# Impact of State-level Policies on Maternal Mortality

> **NIH NIH R01** · TULANE UNIVERSITY OF LOUISIANA · 2020 · $189,240

## Abstract

PROJECT SUMMARY/ABSTRACT
There is a critical need to identify reasons underlying the unacceptably high and rising incidence of
maternal mortality in the US. Of equal concern are the deep and entrenched disparities in both maternal
and infant mortality that persist despite efforts to address individual-level risk factors and improvements
in obstetric care quality and technologies. Previous research endeavors have largely neglected the
influence of policy, despite recent calls for adoption of a human rights approach to addressing and
eliminating preventable maternal mortality. Our overall objective in this application is to determine how
specific state-level policies influence incidence of maternal and infant mortality. We have established
and will continue to build a state policy database for monitoring changes in state-level policies of interest
over time, in conjunction with over ten years of vital records for monitoring state-level maternal and
infant mortality over time. Our specific aims are (1) To identify the impact of state-level policies
intended to protect women's health and improve access to health care on incidence of infant and maternal
mortality (policies include expanded Medicaid income eligibility to adults earning up to 138% federal
poverty level [FPL], expanded Medicaid eligibility to pregnant women earning 200% FPL, mandated
prevision of reasonable accommodations to pregnant workers, and paid family leave); (2) To identify the
impact of state-level policies that limit or restrict women's access to abortion on incidence of infant and
maternal mortality (policies include restrictions on abortion coverage in private insurance, mandatory
waiting period required between counseling and abortion, parental involvement required before minor
obtains an abortion, restricting to provision of abortion service by licensed physician only); and (3) To
identify differential impacts of the policies explored in Aims 1 and 2 on infant and maternal mortality by
race and socioeconomic status. 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 include empirical evidence of the causal impact of state-level policy on maternal and infant
deaths, data glaringly absent from both public health prevention efforts and policymaker agendas.
Findings will also include evidence of the role state-level policies may play in perpetuating deep racial
and socioeconomic inequities in mortality.

## Key facts

- **NIH application ID:** 9971353
- **Project number:** 5R01HD096070-03
- **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:** $189,240
- **Award type:** 5
- **Project period:** 2018-08-24 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9971353

## Citation

> US National Institutes of Health, RePORTER application 9971353, Impact of State-level Policies on Maternal Mortality (5R01HD096070-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9971353. Licensed CC0.

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