216638 Relationship of Paternity Status and Infant Mortality Before and After Welfare Reform

Monday, November 8, 2010 : 9:05 AM - 9:20 AM

Emmanuel Ngui, DrPH, MSc , Department of Pediatrics and Department of Population Health, Medical College of Wisconsin, Center for the Advancement of Underserved Children, Milwaukee, WI
Alicia Cortright, MPH , Infection Prevention and Control, Red Deer Regional Hospital Centre, Red Deer, AB, Canada
Kathleen Blair, RN, MS , Epidemiologist (Retired), City of Milwaukee Health Department, Milwaukee, WI
BACKGROUND: The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) streamlined paternity establishment and reporting and introduced strong child support and enforcement laws. OBJECTIVE: To examine the effects of paternity status on infant mortality (IM) before (1993-1998) and after (1999-2004) PRWORA implementation. METHODS: Analysis of linked birth/infant death singleton data (N= 130,004) from the City of Milwaukee, WI from 1993 to 2004. Models were estimated using logistic regression and adjusted for important covariates (e.g., demographics, smoking, maternal conditions, gestation age). Paternity status measures included unmarried with paternity statement (UPS), court-established paternity (UCEP), no father on record (UNFR), and married with father on record (MFR). RESULTS: Percent of births decreased among UNFR, but increased among UPS and UCEP between pre and post years. Unmarried black women with NFR had 51% lower adjusted odds of IM in pre (OR 0.49 [0.33-0.72]) but not post-PRWORA period. Between the two periods, the likelihood of IM decreased by 11% and 18% among UPS and UCEP, respectively. Prenatal smoking and gestational diabetes were significantly associated with increased IM during post but not PRWORA period. CONCLUSIONS: Findings suggest that establishment of paternity had a protective effect against IM before and after PRWORA. However, IM was significantly lower for unmarried black women with NFR before but not after PRWORA. IMPLICATIONS: Policies and programs that promote paternity establishment and paternal involvement (e.g. fatherhood initiatives, job training, and child support) may help reduce IM. A better understanding of paternal factors and specific welfare changes that influenced IM is needed.

Learning Areas:
Diversity and culture
Public health or related research

Learning Objectives:
1)Examine the changes in paternity status indicated on birth certificates over time 2)Describe the impact of paternity status on infant mortality before and after implementation of welfare reform

Keywords: Infant Mortality, Welfare Reform

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because i initiated and conducted the study in collaboration with my co-authors.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.