Impact of State-Level Policies on Maternal Mortality

项目摘要/摘要 凶杀案仍然是怀孕和产后妇女死亡的主要原因， 这些死亡中的大多数涉及亲密伴侣的暴力和枪支使用。进一步上游 干预措施对于防止未来孕产妇死亡和由妇女承担的创伤至关重要 他们留下的孩子、家庭和社区。之前的研究工作在很大程度上 忽视了国家一级的枪支政策对暴力产妇死亡的影响，尽管最近 呼吁采取人权办法处理和消除可预防的孕产妇 死亡率。这一证据是迫切需要的，因为孕产妇死亡审查委员会 正在全美动员起来，以便在系统和政策层面提出建议 防止产妇死亡，并在扩大其审查暴力产妇的能力的同时 除产科原因外的死亡。我们的具体目标是评估四个因素的因果影响 国家一级的政策，根据怀孕事件影响枪支的获取和拥有- 关联凶杀案。具体地说，我们考察了禁止被判有罪的人的州法律 家庭暴力轻罪或根据最终家庭暴力限制令 拥有枪支(“持有”政策)，以及2)州法律要求施虐者被判有罪 家庭暴力轻罪或家庭暴力限制令下的自首 当他们被禁止拥有枪支时(“放弃”政策)。 我们已经建立并将继续建立一个国家政策数据库，用于监测 随着时间的推移，国家级枪支政策的利益，以及十多年的死亡 随着时间的推移，监测与怀孕有关的凶杀率的州级记录。这个 研究性分析设计利用了自然的实验框架和差异性。 差异分析，允许将每个州在政策实施前后与自身进行比较 变化。这种方法对来自未测量特征的潜在偏差是稳健的，这些特征可能 不同州之间的差异，并影响到该州的人口健康。这项工作的发现将填补 国家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 政策制定者议程。这些发现对于更广泛地采用有效、 为负责以下工作的州孕产妇死亡审查委员会提出循证建议 确定可改变的因素和干预措施，以预防孕产妇死亡和 推进健康公平。

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.