Impact of State-Level Policies on Maternal Mortality

国家政策对孕产妇死亡率的影响

• 批准号: 10163452
• 负责人: Maeve E Wallace
• 金额: $ 14.62万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-24 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10163452
• 关键词: Address; Adopted; Adoption; Age; Attention; Awareness; Cause of Death; Cessation of life; Characteristics; Child; Communities; Country; Dangerousness; Data; Databases; Death Records; Developed Countries; Development; Discipline of obstetrics; Domestic Violence; Failure; Family; Firearms; Future; Geographic state; Goals; Guns; Health; Homicide; Human Rights; Incidence; Intervention; Laws; Life; Link; Maternal Health; Maternal Mortality; Monitor; Natural experiment; Outcome; Ownership; Parents; Perinatal; Policies; Policy Maker; Postpartum Period; Postpartum Women; Pregnancy; Pregnancy Rate; Pregnant Women; Prevention; Public Health; Recommendation; Records; Reporting; Reproduction; Research; Review Committee; Risk; Risk Factors; Shapes; Statutes and Laws; System; Time; Trauma; Variant; Violence; Woman; Work; assault; convict; design; evidence base; evidence based guidelines; experience; gun homicide; gun violence; health equity; innovation; interest; intimate partner violence; mortality; neglect; offender; population health; pregnant; prevent; preventable death; reproductive; trend; virtual; weapons

PROJECT SUMMARY/ABSTRACT Homicide remains a leading cause of death among women who are pregnant and postpartum, and a majority of these deaths involve intimate partner violence and firearm use. Further upstream interventions are critical in preventing future maternal deaths and the trauma borne by the children, families, and communities they leave behind. Previous research endeavors have largely neglected the influence of state-level firearm policies on violent maternal deaths, despite recent calls for adoption of a human rights approach to addressing and eliminating preventable maternal mortality. This evidence is urgently needed at a time when maternal mortality review committees are mobilizing across the US in order to make systems- and policy-level recommendations to prevent maternal death, and while they are broadening their capacity to review violent maternal deaths in addition to obstetric causes. Our specific aim is to estimate the causal impact of four state-level policies that shape access to and ownership of firearms on incidence of pregnancy- associated homicide. Specifically, we examine 1) state laws that prohibits people convicted of domestic violence misdemeanors or under final domestic violence restraining order from possessing firearms (“possession” policies), and 2) state laws that require abusers convicted of domestic violence misdemeanors or those under domestic violence restraining orders to turn in their firearms when they become prohibited from possessing them (“relinquishment” policies). We have established and will continue to build a state policy database for monitoring changes in state-level firearm policies of interest over time, in conjunction with over ten years of death records for monitoring state-level rates of pregnancy-associated homicide over time. The research analytic design makes use of a natural experiment framework and difference-in- difference analysis, allowing for the comparison of each state to itself, before and after the policy change. This approach is robust to potential biases from unmeasured characteristics that may differ between states and influence the state's population health. Findings from this work will fill a critical gap in the scientific evidence base of the causal impact of state-level firearm policy on violent maternal death, data glaringly absent from both public health prevention efforts and policymaker agendas. Such findings are also imperative to the wider adoption of effective, evidence-based recommendations for state maternal mortality review committees responsible for identification of modifiable factors and interventions that could prevent maternal deaths and advance health equity.

项目总结/摘要 杀人仍然是孕妇和产后妇女死亡的主要原因， 其中大多数死亡涉及亲密伴侣暴力和使用火器。更上游 干预措施对于防止今后的孕产妇死亡和产妇所承受的创伤至关重要， 他们留下的孩子、家庭和社区。以前的研究工作主要是 忽视了州一级枪支政策对暴力孕产妇死亡的影响，尽管最近 呼吁采取人权方针，处理和消除可预防的孕产妇死亡问题， mortality.在孕产妇死亡率审查委员会 正在美国各地动员起来，提出系统和政策层面的建议， 预防孕产妇死亡，同时扩大审查暴力孕产妇死亡的能力， 除产科原因外的死亡。我们的具体目标是估计四个因素的因果影响 在怀孕发生率方面影响枪支获取和拥有的州级政策- 关联凶杀案具体来说，我们研究了1）州法律，禁止被判有罪的人 家庭暴力轻罪或根据最终家庭暴力限制令 拥有枪支（“拥有”政策），以及2）要求滥用者被定罪的州法律 家庭暴力轻罪或家庭暴力限制令下的人自首 当他们被禁止拥有枪支时，他们将被禁止拥有枪支（“放弃”政策）。 我们已经建立并将继续建立国家政策数据库，以监测 随着时间的推移，国家一级的枪支政策，以及十多年的死亡， 记录，以监测一段时间以来州一级与怀孕有关的杀人案的发生率。的 研究分析设计利用自然的实验框架和差异， 差异分析，允许在政策之前和之后将每个状态与自身进行比较 变化这种方法对于来自未测量特征的潜在偏差是稳健的， 不同的国家和影响国家的人口健康。这项工作的结果将填补 国家一级枪支政策的因果影响的科学证据基础存在重大差距， 暴力孕产妇死亡，公共卫生预防工作和 决策者议程。这些研究结果对于更广泛地采用有效的， 向各州孕产妇死亡率审查委员会提出循证建议， 确定可以预防孕产妇死亡的可变因素和干预措施， 促进健康公平。