The Status of Women's Reproductive Rights and Adverse Birth Outcomes.

BACKGROUND: Reproductive rights-the ability to decide whether and when to have children-shape women's socioeconomic and health trajectories across the life course. The objective of this study was to examine reproductive rights in association preterm birth (PTB; <37 weeks) and low birth weight (LBW; <2,500g) across states in the United States.

METHODS: Analysis included records for all live births in the United States in 2012 grouped by state. A reproductive rights composite index score was assigned to records from each state based on the following indicators for the year before birth (2011): mandatory sex education, expanded Medicaid eligibility for family planning services, mandatory parental involvement for minors seeking abortion, mandatory abortion waiting periods, public funding for abortion, and percentage of women in counties with abortion providers. Scores were ranked by quartile with the highest quartile reflecting states with strongest reproductive rights. We fit logistic regression models with generalized estimating equations to estimate the odds ratios and 95% confidence intervals for PTB and LBW associated with reproductive rights score controlling for maternal race, age, education, and insurance and state-level poverty.

RESULTS: States with the strongest reproductive rights had the lowest rates of LBW and PTB (7.3% and 10.6%, respectively) compared with states with more restrictions (8.5% and 12.2%, respectively). After adjustment, women in more restricted states experienced 13% to 15% increased odds of PTB and 6% to 9% increased odds of LBW compared with women in states with the strongest rights.

CONCLUSIONS: State-level reproductive rights may influence likelihood of adverse birth outcomes among women residents.