Reproductive and Social Policies, Sociopolitical Stress, and Implications for Maternal and Child Health Equity

Abstract

Purpose of review: Although many environmental exposures (e.g., air pollution) are geographically patterned and persist as a result of historic economic policies (e.g., redlining), the impact of reproductive and social policies on maternal and child health remains incompletely understood. Reproductive and social policies are increasingly important for maternal and child health equity, particularly following the 2022 US Supreme Court decision in Dobbs v Jackson Women's Health Organization ("Dobbs decision"), which restricted access to abortion. Here, we summarize the literature from original research studies examining influences of reproductive and social policy on maternal and child health, focusing on impacts on adverse birth outcomes and policies as sources of stress.

Recent findings: Several studies suggest that those most impacted by the Dobbs decision are younger, non-white, socioeconomically disadvantaged, and living in states with less access to government safety net programs, all of which are compounded by environmental injustices. Further, studies conducted in the wake of the Dobbs decision find elevated stress levels among women of reproductive age. This may represent one pathway leading to adverse birth outcomes, as epidemiologic studies demonstrate that preterm birth rates increased following the 2016 election, a period of heightened stress. Reproductive and social policies are understudied contributors to adverse outcomes for reproductive-aged women and their children. This has important implications for maternal and child health equity, as those who will be the most impacted by reproductive and social policies already experience the highest rates of adverse birth outcomes and environmental toxicant exposure.

Keywords: Health equity; Policy; Pregnancy; Stress.

Figure 1.

Distribution of (A) predicted travel time to the nearest abortion facility following the 2022 United States Supreme Court Decision in Dobbs v Jackson Women’s Health Organization and (B) environmental justice indicators in the southeastern United States. Note: In panel A, we use data on the predicted average travel time to the nearest abortion facility post-Dobbs obtained from the Abortion Access Dashboard (https://experience.arcgis.com/experience/6e360741bfd84db79d5db774a1147815) produced by Professor Caitlin Myers at Middlebury College. We use the predicted average hours as of September 2023, which accounts for all abortion bans that have been implemented up until that date. In panel B, we use the environmental justice indices for PM2.5 for the year 2021. Data were obtained from the United States Environmental Protection Agency’s EJScreen, which calculates indices that combine socioeconomic and demographic characteristics with environmental exposures. Each index combines a demographic index (the percent of people of color and the percent of low-income people) with an environmental indicator that has been converted into a percentile for the given census block group. More details can be found at https://ejscreen.epa.gov/.

Figure 2.

Conceptual model showing hypothesized associations between reproductive and social and policies and maternal and child health equity. Abbreviations: TRAP: targeted regulation of abortion providers