When reproductive rights are less restrictive babies are born healthier

Women, particularly US-born Black women, in states with restrictive reproductive rights policies deliver more low birth weight babies and experience greater health inequities, according to the American Journal of Preventive Medicine

Ann Arbor, October 13, 2020

American women living in states with less restrictive reproductive rights policies are less likely to give birth to low-birth weight babies, according to a new study in the American Journal of Preventive Medicine, published by Elsevier. The findings show that women, particularly US-born Black women, giving birth in states with less restrictive reproductive rights policies have a seven percent lower low-birth weight risk, compared to women in states with more restrictive policies.

“Our study provides evidence that reproductive rights policies play a critical role in advancing maternal and child health equity,” said lead investigator May Sudhinaraset, PhD, of the Department of Community Health Sciences in the UCLA Fielding School of Public Health, Los Angeles, CA, USA.

Compared to infants of normal weight, low birth weight babies may be more at risk for many health problems. Some infants may become sick in the first six days of life or develop infections. Others may even suffer from long-term problems, including delayed motor and social development or learning disabilities.

This research contributes to understanding how broader social policies affect birth outcomes measured by examining race and nativity status. The events of 2020 sharpened national focus on structural racism, which historically and culturally reinforces racial inequities through discriminatory practices and unequal distribution of resources, such as wealth, healthcare, and housing. This dynamic may be an important factor in producing reproductive disadvantages via stress-induced physiological pathways that are exacerbated by racism and tied to poor health outcomes.

The study analyzed birth record data for the nearly four million births that occurred in the 50 states and the District of Columbia in 2016 to assess the associations between reproductive rights policies and adverse birth outcomes. The investigators further evaluated if the associations were different for women of color and immigrants. Compared with women living in states with the most restrictive reproductive rights policies, women living in the least restrictive states had a 7 percent lower low-birth weight risk. Low-birth weight risk was 8 percent lower among Black women living in states with the least restrictive reproductive rights policies compared with their counterparts living in the most restrictive states.

This map indicates the reproductive rights policy climate for each state plus the District of Columbia (2016)
This map indicates the reproductive rights policy climate for each state plus the District of Columbia in the year prior to when women gave birth in 2016 (i.e., preconception year). Data were compiled in 2014 and 2015 (Credit: Elsevier).

The study indicates that expanding reproductive rights may decrease the risk of low-birth weight, particularly for US-born Black women. Specifically, the findings showed significant associations between low-birth weight and states’ reproductive rights climate among US-born, but not foreign-born, Black women. This finding is in line with the growing literature on the context-dependent nature of race as a determinant of population health. It may be that US-born Black women’s reproductive health is affected by the cumulative impact of lifetimes and generations within a systematically racist society.

The national reckoning on racial injustice and the Black Lives Matter movement underscore the critical importance and urgency of addressing longstanding systemic racism and its adverse effects on the health and well-being of black, Indigenous and people of color (BIPOC) women and families, in particular. Black women are more likely to die in pregnancy and childbirth than any other race group, experience more maternal health complications than White women, and experience lower quality maternity care, including disrespectful care during childbirth. Moreover, adverse birth outcomes constitute a major public health priority; yet significant inequities exist across race and nativity status.

Dr. Sudhinaraset concluded, “Addressing the adverse consequences of structural racism requires examination of the historical and present-day policies that negatively affect women of color. Future studies should assess specific evidence-based policies, particularly highlighting women’s lived experiences of policy exclusion or inclusion, and the effects on women and newborn health. Important policy levers can and should be implemented to improve women’s reproductive health overall, including increasing abortion access and mandatory sex education in schools.”


Notes for editors
The article is“Women’s Reproductive Rights Policies and Adverse Birth Outcomes: A State-Level Analysis to Assess the Role of Race and Nativity Status,” by May Sudhinaraset, PhD, Dovile Vilda, PhD, Jessica D. Gipson, MPH, PhD, Marta Bornstein, MPH, and Maeve E. Wallace, MPH, PhD (https://doi.org/10.1016/j.amepre.2020.07.025). It appears in advance of the American Journal of Preventive Medicine, volume 59, issue 6 (December 2020) published by Elsevier.

This work was supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Grants Numbers R01HD092653 and R01HD096070.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or ajpmmedia@elsevier.com. Journalists wishing to interview the authors should contact Brad Smith, Office of Communications, UCLA Fielding School of Public Health, at +1 424 832 6408 (mobile), bssmith@support.ucla.edu; or Keith Brannon, Associate Director of Public Relations, Tulane University, at +1 504-621-2724; kbrannon@tulane.edu.

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

Media contact
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+1 734 936 1590