title: Reproductive justice & preventable deaths: state funding, family planning, abortion, and infant mortality, US 1980-2010.
abstract: BACKGROUND
  Little current research examines associations between infant mortality and US states' funding for family planning services and for abortion, despite growing efforts to restrict reproductive rights and services and documented associations between unintended pregnancy and infant mortality.
  
  
  METHODS
  We obtained publicly available data on state-only public funding for family planning and abortion services (years available: 1980, 1987, 1994, 2001, 2006, and 2010) and corresponding annual data on US county infant death rates. We modeled the funding as both fraction of state expenditures and per capita spending (per woman, age 15-44). State-level covariates comprised: Title X and Medicaid per capita funding, fertility rate, and percent of counties with no abortion services; county-level covariates were: median family income, and percent: black infants, adults without a high school education, urban, and female labor force participation. We used Possion log-linear models for: (1) repeat cross-sectional analyses, with random state and county effects; and (2) panel analysis, with fixed state effects.
  
  
  RESULTS
  Four findings were robust to analytic approach. First, since 2000, the rate ratio for infant death comparing states in the top funding quartile vs. no funding for abortion services ranged (in models including all covariates) between 0.94 to 0.98 (95% confidence intervals excluding 1, except for the 2001 cross-sectional analysis, whose upper bound equaled 1), yielding an average 15% reduction in risk (range: 8 to 22%). Second, a similar risk reduction for state per capita funding for family planning services occurred in 1994. Third, the excess risk associated with lower county income increased over time, and fourth, remained persistently high for counties with a high percent of black infants.
  
  
  CONCLUSIONS
  Insofar as reducing infant mortality is a government priority, our data underscore the need, despite heightened contention, for adequate public funding for abortion services and for redressing health inequities.
authors.affiliation: Dept of Social and Behavioral Sciences (SBS), Harvard T. H. Chan School of Public Health (HSPH), Boston, MA (USA).
authors.forename: Nancy
authors.initials: N
authors.lastname: Krieger
authors.affiliation: Program on Global Health and Human Rights, Institute for Global Health, Keck School of Medicine; Gould School of Law, University of Southern California, Los Angeles, CA.
authors.forename: Sofia
authors.initials: S
authors.lastname: Gruskin
authors.affiliation: Dept of Biostatistics, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA (USA).
authors.forename: Nakul
authors.initials: N
authors.lastname: Singh
authors.affiliation: Dept of Social and Behavioral Sciences (SBS), Harvard T. H. Chan School of Public Health (HSPH), Boston, MA (USA).
authors.forename: Mathew V
authors.initials: MV
authors.lastname: Kiang
authors.affiliation: Dept of Social and Behavioral Sciences (SBS), Harvard T. H. Chan School of Public Health (HSPH), Boston, MA (USA).
authors.forename: Jarvis T
authors.initials: JT
authors.lastname: Chen
authors.affiliation: Dept of Social and Behavioral Sciences (SBS), Harvard T. H. Chan School of Public Health (HSPH), Boston, MA (USA).
authors.forename: Pamela D
authors.initials: PD
authors.lastname: Waterman
authors.affiliation: Dept of Sociology, Harvard University, Cambridge, MA.
authors.forename: Jason
authors.initials: J
authors.lastname: Beckfield
authors.affiliation: Dept of Biostatistics, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA (USA).
authors.forename: Brent A
authors.initials: BA
authors.lastname: Coull
keywords: abortion; family planning; health inequities; infant mortality; reproductive justice; social policy