Reproductive Justice & Preventable Deaths: State Funding, Family Planning, Abortion, and Infant Mortality, US 1980–2010

SSM - Population Health, Volume 2, Pages 277–293, December 2016

USC CLASS Research Paper No. CLASS17-5

18 Pages Posted: 16 Dec 2016 Last revised: 12 Jan 2017

Nancy Krieger

Harvard University - T.H. Chan School of Public Health

Sofia Gruskin

University of Southern California Keck School of Medicine; University of Southern California Gould School of Law; Harvard School of Public Health

Nakul Singh

Harvard University - T.H. Chan School of Public Health

Mathew Kiang

Harvard University - T.H. Chan School of Public Health

Jarvis Chen

Harvard University - T.H. Chan School of Public Health

Pamela Waterman

Harvard University - T.H. Chan School of Public Health

Jason Beckfield

Harvard University - Department of Sociology

Brent Coull

Harvard University - T.H. Chan School of Public Health

Date Written: January 9, 2017

Abstract

Introduction: Little current research examines associations between infant mortality and US states’ funding for family planning services and for abortion, despite growing efforts to restrict reproductive rights and services and documented associations between unintended pregnancy and infant mortality.

Material and methods: We obtained publicly available data on state-only public funding for family planning and abortion services (years available: 1980, 1987, 1994, 2001, 2006, and 2010) and corresponding annual data on US county infant death rates. We modeled the funding as both fraction of state expenditures and per capita spending (per woman, age 15–44). State-level covariates comprised: Title X and Medicaid per capita funding, fertility rate, and percent of counties with no abortion services; countylevel covariates were: median family income, and percent: black infants, adults without a high school education, urban, and female labor force participation. We used Possion log-linear models for: (1) repeat cross-sectional analyses, with random state and county effects; and (2) panel analysis, with fixed state effects.

Results: Four findings were robust to analytic approach. First, since 2000, the rate ratio for infant death comparing states in the top funding quartile vs. no funding for abortion services ranged (in models including all covariates) between 0.94 and 0.98 (95% confidence intervals excluding 1, except for the 2001 cross-sectional analysis, whose upper bound equaled 1), yielding an average 15% reduction in risk (range: 8–22%). Second, a similar risk reduction for state per capita funding for family planning services occurred in 1994. Third, the excess risk associated with lower county income increased over time, and fourth, remained persistently high for counties with a high percent of black infants.

Conclusions: Insofar as reducing infant mortality is a government priority, our data underscore the need, despite heightened contention, for adequate public funding for abortion services and for redressing health inequities.

Keywords: Abortion, Family Planning, Health Inequities, Infant Mortality, Reproductive Justice, Social Policy

JEL Classification: I14, I18, K33

Suggested Citation

Krieger, Nancy and Gruskin, Sofia and Singh, Nakul and Kiang, Mathew and Chen, Jarvis and Waterman, Pamela and Beckfield, Jason and Coull, Brent, Reproductive Justice & Preventable Deaths: State Funding, Family Planning, Abortion, and Infant Mortality, US 1980–2010 (January 9, 2017). SSM - Population Health, Volume 2, Pages 277–293, December 2016; USC CLASS Research Paper No. CLASS17-5. Available at SSRN: https://ssrn.com/abstract=2886057

Nancy Krieger (Contact Author)

Harvard University - T.H. Chan School of Public Health ( email )

677 Huntington Avenue
Boston, MA 02115
United States

Sofia Gruskin

University of Southern California Keck School of Medicine ( email )

2001 N. Soto Street
Los Angeles, CA 90089
United States

HOME PAGE: http://globalhealth.usc.edu/ghhr

University of Southern California Gould School of Law ( email )

699 Exposition Boulevard
Los Angeles, CA 90089
United States

Harvard School of Public Health ( email )

677 Huntington Avenue
Boston, MA 02115
United States

Nakul Singh

Harvard University - T.H. Chan School of Public Health ( email )

677 Huntington Avenue
Boston, MA 02115
United States

Mathew Kiang

Harvard University - T.H. Chan School of Public Health ( email )

677 Huntington Avenue
Boston, MA 02115
United States

Jarvis Chen

Harvard University - T.H. Chan School of Public Health ( email )

677 Huntington Avenue
Boston, MA 02115
United States

Pamela Waterman

Harvard University - T.H. Chan School of Public Health ( email )

677 Huntington Avenue
Boston, MA 02115
United States

Jason Beckfield

Harvard University - Department of Sociology ( email )

Cambridge, MA 02138
United States

Brent Coull

Harvard University - T.H. Chan School of Public Health ( email )

677 Huntington Avenue
Boston, MA 02115
United States

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