Primary Submission Category: Gender
Relationship Between a Reproductive Autonomy Policy Index and All-Cause Mortality
Authors: Zachary Cichon Taylor Riley Jodie Katon Andrew Bossick
Presenting Author: Zachary Cichon*
Policies that restrict reproductive autonomy and relate to structural sexism have been linked to increased morbidity and mortality, adverse birth outcomes, and poor self-reported health for women. However, less is known about the relationship between state-level reproductive autonomy and mortality among the general population and if this varies by gender and race. Our aim was to examine the association between state-level reproductive autonomy and all-cause mortality by race and gender.
A cross-sectional ecological study of all-cause mortality, per 100,000, in the 50 U.S. states between 1/1/2016, and 12/31/2018.
Using a validated composite index of 106 laws that characterize state-level reproductive autonomy and publicly available surveillance and survey data, we performed simple and multivariable linear regression to evaluate the association of the reproductive autonomy index and all-cause mortality. A higher score indicates more reproductive autonomy. Multilevel models were stratified by gender and race and included robust standard errors. Models adjusted for 2016 state-level rates per 100 of age (19-25, 26-34, 35-54, 55-64, ≥65), White race, below poverty line, unemployment, those with a college degree, and foreign born. We estimated 95% confidence intervals and a p-value <0.05 was considered significant.
In our adjusted models a one-unit increase in the index, indicating greater reproductive rights, was associated with decreases in all-cause mortality rates among all genders and races at the state level (Women: all -2.02 CI -3.17, -0.87; Black -3.20 CI -6.14, -0.27; white -1.22 CI -2.41, -0.03; Men: all -3.23 CI -4.64, -1.82; Black -6.67 CI -10.8, -2.60; white -1.93 CI -3.38, -0.47).
The association between higher levels of reproductive autonomy and lower all-cause mortality, particularly by race and gender has health equity implications. Reproductive autonomy policies may be a critical leverage point in reducing adverse societal outcomes for the entire population.