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Primary Submission Category: Structural factors
The association of labor market institution premium generosity and birth outcomes in the US
Authors: Sine Grude, Sine Grude, Rita Hamad, Emily Dore,
Presenting Author: Megan Reynolds*
Individuals experiencing poverty are more likely to have worse birth outcomes than higher income peers. The labor market context (e.g., minimum wage, unions) varies across states and has the potential to impact disparities in health by providing resources for workers. However, little is known about the combined effect of labor market institutions on birth outcomes. To fill this gap, we constructed a composite measure of indicators of state-level support for workers, or what we term the labor market institution premium (LMIP). More specifically, the LMIP was constructed for each state-year, representing the added value of minimum wage, union wage premiums and unemployment insurance compared to federal minimum wage. Using birth certificate data across all 50 states from 2003 to 2019 (n=64,247 ,739), we assessed the relationship between the LMIP and birth outcomes, including measures of gestational age and birthweight. We conducted multivariate linear regression with fixed effects for year and state with a one-year lag (i.e., aligns with the pregnancy period) and two-year lag between exposure and birth for the full sample and subgroups stratified by educational attainment. For the one-year lagged model, we found no association between LMIP score and birth outcomes. For two-year lagged models, we found that a one unit change in LMIP increases birthweight by 8.87 g [95% CI 1.43, 16.31]. For education subgroups, we found that the increase in birthweight is largest among groups with lower education (9.78 g [95%CI 2.94, 16.62] for less than high school, 9.64 g [95% CI 2.21, 17.08] for high school). The findings suggest that labor market institution generosity was associated with higher birthweight when exposed during the preconception period. However, null findings for other outcomes suggest that these institutions may not reach the intended recipients or may not be generous enough to alleviate poor birth outcomes for the working poor.