Defining and operationalizing state policy attitudes toward reproductive autonomy, 2010-2023

• In Event: Upstream determinants of health and healthcare decision making, featuring a reproductive health perspective

Abstract

A state’s policy attitude toward reproductive autonomy refers to the executive, legislative, or judicial actions that ultimately decide whether people should have equitable opportunity to make optimal personal decisions about contraception, pregnancy, outcomes of pregnancy, parenthood, and other reproductive health choices across the life course. Legislative “attitudes” are reflected in the policies introduced, rejected, and enacted. The novel legislative construct developed in this study operationalizes the upstream policy determinants of reproductive autonomy, an internationally-recognized human right, and indicator of long term reproductive health and well-being outcomes. While reproductive health policy evaluations often focus on a single policy intervention to understand its association with specific outcomes, there is growing concern for how regimes of policies, or policies operating in aggregate, relate to downstream health outcomes as well. While several studies in and outside of reproductive health have aimed to operationalize the state policy environment, a formal evaluation of methodologies that characterize complex state-level legislative landscapes would improve the ability to analyze the impacts of population-wide exogenous shocks or policy interventions. 

This work builds on a previous study that first defines the multidimensional conceptual construct of the state attitude toward reproductive autonomy and then operationalizes it into an empirical construct. Using five publicly available policy resources, I narrowed the universe of available longitudinal indicators to those relevant to the novel construct proposed in this study. The previous study leveraged this data across social, economic, and healthcare sectors between 2010 and 2024 and outlines the construction of a resulting database that includes 91 policy variables. This study examines five options for variable reduction, or the consolidation of multiple variables into a concise metric or set of metrics, to characterize the state policy environment. Then, this study will deploy the approach best equipped for an empirical examination of the relationship between the state policy attitudes toward reproductive autonomy and population-level birthing-related morbidity, a crucial population health indicator, using state level outcomes reported by the National Vital Statistics System and the Healthcare Cost and Utilization Project.

Preliminary findings favor variable reduction options that exploit the correlated nature of policies across states (i.e. the non-random selection into expansive social, economic, and healthcare policy exposures that advance reproductive autonomy). Methods such as factor analysis or sequence analysis allow for further investigation of policy regimes that do not have the same limitations as a composite score-based index. Composite score metrics, the most common approach in existing literature, subtract the number of restrictive policies from the total number of expansive policies in a given state-year. Composite scores equalize the impact of any individual policy indicator on the outcome of interest, which can induce biases due to policy inclusion and availability.

This project aims to advance the study of state policy environments and their applications to key policy questions about population reproductive health outcomes. Here, I investigate whether incorporating greater nuance in the operationalization of state policy attitudes toward reproductive autonomy can help identify significant policy determinants of population-level reproductive health outcomes.

Author

• Monika Nayak, University of California - Los Angeles
  Presenting Author