State-Level Abortion Policy Hostility and Unplanned Births in the Pre-Dobbs Era

Julia C P Eddelbuettel; Sharon Sassler

doi:10.1215/00703370-10952575

State-Level Abortion Policy Hostility and Unplanned Births in the Pre-Dobbs Era

Demography. 2023 Oct 1;60(5):1469-1491. doi: 10.1215/00703370-10952575.

Authors

Julia C P Eddelbuettel^{1

2}, Sharon Sassler¹

Affiliations

¹ Department of Policy Analysis and Management, Brooks School of Public Policy, Cornell University, Ithaca, NY, USA.
² Ph.D. Program in Health Policy, Harvard University, Cambridge, MA, USA.

PMID: 37680171
DOI: 10.1215/00703370-10952575

Abstract

An increasingly hostile policy climate has reshaped abortion access in the United States. Recent literature has studied the effects of restrictive abortion policies on reproductive health outcomes. This study is the first to investigate the association between state-level abortion policy hostility and the pregnancy intentions of women with a pregnancy resulting in live birth. Data are from the Pregnancy Risk Assessment Monitoring System survey, merged with a state-level legislative database from 2012-2018 and other state-level controls. Cross-sectional results reveal that a one-unit increase in abortion policy hostility is associated with a relative risk (odds) of having a live birth resulting from an unintended versus intended pregnancy that is 1.02 times as high (RRR = 1.02, 95% confidence interval = 1.01, 1.03). This result corresponds to a 13% increase in the predicted probability of having a live birth resulting from an unintended pregnancy between a zero-hostility and a maximum-hostility state. Models stratified by demographic and socioeconomic characteristics reveal that the association between abortion policy hostility and live birth resulting from an unintended pregnancy is particularly robust among women in younger, less educated, Medicaid, uninsured, and rural populations.

Keywords: Abortion policy; Abortion restrictions; PRAMS; Unintended pregnancy; Unplanned birth.