E2.03 - Oral: Contraception Deserts: How Infant and Maternal Mortality Are Influenced by Reproductive Care Between States

Brief Abstract Summary: After the overturning of Roe v. Wade, conservative states have restricted access to abortions, shuttering reproductive health clinics leading to contraception deserts. This increases the chances for unintended pregnancies and detrimental outcomes for maternal and infant health for those who decide to give birth. The purpose of this study is to determine whether contraception deserts, pharmacists prescribing birth control policies, and restrictive abortion policies increase the likelihood of high maternal and infant mortality. A binary logistic regression with predictors like the presence of contraception deserts, the policy allowing pharmacists to prescribe birth control, and restrictive abortion policies will be conducted for five of the highest and five of the lowest maternal and infant mortality. The results can be used to develop public health education programs on access to contraceptives and state level policies that may affect sexual and reproductive health.

Detailed abstract description: More than 19 million women of reproductive age living in the United States are in need of publicly funded contraception and live in contraception deserts. A contraception desert refers to a geographical area where individuals have insufficient access to all contraceptive methods, specifically, they lack reasonable access in their county to a health center that offers the full range of contraceptive methods. Currently, approximately 1.2 million of these women live in a county without a single health center offering the breadth of contraceptive methods. After the overturning of Roe v. Wade and efforts in more conservative states to decrease access to abortions, many reproductive health clinics shut down leaving many individuals in several states with decreased access to reproductive and contraceptive care. The implications of which are increasing the chances for unintended pregnancies and detrimental outcomes for maternal and infant health for those who decide to give birth. According to the CDC, in 2022 the top five states with the lowest infant mortality rates were Massachusetts, New Hampshire, New Jersey, Rhode Island, and California. All these states have less restrictive policies around abortion and provide access to over-the-counter (OTC) birth control such as the O-Pill or policies allowing pharmacists to prescribe birth control. Those states with the highest infant mortality rates, Mississippi, South Dakota, Arkansas, Delaware, and Louisiana (which recently banned access to Plan B), have some of the most restrictive abortion policies (with the exception of Delaware) and three of these states have some of the highest maternal mortality rates in the US. Additionally, these states do not allow pharmacists to prescribe self-administered birth control as of 2024 except for Delaware which is working to implement the law, and South Dakota which is using collaborative practice agreements to provide contraception. Access to contraception is paramount to decreasing maternal and infant mortality, decreasing the number of women seeking abortions through illegal means, or having to travel to states where abortions are less restricted. The purpose of this study is to determine whether contraception deserts, pharmacists prescribing birth control policies, and restrictive abortion policies increase the likelihood of high maternal and infant mortality. CDC data on the highest and lowest infant and maternal mortality rates of the states mentioned will be used alongside state-level policies about pharmacists' ability to prescribe birth control and states abortion policies. A binary logistic regression with predictors like the presence of contraception deserts, the policy allowing pharmacists to prescribe birth control, and restrictive abortion policies will be conducted. The results of this study can be used to help develop public health education programs on access to contraceptives and state level policies that may affect sexual and reproductive health.