes | 5 |
Oklahoma | Yes | Yes | Yes | Yes | No | 4 |
Oregon | No | No | No | No | No | 0 |
Pennsylvania | Yes | Yes | Yes | Yes | No | 4 |
Rhode Island | Yes | Yes | Yes | No | No | 3 |
South Carolina | Yes | Yes | Yes | Yes | No | 4 |
South Dakota | Yes | Yes | Yes | Yes | No | 4 |
Tennessee | Yes | Yes | Yes | No | No | 3 |
Texas | Yes | Yes | Yes | Yes | No | 4 |
Utah | Yes | Yes | Yes | Yes | Yes | 5 |
Vermont | No | No | No | No | No | 0 |
Virginia | Yes | Yes | Yes | Yes | No | 4 |
Washington | No | No | No | No | No | 0 |
West Virginia | No | Yes | Yes | Yes | No | 3 |
Wisconsin | Yes | Yes | Yes | Yes | Yes | 5 |
Wyomimg | Yes | Yes | No | No | No | 2 |
Individual Level Characteristics | n | Percentage |
---|---|---|
Birth year | ||
2008 | 4,109,463 | 34.3 |
2009 | 3,993,282 | 33.4 |
2010 | 3,869,884 | 32.3 |
Mother′s Race | ||
White | 6,410,568 | 53.5 |
Black | 1,773,995 | 14.8 |
Native | 118,496 | 1.0 |
Asian | 692,386 | 5.8 |
Latin | 2,922,361 | 24.4 |
Other | 54,822 | 0.5 |
Education | ||
Less than high school | 2,396,987 | 20.2 |
High School | 3,277,870 | 27.4 |
Post-secondary | 6,297,772 | 52.5 |
Marital Status | ||
Single | 4,913,782 | 41.0 |
Married | 7,058,847 | 59.0 |
Birth order | ||
First | 3,986,136 | 33.3 |
Second | 3,355,612 | 28.0 |
Third | 2,155,132 | 18.0 |
Fourth or more | 2,475,749 | 20.7 |
Mother′s nativity | ||
Foreign-born | 2,829,786 | 23.6 |
US Born | 9,142,843 | 76.4 |
US State-Level Characteristics 2010 | Mean (SD) | Max, Min |
Median Income, USD | 49973.65 (8130.60) | (36,851, 68,854) |
Population, 2010 | 6,054,080 (6,824,211) | (563,767, 37,300,000) |
African American (%) | 12 (11.8) | (0.40, 0.55) |
Proportion in poverty (%) | 14.8 (3.1) | (8.3, 22.4) |
Odds for Infant Mortality | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
OR | OR | OR | OR | OR | OR | OR | ||||||||
95%CI | 95%CI | 95%CI | 95%CI | 95%CI | 95%CI | 95%CI | ||||||||
State Characteristics | ||||||||||||||
Abortion Laws | ||||||||||||||
one or two restrictions (reference group: no restrictions) | 1.08 | |||||||||||||
(0.99,1.18) | ||||||||||||||
3 or more restrictions (reference group: no restrictions) | 1.10 | |||||||||||||
(1.01,1.20) | ||||||||||||||
Medicare restrictions (reference group: no) | ||||||||||||||
Yes | 1.03 | 1.00 | ||||||||||||
(0.96,1.11) | (0.93,1.08) | |||||||||||||
Parental Involvement (reference group: no) | ||||||||||||||
Yes | 1.10 | 1.11 | ||||||||||||
(1.02,1.19) | (1.01,1.21) | |||||||||||||
Mandatory counselling (reference group: no) | ||||||||||||||
Yes | 1.04 | 1.04 | ||||||||||||
(0.98,1.09) | (0.96,1.13) | |||||||||||||
Mandatory wait period (reference group: no) | ||||||||||||||
Yes | 1.03 | 0.97 | ||||||||||||
(0.98,1.09) | (0.89,1.06) | |||||||||||||
Two visit-law (reference group: no) | ||||||||||||||
Yes | 1.01 | 0.98 | ||||||||||||
(0.93,1.09) | (0.90,1.06) | |||||||||||||
State Median Income Z-score | 0.97 | 0.97 | 0.97 | 0.97 | 0.96 | 0.96 | 0.98 | |||||||
(0.93,1.02) | (0.92,1.02) | (0.93,1.02) | (0.92,1.01) | (0.92,1.01) | (0.92,1.01) | (0.93,1.03) | ||||||||
Proportion Black Z-score | 0.98 | 0.97 | 0.98 | 0.98 | 0.98 | 0.98 | 0.98 | |||||||
(0.94,1.01) | (0.94,1.01) | (0.95,1.02) | (0.94,1.02) | (0.94,1.02) | (0.94,1.02) | (0.95,1.03) | ||||||||
Proportion Poor Z-score | 0.98 | 0.98 | 0.98 | 0.98 | 0.97 | 0.97 | 0.99 | |||||||
(0.93,1.04) | (0.92,1.04) | (0.93,1.04) | (0.92,1.03) | (0.92,1.03) | (0.92,1.03) | (0.93,1.05) | ||||||||
State Population Z-score | 0.99 | 0.99 | 0.99 | 0.99 | 0.99 | 0.99 | 0.99 | |||||||
(0.97,1.01) | (0.97,1.01) | (0.97,1.01) | (0.97,1.01) | (0.97,1.01) | (0.97,1.01) | (0.97,1.01) | ||||||||
Census Division (reference group: New England) | ||||||||||||||
Middle Atlantic | 1.13 | 1.08 | 1.08 | 1.08 | 1.06 | 1.08 | 1.10 | |||||||
(0.98,1.29) | (0.95,1.23) | (0.95,1.21) | (0.95,1.23) | (0.93,1.21) | (0.95,1.23) | (0.96,1.25) | ||||||||
East North Central | 1.25 | 1.24 | 1.24 | 1.24 | 1.22 | 1.25 | 1.24 | |||||||
(1.11,1.41) | (1.11,1.39) | (1.08,1.42) | (1.11,1.40) | (1.08,1.38) | (1.10,1.41) | (01.09,1.40) | ||||||||
West North Central | 1.10 | 1.11 | 1.06 | 1.21 | 1.09 | 1.12 | 1.08 | |||||||
(0.98,1.23) | (0.99,1.24) | (0.95,1.19) | (1.06,1.37) | (0.97,1.23) | (1.00,1.25) | (0.95,1.21) | ||||||||
South Atlantic | 1.21 | 1.22 | 1.16 | 1.22 | 1.21 | 1.24 | 1.16 | |||||||
(1.08,1.36) | (1.09,1.37) | (1.03,1.31) | (1.09,1.37) | (1.08,1.36) | (1.10,1.39) | (1.02,1.31) | ||||||||
East South Central | 1.29 | 1.30 | 1.24 | 1.30 | 1.30 | 1.32 | 1.24 | |||||||
(1.13,1.48) | (1.14,1.49) | (1.08,1.42) | (1.14,1.49) | (1.14,1.49) | (1.16,1.51) | (1.08,1.42) | ||||||||
West South Central | 1.20 | 1.21 | 1.15 | 1.21 | 1.19 | 1.23 | 1.16 | |||||||
(1.05,1.37) | (1.06,1.38) | (1.01,1.31) | (1.06,1.37) | (1.04,1.37) | (1.08,1.39) | (1.01,1.33) | ||||||||
Mountain | 1.08 | 1.07 | 1.05 | 1.08 | 1.06 | 1.07 | 1.06 | |||||||
(0.97,1.20) | (0.96,1.19) | (0.94,1.17) | (0.96,1.20) | (0.95,1.19) | (0.96,1.20) | (0.95,1.19) | ||||||||
Pacific | 1.07 | 1.03 | 1.06 | 1.03 | 1.02 | 1.02 | 1.07 | |||||||
(0.94,1.21) | (0.91,1.16) | (0.94,1.19) | (0.91,1.16) | (0.91,1.15) | (0.91,1.15) | (0.95,1.20) | ||||||||
Individual Characteristics | ||||||||||||||
Birth cohort | ||||||||||||||
2009 (reference group: 2008) | 0.97 | 0.97 | 0.97 | 0.97 | 0.97 | 0.97 | 0.97 | |||||||
(0.95,0.99) | (0.95,0.99) | (0.95,0.99) | (0.95,0.99) | (0.95,0.99) | (0.95,0.99) | (0.95,0.99) | ||||||||
2010 (reference group: 2008) | 0.94 | 0.94 | 0.94 | 0.94 | 0.94 | 0.94 | 0.94 | |||||||
(0.93,0.96) | (0.93,0.96) | (0.93,0.96) | (0.93,0.95) | (0.93,0.96) | (0.93,0.96) | (0.93,0.96) | ||||||||
Mother′s Age (years) | ||||||||||||||
(0.99,1.01) | (0.99,1.01) | (0.99,1.01) | (0.99,1.01) | (0.99,1.01) | (0.99,1.01) | (0.99,1.01) | ||||||||
Mother′s Race ((reference group): white) | ||||||||||||||
Black | 1.88 | 1.88 | 1.88 | 1.88 | 1.88 | 1.88 | 1.88 | |||||||
(1.84,1.92) | (1.84,1.92) | (1.84,1.92) | (1.84,1.92) | (1.84,1.92) | (1.84,1.92) | (1.84,1.92) | ||||||||
Native | 1.31 | 1.31 | 1.31 | 1.31 | 1.31 | 1.31 | 1.31 | |||||||
(1.23,1.40) | (1.23,1.40) | (1.23,1.40) | (1.23,1.40) | (1.23,1.40) | (1.23,1.40) | (1.23,1.40) | ||||||||
Asian | 1.15 | 1.15 | 1.15 | 1.15 | 1.15 | 1.15 | 1.15 | |||||||
(1.10,1.20) | (1.10,1.20) | (1.10,1.20) | (1.10,1.20) | (1.10,1.20) | (1.10,1.20) | (1.10,1.20) | ||||||||
Hispanic | 0.98 | 0.98 | 0.98 | 0.98 | 0.98 | 0.98 | 0.98 | |||||||
(0.96,1.01) | (0.96,1.01) | (0.96,1.01) | (0.96,1.01) | (0.96,1.01) | (0.96,1.01) | (0.96,1.01) | ||||||||
Other | 1.25 | 1.25 | 1.25 | 1.25 | 1.25 | 1.25 | 1.25 | |||||||
(1.12,1.39) | (1.12,1.39) | (1.12,1.39) | (1.12,1.39) | (1.12,1.39) | (1.12,1.39) | (1.12,1.39) | ||||||||
Education (ref: less than high school) | ||||||||||||||
High School | 0.89 | 0.89 | 0.89 | 0.89 | 0.89 | 0.89 | 0.89 | |||||||
(0.87,0.91) | (0.87,0.91) | (0.87,0.91) | (0.87,0.91) | (0.87,0.91) | (0.87,0.91) | (0.87,0.91) | ||||||||
Post-Secondary | 0.68 | 0.68 | 0.68 | 0.68 | 0.68 | 0.68 | 0.68 | |||||||
(0.66,0.69) | (0.66,0.69) | (0.66,0.69) | (0.66,0.69) | (0.66,0.69) | (0.66,0.69) | (0.66,0.69) | ||||||||
With Partner (reference group: coupled) | ||||||||||||||
Single | 1.33 | 1.33 | 1.33 | 1.33 | 1.33 | 1.33 | 1.33 | |||||||
(1.30,1.35) | (1.32,1.35) | (1.30,1.35) | (1.30,1.35) | (1.30,1.35) | (1.30,1.35) | (1.30,1.35) | ||||||||
Nativity (reference group: born outside USA) | ||||||||||||||
US born | 1.30 | 1.30 | 1.30 | 1.31 | 1.30 | 1.30 | 1.30 | |||||||
(1.27,1.33) | (1.27,1.33) | (1.27,1.33) | (1.23,1.40) | (1.27,1.33) | (1.27,1.33) | (1.27,1.33) | ||||||||
Birth Order (reference group: first born) | ||||||||||||||
Second | 1.04 | 1.04 | 1.04 | 1.04 | 1.04 | 1.04 | 1.04 | |||||||
(1.02,1.06) | (1.02,1.06) | (1.02,1.06) | (1.02,1.06) | (1.02,1.06) | (1.02,1.06) | (1.02,1.06) | ||||||||
Third | 1.11 | 1.11 | 1.11 | 1.11 | 1.11 | 1.11 | 1.11 | |||||||
(1.08,1.14) | (1.08,1.14) | (1.08,1.14) | (1.08,1.14) | (1.08,1.14) | (1.08,1.14) | (1.08,1.14) | ||||||||
1.39 | 1.39 | 1.39 | 1.39 | 1.39 | 1.39 | 1.39 | ||||||||
Fourth or more | (1.36,1.42) | (1.36,1.42) | (1.36,1.42) | (1.36,1.42) | (1.36,1.42) | (1.36,1.42) | (1.36,1.42) |
Odds for Infant Mortality | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
≤19 Years Age | 20 to 25 Years | 25 to 30 Years | 30 to 34 Years | 35 and Older | ||||||
OR | 95%CI | OR | 95%CI | OR | 95%CI | OR | 95%CI | OR | 95%CI | |
State Characteristics | ||||||||||
Parental Involvement (ref: no) | ||||||||||
Yes | 1.09 | (1.00,1.19) | 1.10 | (1.03,1.17) | 1.03 | (0.94,1.12) | 1.07 | (0.97,1.18) | 1.07 | (0.98,1.16) |
State Median Income Z-score | 0.91 | (0.84,0.99) | 0.98 | (0.92,1.04) | 0.95 | (0.89,1.02) | 1.04 | (0.95,1.14) | 0.89 | (0.82,0.96) |
Proportion Black Z-score | 1.05 | (0.99,1.11) | 0.97 | (0.93,1.01) | 1.00 | (0.94,1.05) | 0.95 | (0.89,1.03) | 1.05 | (0.98,1.12) |
Proportion Poor Z-score | 0.88 | (0.81,0.96) | 0.99 | (0.93,1.06) | 0.99 | (0.91,1.07) | 0.99 | (0.89,1.11) | 0.87 | (0.79,0.96) |
State Population Z-score | 0.99 | (0.96,1.02) | 0.99 | (0.97,1.01) | 1.00 | (0.98,1.03) | 0.98 | (0.95,1.02) | 1.02 | (0.99,1.05) |
Census Division (ref: New England) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Middle Atlantic | 1.14 | (0.96,1.35) | 1.12 | (0.99,1.27) | 1.00 | (0.87,1.15) | 1.11 | (0.95,1.30) | 0.93 | (0.82,1.07) |
East North Central | 1.17 | (0.99,1.38) | 1.21 | (1.07,1.37) | 1.18 | (1.03,1.35) | 1.40 | (1.20,1.63) | 1.15 | (1.01,1.32) |
West North Central | 1.06 | (0.89,1.26) | 1.07 | (0.93,1.22) | 1.03 | (0.89,1.19) | 1.16 | (0.98,1.37) | 0.98 | (0.85,1.14) |
South Atlantic | 1.06 | (0.89,1.26) | 1.20 | (1.05,1.37) | 1.11 | (0.96,1.29) | 1.26 | (1.05,1.50) | 0.97 | (0.83,1.13) |
East South Central | 1.18 | (0.98,1.41) | 1.24 | (1.06,1.44) | 1.26 | (1.07,1.49) | 1.42 | (1.18,1.70) | 1.22 | (1.03,1.44) |
West South Central | 1.16 | (0.97,1.38) | 1.14 | (0.99,1.30) | 1.11 | (0.96,1.29) | 1.38 | (1.16,1.65) | 1.17 | (1.01,1.36) |
Mountain | 1.15 | (0.97,1.36) | 0.98 | (0.86,1.13) | 1.05 | (0.91,1.21) | 1.24 | (1.06,1.45) | 1.12 | (0.97,1.29) |
Pacific | 1.14 | (0.95,1.37) | 1.08 | (0.94,1.24) | 0.99 | (0.85,1.15) | 1.11 | (0.93,1.33) | 1.02 | (0.88,1.19) |
Individual Characteristics | ||||||||||
Birth cohort | ||||||||||
2008 (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
2009′ | 0.95 | (0.91,1.00) | 0.98 | (0.95,1.01) | 0.98 | (0.94,1.01) | 0.99 | (0.94,1.04) | 0.94 | (0.89,0.98) |
2010′ | 0.91 | (0.87,0.96) | 0.95 | (0.92,0.98) | 0.96 | (0.92,0.99) | 1.00 | (0.95,1.05) | 0.89 | (0.85,0.93) |
Mother′s Race (ref: white) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Black | 1.44 | (1.37.1.51) | 1.72 | (1.66,1.78) | 2.01 | (1.93,2.10) | 2.29 | (2.16,2.42) | 2.35 | (2.22,2.49) |
Native | 0.99 | (0.85,1.16) | 1.34 | (1.21,1.49) | 1.34 | (1.17,1.55) | 1.39 | (1.13,1.71) | 1.45 | (1.16,1.81) |
Asian | 1.26 | (1.06,1.49) | 1.07 | (0.98,1.18) | 1.18 | (1.09,1.29) | 1.26 | (1.15,1.38) | 1.14 | (1.04,1.25) |
Hispanic | 0.83 | (0.78,0.89) | 0.93 | (0.89,0.97) | 1.04 | (0.99,1.10) | 1.10 | (1.03,1.18) | 1.13 | (1.06,1.22) |
Other | 1.02 | (0.76,1.36) | 1.16 | (0.96,1.41) | 1.20 | (0.96,1.51) | 1.44 | (1.10,1.88) | 1.44 | (1.13,1.84) |
Education (ref: less than high school) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
High School | 0.86 | (0.82,0.90) | 0.88 | (0.85,0.91) | 0.93 | (0.89,0.97) | 1.01 | (0.94,1.08) | 0.98 | (0.92,1.05) |
Post-Secondary | 0.82 | (0.76,0.88) | 0.71 | (0.69,0.74) | 0.73 | (0.69,0.76) | 0.74 | (0.69,0.79) | 0.68 | (0.63,0.73) |
Martial Status (ref: coupled) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Single | 1.11 | (1.04,1.19) | 1.24 | (1.21,1.28) | 1.34 | (1.30,1.39) | 1.39 | (1.32,1.45) | 1.27 | (1.21,1.33) |
Nativity (ref: born outside USA) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
US born | 1.28 | (1.18,1.38) | 1.32 | (1.26,1.38) | 1.36 | (1.30,1.43) | 1.32 | (1.24,1.40) | 1.22 | (1.15,1.29) |
Birth Order (ref: first) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Second | 1.49 | (1.42,1.56) | 1.07 | (1.03,1.10) | 0.96 | (0.91,1.00) | 0.83 | (0.78,0.88) | 0.79 | (0.74,0.85) |
Third | 1.83 | (1.70,1.98) | 1.22 | (1.18,1.27) | 1.04 | (1.00,1.10) | 0.90 | (0.84,0.96) | 0.78 | (0.73,0.84) |
Fourth or more | 1.76 | (1.58,1.96) | 1.54 | (1.48,1.60) | 1.37 | (1.31,1.43) | 1.12 | (1.06,1.19) | 0.99 | (0.93,1.05) |
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Pabayo, R.; Ehntholt, A.; Cook, D.M.; Reynolds, M.; Muennig, P.; Liu, S.Y. Laws Restricting Access to Abortion Services and Infant Mortality Risk in the United States. Int. J. Environ. Res. Public Health 2020, 17, 3773. https://doi.org/10.3390/ijerph17113773
Pabayo R, Ehntholt A, Cook DM, Reynolds M, Muennig P, Liu SY. Laws Restricting Access to Abortion Services and Infant Mortality Risk in the United States. International Journal of Environmental Research and Public Health. 2020; 17(11):3773. https://doi.org/10.3390/ijerph17113773
Chicago/Turabian StylePabayo, Roman, Amy Ehntholt, Daniel M. Cook, Megan Reynolds, Peter Muennig, and Sze Y. Liu. 2020. "Laws Restricting Access to Abortion Services and Infant Mortality Risk in the United States" International Journal of Environmental Research and Public Health 17, no. 11: 3773. https://doi.org/10.3390/ijerph17113773