State reproductive rights policies and unintended pregnancy.

Objective: States' reproductive health policies may have consequences for the rate of unintended pregnancy. This study analyzed the association of states' reproductive rights policies with the likelihood of respondents reporting unintended (wanted later and unwanted pregnancies) and unwanted pregnancy. Study design: This was a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System using 2016-2019 data from 43 states and DC. Institute for Women's Policy Research state reproductive rights rankings were used to categorize states as having restricted, some protection, or protected reproductive rights. Poisson regressions were used to estimate the associations of state reproductive rights rankings with unintended and unwanted pregnancies, controlling for individual-level sociodemographic characteristics. A sensitivity analysis restricted to Medicaid-covered births was performed. Results: A total of 154,062 respondents represented a weighted population of 7,826,006 of whom 25.6% reported an unintended and 6.6% an unwanted pregnancy. When compared to states with protected reproductive rights, states with restricted reproductive rights had a 6% higher likelihood of unintended pregnancy (IRR 1.07, 95% CI 1.04, 1.10). This association was amplified when limited to a Medicaid population (13% higher likelihood, IRR 1.13, 95% CI 1.08, 1.17). Conclusion: State reproductive rights rankings were associated with unintended and unwanted pregnancies. Further restricting reproductive rights at the state level may increase this already major health and economic burden.