Abstract
Background
In 2011, Oregon implemented a policy that reduced the state's rate of early (before
39 weeks' gestation) elective (without medical need) births.
Objective
This analysis measured differential policy effects by race, examining whether Oregon's
policy was associated with changes in non-Hispanic Black–White disparities in early
elective cesarean and labor induction.
Methods
We used Oregon birth certificate data, defining prepolicy (2008–2010) and postpolicy
(2012–2014) periods, including non-Hispanic Black and White women who gave birth during
these periods (n = 121,272). We used longitudinal spline models to assess policy impacts by race and
probability models to measure policy-associated changes in Black–White disparities.
Results
We found that the prepolicy Black–White differences in early elective cesarean (6.1%
vs. 4.3%) were eliminated after policy implementation (2.8% vs. 2.5%); adjusted models
show decreases in the odds of elective early cesarean among Black women after the
policy change (adjusted odds ratio, 0.47; 95% confidence interval, 0.22–1.00; p = .050) and among White women (adjusted odds ratio, 0.79; 95% confidence interval,
0.67–0.93; p = .006). Adjusted probability models indicated that policy implementation resulted
in a 1.75-percentage point narrowing (p = .011) in the Black–White disparity in early elective cesarean. Early elective induction
also decreased, from 4.9% and 4.7% for non-Hispanic Black and non-Hispanic White women
to 3.8% and 2.5%, respectively; the policy was not associated with a statistically
significant change in disparities.
Conclusions
A statewide policy reduced racial disparities in early elective cesarean, but not
early elective induction. Attention to differential policy effects by race may reveal
changes in disparities, even when that is not the intended focus of the policy.
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Biography
Katy B. Kozhimannil, PhD, MPA, is Associate Professor in the Division of Health Policy and Management at the University of Minnesota. She conducts research to inform the development, implementation, and evaluation of health policy that affects women, families, and communities.
Biography
Ifeoma Muoto, PhD, is a Postgraduate Administrative Fellow at Kaiser Permanente Southern California. Her focus areas include strategy, process improvement, and health systems development, to promote population health.
Biography
Blair G. Darney, PhD, MPH, is a health services researcher affiliated with the Oregon Health & Science University Department of Obstetrics and Gynecology and Instituto Nacional de Salud Publica (Cuernavaca, Mexico). Her research interests include maternal morbidity and mortality, contraception, and abortion.
Biography
Aaron B. Caughey, MD, PhD, is Professor/Chair, Department of Obstetrics and Gynecology at Oregon Health and Science University School of Medicine. He utilizes clinical epidemiology, health economics, health policy, and the decision sciences to examine obstetric care and outcomes.
Biography
Jonathan M. Snowden, PhD, is Assistant Professor in the Oregon Health and Science University /Portland State University School of Public Health. He is an epidemiologist and health services researcher focusing on analytical methods to study and mitigate sexual/reproductive health disparities.
Article info
Publication history
Published online: December 19, 2017
Accepted:
November 30,
2017
Received in revised form:
November 10,
2017
Received:
April 13,
2017
Footnotes
Funding Statement: Supported by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R00 HD079658-03), the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number R40 MC26809-01-00, and a Jr. Investigator Award from the Society of Family Planning (SFPRF9-JI2). The funding organizations had no role in design or conduct of the study; collection, management, analysis, or interpretation of the data; and preparation, review, or approval of the manuscript.
Identification
Copyright
© 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc.
