Abstract
Introduction
This study analyzed the association between the implementation of the Tennessee Fetal
Assault Law (TFAL), which allowed prosecutors to incarcerate people who used substances
during pregnancy, and out-of-state births among residents of Tennessee.
Methods
The main data source is vital records on singleton births in hospitals to people aged
15–44 years during the period January 2010 to June 2016. We include data from 33 states
and the District of Columbia where birth certificate data are comparable over this
time period. The statistical significance of the difference in outcomes observed before
and after TFAL implementation was tested using a difference-in-differences analysis
between Tennessee and the comparison group.
Results
After TFAL implementation, the odds of having an out-of-state birth increased by 13%
for residents of Tennessee (odds ratio, 1.13; 95% confidence interval, 1.09–1.16)
relative to residents of the comparison states. When we adopted different thresholds
for travel distances to the birth hospital, the odds of residents of Tennessee having
an out-of-state birth more than 75 miles away increased by 17% (odds ratio, 1.17;
95% confidence interval, 1.13–1.21) after TFAL implementation.
Conclusion
The results of this study suggest that the implementation of a policy allowing incarceration
of people who use substances during pregnancy is associated with an increase in out-of-state
births, potentially putting pregnant people and their infants at greater risk.
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Biography
Sung W. Choi, PhD, is an assistant professor of Health Administration in the School of Public Affairs at the Pennsylvania State University in Harrisburg, PA. His research interests include substance abuse and racial/ethnic disparities in health and health care.
Biography
Edeanya Agbese, MPH, is a research project manager in the Center for Applied Studies in Health Economics at the Pennsylvania State University in Hershey, PA. Her research interests include mental health and substance abuse.
Biography
Austin C. Cohrs, MPH, is a research project manager in the Center for Applied Studies in Health Economics at the Pennsylvania State University in Hershey, PA. His research interests include mental health and behavioral health.
Biography
Christal Ramos, PhD, is a senior research associate in the Urban Institute's Health Policy Center, where her research interests include payment and delivery system reforms, health information technology, and opioid use disorder and treatment, particularly in Medicaid.
Biography
Douglas L. Leslie, PhD, is a professor and vice chair for education in the department of Public Health at the Pennsylvania State University in Hershey, PA. He has extensive research expertise in health services research, health economics, and pharmacoeconomics.
Article info
Publication history
Published online: November 25, 2022
Accepted:
September 28,
2022
Received in revised form:
September 11,
2022
Received:
September 17,
2021
Footnotes
Funding Statement: This work was supported by the Social Science Research Institute at the Pennsylvania State University.
Data Statement: Following the data use agreement with the National Center for Health Statistics, raw data would remain confidential and would not be shared.
Conflict of Interest: Douglas Leslie reports funding from the National Institute of Mental Health, the Agency for Healthcare Research and Quality, Department of Health and Human Services/Substance Abuse and Mental Health Services Administration. He has also been retained as an expert witness in litigation related to the role of pharmaceutical manufacturers and distributors in the opioid epidemic and received funding from Eglet Adams, and Simon Greenstone Panatier. Sung W. Choi reports funding from Penn State University. Edeanya Agbese, Austin C. Cohrs, and Christal Ramos declare that they have no conflict of interest.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
