Immigration Policy and Preterm Birth Among Hispanic Women in Georgia from 2009-2014 Open Access
Ramirez, Yesenia (Spring 2020)
Abstract
Background: Immigration remains one of the most divisive policy topics debated in state legislatures. In 2011, the Georgia House Bill 87 (HB 87) was enacted and cultivated a prevalent anti-immigrant environment that increased fear, anxiety, and stress throughout Hispanic communities. The purpose of the law remains to apprehend and remove undocumented individuals from the state. Few studies have analyzed the effect of immigration policy on birth outcomes and none have analyzed HB 87 as a primary exposure to preterm birth.
Objective: The goal of this study is to evaluate the measure of effect of HB 87 implementation on preterm birth risk among Hispanic women in Georgia.
Methodology: Using vital records data from 2009-2014 for all singleton live-births to Hispanic mothers in Georgia and Florida, difference-in-difference modeling with fixed effects was used to estimate the intervention effect. Triple difference models were used to estimate the interaction across nativity status or Hispanic origin. Logistic regression was used to determine the validity of model assumptions, while Wald and likelihood ratio tests were used to determine the statistical significance of model coefficients. All statistical analyses was conducted in SAS.
Results: After adjusting for maternal education, age, Medicaid status, nativity, Hispanic origin, and early entry into prenatal care, the risk of preterm birth was 11% lower among Hispanic women in Georgia relative to what would have been expected in absence of the law (RR: 0.89; 95 % CI: (0.86, 0.93)). There was a slight 3% increase in risk of preterm delivery among women of Mexican, South or Central American origin, although the results straddle the null (RR: 1.03; 95% CI: (0.94, 1.12)). Contrarily, women of Puerto Rican, Cuban and other Hispanic origin experienced a decrease in risk of the outcome (RR: 0.92; 95% CI: (0.83, 1.03)). Lastly, HB 87 was most protective against foreign born women, with a decreased risk of 16% (RR: 0.84; 95% CI (0.80,0.90)).
Discussion: Results for this analysis were contrary to the established hypothesis which predicted a harmful effect of the law. However, findings from models assessing interaction by Hispanic origin suggest that the level of risk varies across groups.
Table of Contents
Table of Contents
Introduction 2
Problem Statement 3
Preterm Birth 3
Post-911 Immigration Policy Overview 4
Purpose Statement 7
Background 8
Restrictive Immigration Policies (2010 – 2011) 8
Arizona: SB 1070 8
Georgia: HB 87 9
Politics of Places 12
Immigration Policy Formation 12
Policy as a Social Determinant of Health: Pregnancy & Infant Outcomes 13
Immigration Policy and Latino Health 15
Health Care Utilization 15
Mental & Physical Health 16
Immigration Policy & Birth Outcomes 19
Immigration Raids 19
State Omnibus Bills 19
Georgia 22
Methods 24
Data Sources 24
Study Sample 24
Exposure 24
Outcome 25
Target Population 25
Statistical Analyses 25
Additional Covariates 27
Results 30
Discussion 34
Tables 39
Figures 43
References 46
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