Impact of State-level Policies on Maternal Mortality

项目摘要/摘要 迫切需要找出令人无法接受的高发病率和不断上升的原因 美国的孕产妇死亡率。同样令人担忧的是，母婴之间根深蒂固的差异 和婴儿死亡率，尽管努力解决个人层面的风险因素和改善 在产科护理质量和技术方面。以前的研究在很大程度上忽略了 政策的影响，尽管最近呼吁采取人权办法来解决和 消除可预防的孕产妇死亡率。这个应用程序的总体目标是确定如何 国家一级的具体政策影响孕产妇和婴儿死亡率。我们已经确立了 并将继续建立州政策数据库，以监测州一级感兴趣的政策的变化 随着时间的推移，结合十多年来监测州一级孕产妇和 随着时间的推移，婴儿死亡率。我们的具体目标是(1)确定国家层面政策的影响 旨在保护妇女健康和改善获得保健服务的机会，以减少婴儿和产妇的发病率 死亡率(政策包括扩大联邦收入高达138%的成年人的医疗补助收入资格 贫困水平[FPL]，将医疗补助资格扩大到收入200%FPL的孕妇，强制 预测为怀孕工人提供合理的住宿和带薪家庭假)；(2)确定 限制或限制妇女堕胎的州级政策对婴儿和 产妇死亡率(政策包括对私人保险中堕胎保险的限制，强制性 咨询和堕胎之间需要等待时间，未成年人之前需要父母参与 获得堕胎，仅限于由有执照的医生提供堕胎服务)；及 确定目标1和目标2中探讨的政策对婴儿和孕产妇死亡率的不同影响 种族和社会经济地位。研究性分析设计利用自然实验 框架和差异差异分析，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是稳健的 各州之间可能有所不同并影响该州人口健康的特征。调查结果来自 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 死亡人数，公共卫生预防工作和政策制定者议程上都明显缺乏数据。 调查结果还将包括州一级的政策在延续深刻种族方面可能发挥的作用的证据 以及死亡率方面的社会经济不平等。

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.