Association of Restricted Abortion Access With Maternal and Infant Health by Maternal Nativity: A Difference‐In‐Differences Analysis

ABSTRACT

Objective

To measure the association between restricted abortion access and maternal and infant health by maternal nativity (whether they were born in the US).

Design

Observational population-based retrospective cohort study.

Setting

United States.

Population

All births (N = 33 663 837) in the United States from 2011 to 2019.

Methods

We use Centers for Disease Control and Prevention (CDC) Period Linked Birth/Infant Deaths datafiles, with a dataset of state-level abortion restrictions (Targeted Restrictions on Abortion Providers (TRAP) laws) to estimate the association between restricted abortion access and maternal and infant health by maternal nativity. We examine restricted abortion access and maternal nativity in a triple-differences framework.

Main Outcomes Measures

The primary outcome we examine is maternal morbidity (defined by the CDC as any delivery involving third- or fourth- degree perineal laceration, ruptured uterus, unplanned hysterectomy, or maternal admission to intensive care). We also explore several secondary factors associated with maternal and infant health (birth interval, birth weight, receiving care in the first trimester, and gestational age at birth).

Results

While we find no impact of TRAP laws on non-immigrants, foreign-born individuals in states with TRAP laws have 15% higher odds of maternal morbidity (aOR = 1.15; CI = 1.00–1.31) compared to US-born individuals in states without TRAP laws.

Conclusions

Anti-abortion legislation can worsen existing inequalities in maternal and infant health. These findings underscore the urgent need for policies that ensure equitable access to reproductive healthcare for immigrant populations.