Immigration Policy and Preterm Birth Among Hispanic Women in Georgia from 2009-2014 Open Access

Ramirez, Yesenia (Spring 2020)

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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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