Political Ideology Direction of Policy Agendas and Maternal Mortality Outcomes in the U.S., 1915–2007.

Objectives: The causes for persistently high and increasing maternal mortality rates in the United States have been elusive. Methods: We use the shift in the ideological direction of the Republican and the Democratic parties in the 1960s, to test the hypothesis that fluctuations in overall and race-specific maternal mortality rates (MMR) follow the power shifts between the parties before and after the Political Realignment (PR) of the 1960s. Results: Using time-series data analysis methods, we find that, net of trend, overall and race-specific MMRs were higher under Democratic administrations than Republican ones before the PR (1915–1965)—i.e., when the Democratic Party was a protector of the Jim Crow system. This pattern, however, changed after the PR (1966–2007), with Republican administrations underperforming Democratic ones—i.e., during the period when the Republican Party shifted toward a more economically and socially conservative agenda. The pre-post PR partisan shifts in MMRs were larger for Black (9.5%, p <. 01 ) relative to White mothers (7.4%, p <. 05 ) during the study period. Conclusions for Practice: These findings imply that parties and the ideological direction of their agendas substantively affect the social determinants of maternal health and produce politized health outcomes. Significance: What Is Already Known on This Subject?: The causes for persistently high and increasing maternal mortality rates in the United States have been elusive. What This Study Adds?: We find that, net of trend, MMRs are higher under the most racially-conservative party of the period: The Democratic Party before the Political Realignment, the Republican Party after. Institutionalized racism—in the form of racialized federal-level policy—has detrimentally affected the health of all in the past century. Our findings bear important implications for political science, medical sociology, public health, and policy: A deep understanding of political processes is necessary for promoting health equity. [ABSTRACT FROM AUTHOR]