We analyzed data from the National Abortion Rights Action League Foundation (NARAL) and the National Center for Health Statistics to assess whether abortion policies affect the birth prevalence of Down syndrome. The NARAL data reports if publicly funded health care includes abortion services in case of life endangerment (all states), rape or incest (20 states), fetal deformity (15 states) or all or most circumstances (12 states). The study population included live births to African American (N=656,987) and Non-Hispanic Whites (N=2,587,922) in 1990. Statistical analyses included ethnicity-specific multi-level (hierarchical) logistic regression models; individual-level covariates were maternal age, education, marital status, paternal education and prenatal care and the state-level covariate was the policy on public financing of abortions. For non-Hispanic Whites, the maternal age-adjusted risk of Down syndrome was about 40 % lower in the 12 states in which publicly funded health care included abortion services for all or most circumstances [age-adjusted Odds Ratio, 0.61, 95 % CI, 0.42-0.88]; this association was essentially unchanged after adjustment for individual-level SES factors [age- and SES- adjusted Odds Ratio, 0.64, 95 % CI, 0.44-0.93]. For African Americans the effect sizes were smaller in magnitude; age- and age- and SES- adjusted odds ratios were 0.77 and 0.82 respectively; and did not reach statistical significance – perhaps in part due to their smaller number of births, and hence Down syndrome cases. Future studies should assess whether this association between abortion policies and cases of Down syndrome is due to differences in access or use of prenatal diagnosis.
Learning Objectives: 1. Recognize that there are significant variations in state-level birth prevalence of Down syndrome in the United States. 2. Articulate the main finding of the study that states in which publicly funded health care includes abortion services for all or most circumstances have substantially lower age- and socioeconomic status- adjusted birth prevalence of Down syndrome
Keywords: Abortion, Birth Defects
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
The 128th Annual Meeting of APHA