Term of Award
Summer 2025
Degree Name
Doctor of Public Health (Dr.P.H.)
Document Type and Release Option
Dissertation (restricted to Georgia Southern)
Copyright Statement / License for Reuse
This work is licensed under a Creative Commons Attribution 4.0 License.
Department
Department of Health Policy and Community Health
Committee Chair
Joanne Chopak-Foss
Committee Member 1
Tilicia Mayo-Gamble
Committee Member 2
Logan Cowan
Committee Member 3
Samuel Opoku
Abstract
Introduction: Restrictive abortion policies have expanded across the U.S., creating barriers to reproductive healthcare that may impact maternal health. Hypertensive disorders of pregnancy (HDP), a leading cause of maternal morbidity and mortality, could be influenced by such policies. While previous studies have linked restrictive abortion laws to poor maternal and infant outcomes, little is known about their specific relationship with HDP.
Objective: This study aimed to examine the association between state-level abortion policy restrictiveness and the odds of HDP among U.S. women in 2018 and 2021.
Methods: A quantitative cross-sectional analysis was conducted using 2018 and 2021 data from the National Center for Health Statistics (NCHS) Birth – Limited Geography dataset. A composite index of abortion policy restrictiveness, based on 12 enacted policies, categorized states into tertiles (low, moderate, high restrictiveness). Generalized linear mixed models (GLMMs) with a binomial distribution and logit link were used to assess the relationship between abortion policy restrictiveness and HDP, adjusting for maternal demographic, socioeconomic, and health factors. State-level random intercepts accounted for clustering. To assess moderation effects, an additional GLMM was specified with interaction terms between abortion policy restrictiveness and selected moderators: maternal age, race/ethnicity, insurance type, and pre-pregnancy BMI. This model tested whether the strength or direction of the association varied across subgroups defined by these individual-level characteristics.
Results: No significant association was found between highly restrictive abortion policies and HDP in either 2018 (OR = 0.979, 95% CI: 0.852–1.125, p = 0.764) or 2021 (OR = 0.926, 95% CI: 0.790–1.084, p = 0.341). In 2018, moderate restrictiveness was associated with slightly lower odds of HDP (OR = 0.886, 95% CI: 0.791–0.992, p = 0.036), but this was not replicated in 2021. Furthermore, significant interaction effects revealed abortion policy restrictiveness influenced odds of HDP across age, race, insurance, BMI.
Discussion: Restrictive abortion policies alone do not significantly affect HDP odds. Instead, maternal sociodemographic factors are more influential. These findings highlight the need for further research on how broader social determinants of health and access to reproductive care intersect with pregnancy-related complications like HDP.
Recommended Citation
Riggins, Alisha, "The Impact of Restrictive Abortion Policies on Hypertensive Disorders of Pregnancy in the United States, 2018 and 2021" (2025). Theses & Dissertations. 3000.
https://digitalcommons.georgiasouthern.edu/etd/3000
Research Data and Supplementary Material
No
