# Impact of State-Level Policies on Maternal Mortality

> **NIH NIH R01** · TULANE UNIVERSITY OF LOUISIANA · 2020 · $146,153

## Abstract

PROJECT SUMMARY/ABSTRACT
Homicide remains a leading cause of death among women who are pregnant and postpartum, and
a majority of these deaths involve intimate partner violence and firearm use. Further upstream
interventions are critical in preventing future maternal deaths and the trauma borne by the
children, families, and communities they leave behind. Previous research endeavors have largely
neglected the influence of state-level firearm policies on violent maternal deaths, despite recent
calls for adoption of a human rights approach to addressing and eliminating preventable maternal
mortality. This evidence is urgently needed at a time when maternal mortality review committees
are mobilizing across the US in order to make systems- and policy-level recommendations to
prevent maternal death, and while they are broadening their capacity to review violent maternal
deaths in addition to obstetric causes. Our specific aim is to estimate the causal impact of four
state-level policies that shape access to and ownership of firearms on incidence of pregnancy-
associated homicide. Specifically, we examine 1) state laws that prohibits people convicted of
domestic violence misdemeanors or under final domestic violence restraining order from
possessing firearms (“possession” policies), and 2) state laws that require abusers convicted of
domestic violence misdemeanors or those under domestic violence restraining orders to turn in
their firearms when they become prohibited from possessing them (“relinquishment” policies).
We have established and will continue to build a state policy database for monitoring changes in
state-level firearm policies of interest over time, in conjunction with over ten years of death
records for monitoring state-level rates of pregnancy-associated homicide over time. The
research analytic design makes use of a natural experiment framework and difference-in-
difference analysis, allowing for the comparison of each state to itself, before and after the policy
change. This approach is robust to potential biases from unmeasured characteristics that may
differ between states and influence the state's population health. Findings from this work will fill
a critical gap in the scientific evidence base of the causal impact of state-level firearm policy on
violent maternal death, data glaringly absent from both public health prevention efforts and
policymaker agendas. Such findings are also imperative to the wider adoption of effective,
evidence-based recommendations for state maternal mortality review committees responsible for
identification of modifiable factors and interventions that could prevent maternal deaths and
advance health equity.

## Key facts

- **NIH application ID:** 10163452
- **Project number:** 3R01HD096070-03S1
- **Recipient organization:** TULANE UNIVERSITY OF LOUISIANA
- **Principal Investigator:** Maeve E Wallace
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $146,153
- **Award type:** 3
- **Project period:** 2018-08-24 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10163452

## Citation

> US National Institutes of Health, RePORTER application 10163452, Impact of State-Level Policies on Maternal Mortality (3R01HD096070-03S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10163452. Licensed CC0.

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