The impact of state-level factors on infant health
Summary
The recent increasing trends in infant mortality, preterm birth, and low birthweight are major public health problems in the United States (US). The persistent racial inequities in these outcomes, such as Black infants being twice as likely to die as White infants, significantly contributes to these elevated rates. Punitive policies that penalize substance use during pregnancy or restrict access to reproductive health care have been linked to poor infant health outcomes and racial inequities therein. However, there is a paucity of research that examines the public health effects of fetal protection laws (FPLs), which have the stated intent of promoting fetal health by legally regulating pregnancy. These laws may result in delayed healthcare seeking, due to fear of legal consequences, and subsequent adverse birth outcomes, which disproportionately affect racially minoritized, low-income, and rural populations. Despite the recent parallel rise in both FPLs and poor infant health, we lack evidence on how FPLs influence maternal-infant health care access, outcomes, and inequities. This project will leverage National Center for Health Statistics natality data and rigorous quasi-experimental methods to investigate the impact of FPLs on prenatal care, low birthweight, and preterm birth (Aim 1) and estimate the disparate impact of FPLs on these outcomes by race/ethnicity, socioeconomic status, and residence (Aim 2). We will also examine obstetrician-gynecologists' perceptions of how the implementation of FPLs influence their provision of perinatal care through in-depth qualitative interviews (Aim 3). This timely and innovative research will produce the first comprehensive evidence of how FPLs contribute to worsening infant health, which is critical as these laws proliferate across the US with unknown public health effects. This proposal aligns with NICHDs scientific priority to understand the impacts of policy changes on infants, pregnant people, and health inequities (NOSI NOT-HD-22-038). This research is complemented by a mentored training plan that builds on my background in social and perinatal epidemiology and includes structured mentorship, coursework, and directed studies in the following areas: 1) policy surveillance; 2) advanced quasi-experimental approaches; and 3) qualitative interviewing and analysis. I will also foster independent research leadership skills through professional development training in grant writing, project management, and research communication. An exceptional mentorship team with relevant research expertise and substantial mentoring experience will support completion of the proposed research, training plan, and a successful transition to independence. The strategically integrated mentorship, training, and research plans will provide me with a unique set of expertise and skills to conduct long-term, impactful research on the implications of policy changes on reproductive, maternal, and infant health in future R-series proposals. This Pathway to Independence Award will enable me to develop into an independent investigator and achieve my career goals of generating rigorous epidemiological evidence to improve reproductive, maternal, and infant health outcomes and reduce inequities in the US.