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: 10199766
• 负责人: Maeve E Wallace
• 金额: $ 21.64万
• 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/10199766
• 关键词: Address; Adoption; Adult; Cessation of life; Characteristics; Color; Counseling; Country; Data; Data Collection; Databases; Death Records; Development; Economics; Eligibility Determination; European; Excision; Family Leave; Funding; Geographic state; Goals; Health Policy; Health Services Accessibility; Health Status; Healthcare; Human Rights; Improve Access; Incidence; Income; Individual; Infant Mortality; Insurance; Insurance Coverage; Intervention; Investigation; Live Birth; Low income; Maternal Health; Maternal Mortality; Measures; Medicaid; Medicaid eligibility; Minor; Monitor; Natural experiment; Not Hispanic or Latino; Outcome; Physicians; Play; Policies; Policy Maker; Population; Pregnant Women; Prevention; Privatization; Public Health; Quality of Care; Race; Records; Reproduction; Reproductive Health; Research; Risk Factors; Role; Safety; Services; Shapes; Social Policies; Socioeconomic Status; Subgroup; Technology; Time; United Nations; Variant; Woman; Women' s Health; Work; abortion; adverse birth outcomes; barrier to care; black women; design; evidence base; experience; federal poverty level; health care availability; health care service; health equity promotion; improved; infant death; innovation; interest; mortality; mortality disparity; neglect; obstetric care; parental involvement; population health; pregnant; prevent; preventable death; reproductive; social; socioeconomics; trend

PROJECT SUMMARY/ABSTRACT There is a critical need to identify reasons underlying the unacceptably high and rising incidence of maternal mortality in the US. Of equal concern are the deep and entrenched disparities in both maternal and infant mortality that persist despite efforts to address individual-level risk factors and improvements in obstetric care quality and technologies. Previous research endeavors have largely neglected the influence of policy, despite recent calls for adoption of a human rights approach to addressing and eliminating preventable maternal mortality. Our overall objective in this application is to determine how specific state-level policies influence incidence of maternal and infant mortality. We have established and will continue to build a state policy database for monitoring changes in state-level policies of interest over time, in conjunction with over ten years of vital records for monitoring state-level maternal and infant mortality over time. Our specific aims are (1) To identify the impact of state-level policies intended to protect women's health and improve access to health care on incidence of infant and maternal mortality (policies include expanded Medicaid income eligibility to adults earning up to 138% federal poverty level [FPL], expanded Medicaid eligibility to pregnant women earning 200% FPL, mandated prevision of reasonable accommodations to pregnant workers, and paid family leave); (2) To identify the impact of state-level policies that limit or restrict women's access to abortion on incidence of infant and maternal mortality (policies include restrictions on abortion coverage in private insurance, mandatory waiting period required between counseling and abortion, parental involvement required before minor obtains an abortion, restricting to provision of abortion service by licensed physician only); and (3) To identify differential impacts of the policies explored in Aims 1 and 2 on infant and maternal mortality by race and socioeconomic status. 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 include empirical evidence of the causal impact of state-level policy on maternal and infant deaths, data glaringly absent from both public health prevention efforts and policymaker agendas. Findings will also include evidence of the role state-level policies may play in perpetuating deep racial and socioeconomic inequities in mortality.

项目总结/摘要 目前迫切需要查明儿童死亡率高得令人无法接受且不断上升的原因， 美国的孕产妇死亡率。同样令人关切的是，产妇和新生儿的营养状况存在着根深蒂固的差距， 和婴儿死亡率，尽管努力解决个人层面的风险因素和改善， 产科护理质量和技术。以前的研究工作在很大程度上忽视了 尽管最近有人呼吁采取人权办法， 消除可预防的孕产妇死亡。我们在本申请中的总体目标是确定 国家一级的具体政策影响产妇和婴儿死亡率。我们建立 并将继续建立一个国家政策数据库，以监测国家一级相关政策的变化 随着时间的推移，结合十多年来用于监测州一级孕产妇和新生儿死亡率的重要记录， 随着时间的推移，婴儿死亡率。我们的具体目标是（1）确定国家一级政策的影响 旨在保护妇女健康和改善获得保健的机会， 死亡率（政策包括将医疗补助收入资格扩大到收入高达联邦 贫困水平[FPL]，将医疗补助资格扩大到收入200% FPL的孕妇， （2）为怀孕工人提供合理的便利和带薪家事假）; 限制或限制妇女堕胎的州一级政策对婴儿和青少年死亡率的影响 产妇死亡率（政策包括限制私人保险中的堕胎保险，强制性 咨询和堕胎之间需要等待时间，未成年人堕胎前需要父母参与 获得堕胎，仅限于由有执照的医生提供堕胎服务）;以及（3） 查明目标1和2所探讨的政策对婴儿和产妇死亡率的不同影响， 种族和社会经济地位。研究分析设计利用自然实验 框架和差异中的差异分析，允许将每个状态与其自身进行比较， 政策变化前后。这种方法对来自未测量的潜在偏差具有鲁棒性 各州之间可能存在差异并影响该州人口健康的特征。的结果 这项工作将包括国家一级政策对母婴的因果影响的经验证据 公共卫生预防工作和政策制定者的议程都严重缺乏死亡数据。 调查结果还将包括证据的作用，国家一级的政策可能发挥在延续深种族 和社会经济不平等的问题。