The authors of a recent study found that Black women in the United States have a lower risk of giving birth to low birth weight babies if they live in states with less restrictive reproductive rights, when compared with women who live in states with more restrictive policies.1

“Our study found that, overall, women in states with less restrictive reproductive policies give birth to healthier babies,” says May Sudhinaraset, PhD, associate professor in the department of community health sciences at the University of California, Los Angeles. “Low birth weight risk was 8% lower among Black women living in states with the least restrictive reproductive rights policies, compared with their counterparts in the most restrictive states.”

The study was a retrospective, cross-sectional analysis of all births within 50 states and the District of Columbia, using 2016 birth record data. “The United States has a long history of reproductive policies that have worked against women of color, particularly Black women, including involuntary sterilizations or targeting Black women for contraceptive technologies,” Sudhinaraset says. “This has led to infringements on Black women’s reproductive autonomy and results in mistrust of the broader healthcare system.”

The study results provide evidence that less restrictive reproductive rights policies may improve outcomes for women, their children, and their communities, she adds.

Restrictive policies include:

  • restricted access to information or essential health services;
  • requiring parental consent for minors seeking abortions;
  • mandatory waiting periods for abortion services;
  • lack of public funding for abortions;
  • living in counties without an abortion provider;
  • lack of expanded access for Medicaid family planning services;
  • little or no access to evidence-based sex education in schools.

“States were categorized into three categories of most restrictive, moderately restrictive, and least restrictive,” Sudhinaraset explains.

Sudhinaraset and colleagues studied the reproductive rights policies of 2015, which was the preconception period before women delivered in 2016. It did not compare results within a state that might have changed its policy over the years.

“We did not look at individual policies, and, therefore, did not look at states pre- and post-policy,” Sudhinaraset notes. “This is an area of great interest for future research, given the increasing attacks on reproductive autonomy and reproductive policies in our country.”

State efforts to improve prenatal care and reduce the rates of low birth weight babies have not reached all women, which is a problem the study results highlight. “While there have been efforts to improve quality of care and state campaigns to improve prenatal care, there are still women who are left behind,” Sudhinaraset says. “This includes studies that have found that Black women and women of color are more likely to be disrespected and mistreated during childbirth and less likely to use prenatal care, despite efforts to improve prenatal care.”

The study sheds light on how reproductive rights policies are an overlooked social determinant of health, she adds.

“Restrictive reproductive rights may not only restrict access to essential healthcare services, but it can also cause stress during pregnancy, leading to adverse birth outcomes,” Sudhinaraset explains. “The cumulative exposure to restrictive policies have disproportionately impacted women of color and have served as a form of structural racism and tool of oppression.”


  1. Sudhinaraset M, Vilda D, Gipson JD, et al. Women’s reproductive rights policies and adverse birth outcomes: A state-level analysis to assess the role of race and nativity status. Am J Prev Med 2020;59:787-795.