State-Level Abortion Policy Hostility and Unplanned Births in the Pre-Dobbs Era

An increas ingly hos tile pol icy cli mate has reshaped abor tion access the United States. Recent lit er a ture has stud ied the effects of restric tive abor tion pol- icies on reproductive health outcomes. This study is the first to investigate the asso- ci a tion between state -level abor tion pol icy hos til ity and the preg nancy inten tions women with a preg nancy resulting in live birth. Data are from the Pregnancy Risk Assessment Monitoring System sur vey, merged with a state -level leg is la tive data- base from 2012-2018 and other state -level con trols. Cross-sec tional results reveal that a one -unit increase in abor tion pol icy hos til ity is asso ci ated with a rel a tive risk (odds) of hav ing a live birth resulting from an unin tended ver sus intended preg nancy that is 1.02 times as high (RRR = 1.02, 95% confidence interval = 1.01, 1.03). This result cor re sponds to a 13% increase in the predicted prob a bil ity of hav ing a live birth resulting from an unin tended preg nancy between a zero-hos til ity and a max i mum- hostility state. Models stratified by demographic and socioeconomic characteristics reveal that the asso ci a tion between abor tion pol icy hos til ity and live birth resulting from an unin tended preg nancy is par tic u larly robust among women in youn ger, less educated, Medicaid, uninsured, and rural populations.