LAUSR

ABSTRACT Objective We leverage state-level variability in social policies that confer legal protections for sexual minorities (e.g., employment nondiscrimination acts) and examine their association with birth outcomes among sexual minority women. Methods We link measures of structural protections (i.e., social policies) to a prospective, population-based cohort of US adults—the National Longitudinal Study of Adolescent to Adult Health (n = 7913 total singleton births, n = 274 singleton births to bisexual women, n = 53 singleton births to lesbian women)—which includes measurement of key risk factors for birth outcomes over the life course. Results Lesbian, gay, bisexual (LGB) policy protections were associated with better birth outcomes for lesbian women. For example, among lesbian women, the predicted birth weight for infants in states with no policy protections was 3.01 kg (95% confidence interval = 2.71–3.30) but was 3.71 kg (95% confidence interval = 3.46–3.96) in states with three or four policy protections. In negative control analyses, there was no association between LGB policy protections and birth outcomes among the nonstigmatized group (i.e., heterosexual women), providing evidence of specificity. Furthermore, in states with the most LGB policy protections, lesbian women were at lower risk for preterm births and had infants with higher birth weights than heterosexual and bisexual women. These associations remained robust after adjusting for 13 risk factors, including demographics, prior and current indicators of socioeconomic status, preconception and perinatal risk factors, and neighborhood characteristics. Conclusions These results provide novel evidence that sexual orientation–related policy protections, measured at the state level, are associated with a decreased risk for adverse birth outcomes among lesbian women.