Development of a Composite Risk Index to Examine the Impact of Diverse State Policy on Population Level Maternal and Neonatal Outcomes

Abstract

Despite major successes in some reproductive health outcomes over the last several decades, more work is needed that enables the state-level reproductive autonomy of birthing people, especially minoritized communities. Assessing the composite effect of state policies that impact reproductive autonomy by restricting or enabling the ability to make independent choices around reproduction represents a novel way to examine the effect of upstream policy determinants on reproductive health. This research first systematically reviewed existing data to understand the impact of state laws on reproductive health care outcomes, and then used publicly available data from CDC Wonder and PubMed, and primary data from a Delphi panel, and state laws for all 50 states. Specific aims included: (1) Summarizing associations between health policies and reproductive health care outcomes and their impacts using systematic review; (2) Creating a composite risk index as a function of state policies and examining its association with severe maternal morbidity and mortality, preterm birth, and low birthweight; and (3) Examining if the index is associated with racial disparities in preterm birth and low birthweight. Results from our systemic review documented that most studies have focused solely on abortion, as well as evaluations of single policies. Additionally, we identified several policy gaps, including heartbeat laws and criminalization of substance use during pregnancy. We found that more reproductive autonomy enabling states had higher rates of severe maternal morbidity, but lower rates of maternal mortality, preterm birth, and rates of racial disparities in preterm birth and low birthweight. This research provided insight into the impact of state-policy on reproductive health outcomes, and the impact of structural racism on racialized disparities.