State-Level Social and Economic Policies and Their Association With Perinatal and Infant Outcomes

Jessica L. Webster, David Paul, Jonathan Purtle, Robert Locke, Neal D. Goldstein

Research output: Contribution to journalArticlepeer-review


Policy Points State-level social and economic policies that expand tax credits, increase paid parental leave, raise the minimum wage, and increase tobacco taxes have been demonstrated to reduce adverse perinatal and infant health outcomes. These findings can help prioritize evidence-based legislated policies to improve perinatal and infant outcomes in the United States. Context: Rates of preterm birth and infant mortality are alarmingly high in the United States. Legislated efforts may directly or indirectly reduce adverse perinatal and infant outcomes through the enactment of certain economic and social policies. Methods: We conducted a narrative review to summarize the associations between perinatal and infant outcomes and four state-level US policies. We then used a latent profile analysis to create a social and economic policy profile for each state based on the observed policy indicators. Findings: Of 27 articles identified, nine focused on tax credits, eight on paid parental leave, four on minimum wages, and six on tobacco taxes. In all but three studies, these policies were associated with improved perinatal or infant outcomes. Thirty-three states had tax credit laws, most commonly the earned income tax credit (n = 28, 56%). Eighteen states had parental leave laws. Two states had minimum wage laws lower than the federal minimum; 14 were equal to the federal minimum; 29 were above the federal minimum; and 5 did not have a state law. The average state tobacco tax was $1.76 (standard deviation = $1.08). The latent profile analysis revealed three policy profiles, with the most expansive policies in Western and Northeastern US states, and the least expansive policies in the US South. Conclusions: State-level social and economic policies have the potential to reduce adverse perinatal and infant health outcomes in the United States. Those states with the least expansive policies should therefore consider enacting these evidence-based policies, as they have shown a demonstratable benefit in other states.

Original languageEnglish (US)
Pages (from-to)218-260
Number of pages43
JournalMilbank Quarterly
Issue number1
StatePublished - Mar 2022


  • infant mortality
  • latent profile analysis
  • low birthweight
  • policy
  • premature birth
  • review
  • Premature Birth
  • Public Policy
  • Infant Mortality
  • United States
  • Humans
  • Income
  • Infant
  • Pregnancy
  • Taxes
  • Female
  • Infant, Newborn

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy


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