States with Left-Leaning Policies Have Better Birth Outcomes

Findings from Association of US state policy orientation with adverse birth outcomes: a longitudinal analysis are described by lead author Alicia R Riley. Additional authors include Jacob M Grumbach and PTBi researchers, Daniel Collin, Jacqueline M Torres, and Rita Hamad. Read the full paper here

Please describe your research findings.

Worse birth outcomes, including low birth weight and preterm birth, are more likely among infants born in states with a more right-leaning policy orientation.

What is important or unique about this study?

This is one of the first studies to measure right-left state policy orientation over time and connect that to infant health. By doing so, we provide groundbreaking evidence that infant health may be affected by the overall policy environment in the state where the mother lives.

[This] should be a wake-up call for healthcare institutions and providers in states with more right-leaning policy environments...

Alicia R. Riley, Researcher and Co-author

 What is already known about this topic, and how do your findings add to or change this existing knowledge?

In the US, there are dramatic geographic disparities in adverse birth outcomes across states. For instance, the percent of births that were preterm in 2018 ranged from a minimum of 7.8% in Oregon to a maximum of 13.0% in Louisiana. Previous studies have shown that birth outcomes are highly sensitive to the influence of specific policies, including policies to reduce poverty and improve maternal nutrition. Our study draws attention to the ways that a state’s overall policy orientation matters for infant health. Our measure of state policy orientation draws on 135 specific policies that span 16 issue areas, from immigration, to health and welfare, to housing and transportation.

It makes intuitive sense that mothers’ lives are shaped by the policy environments where they live, but most prior studies had looked at policies one at a time. Our study is the first to demonstrate the impact of a state’s overall policy context by bringing together data in a new way

How does your research impact current clinical practice? How does your research impact patients?

Alicia Riley

Alicia Riley,
UCSF Postdoctoral Scholar, Epidemiology & Biostatistics

It should be a wake-up call for healthcare institutions and providers in states with more right-leaning policy environments that their patients may be at a slightly higher risk of adverse birth outcomes because of where they live, and thus, may need more support. In our study, among the most right-leaning states were Alabama, Mississippi, and South Carolina and among the most left-leaning states were California, New Jersey, and New York.

For patients, our study validates what they may already know: that a whole range of concerns and stressors can impact their health, and these concerns and stressors may sometimes be related to state policies on issues ranging from abortion to civil rights. Our study does not suggest that moving from a right-leaning state to a left-leaning state will improve the health of any individual mother or infant, since what is true at a population level may not be true for any individual patient.

What should researchers/providers/patients/public health workers/etc. do as a result of these findings?

Our results highlight the role of state policies in explaining the geographic disparities in infant health that exist in the U.S. The public should be mindful that state-level policy has become increasingly consequential for health in the U.S., including for infant health. Advocating for better state policies may be one way to improve infant health outcomes in their state. Our study suggests that left-leaning or liberal policies that expand the use of state power for economic regulation, redistribution, protection of marginalized social groups, and that restrict state power for punishment may be a promising direction.