State-level Variation in Maternal Mortality

PROJECT ABSTRACT Rates of maternal mortality have been increasing annually despite growing public attention and efforts to promote maternal health. Moreover, rates of pregnancy-associated mortality including homicide, suicide, and drug overdose are alarmingly high and rising as well, and disparities characterize all of these outcomes. Concurrently, state reproductive health policies have grown increasingly restrictive in recent years, and an unprecedented number of states have enacted total bans on pregnancy termination or narrow gestational limits on care since 2022. Extant research has failed to interrogate the interconnectedness of these two issues, and the role of state policies as determinants of maternal and infant health outcomes and disparities remains unknown. Our overall objective in this application is to fill a critical gap in the scientific evidence by evaluating the impact of the current policy environment on trends and disparities in maternal mortality; pregnancy-associated homicide, suicide, and drug overdose; infant mortality; and preterm birth. We have established and will continue to expand a national longitudinal geodatabase for monitoring trends in state policies, macrosocial contexts, maternal and infant mortality and other maternal population health outcomes US that includes and extends back 16 years from the most recently available data (2023). Our specific aims are to (1) identify the impact of state reproductive health policy changes on state trends in maternal health including pregnancy-associated mortality (homicide, suicide, drug overdose) and maternal mortality; (2) identify the impact of state policy changes on state trends in infant health including all-cause and cause-specific infant mortality and preterm birth; and (3) identify the impact of state policy changes on disparities in maternal and infant health outcomes. The research approach applies rigorous and innovative econometric methods that exploit a natural experiment framework to establish empirical evidence of the causal impact of state policies on trends in the most severe and salient indicators of maternal and infant population health.