The Impact of State Safety-Net Policies on Perinatal Birth Outcomes by Maternal Race.

OBJECTIVE:To examine the association between state safety-net policy robustness and rates of low birthweight and preterm births (2007-2018). METHODS:We created a state safety-net policy robustness index incorporating policies related to administrative burden, benefits, and eligibility for seven programs that provide health insurance, food, shelter, and cash assistance. Using quasi-Poisson regression models (state and year fixed effects, time-varying confounders), we assessed the association between policy robustness and low birthweight and preterm birth rates and examined differential associations by race/ethnicity via stratified models. RESULTS:Our sample consisted of 2922 state-year-race observations for preterm births and 2017 observations for low birthweight births. Our stratified findings suggest that more robust safety-net policies (e.g., more benefits, greater eligibility, and less administrative burden) are associated with declines in low birthweight and preterm birth among historically marginalized and racialized groups, including infants born to Asian and Pacific Islander, Black, and Hispanic birthing people. CONCLUSIONS:The combination of state safety-net programs may imply important roles in reducing the prevalence of low birthweight and preterm birth.