ImportanceIn 2017, New York, New York, launched the United States’ first right-to-counsel program, guaranteeing lawyers to low-income tenants in select zip codes, which was associated with reducing eviction risk by half. Given documented associations between evictions during pregnancy and adverse birth outcomes, the right-to-counsel program may be associated with improved birth outcomes.ObjectiveTo measure associations between zip code–level right-to-counsel access and risk of adverse birth outcomes, including preterm birth and low birth weight, among infants born to Medicaid-insured birthing parents.Design, Setting, and ParticipantsThis retrospective cohort study leveraged the staggered rollout of New York’s right-to-counsel program from January 2016 to February 2020 as a natural experiment using a population-based sample of live births to Medicaid-insured birthing parents residing in New York, New York. Data were analyzed from February 2022 to September 2024.ExposureZip code right-to-counsel status 9 months prior to birth.Main Outcomes and MeasuresAdverse birth outcomes were measured using individual birth records from the New York Bureau of Vital Statistics. Outcomes included dichotomous indicators of low birth weight (<2500 g), preterm birth (<37 weeks’ gestation), and a composite of both. Difference-in-differences linear probability models controlled for year, month, and zip code and included clustered standard errors.ResultsAmong 260 493 live births (mean [SD] birthing parent age, 29 [6] years) from January 2016 to February 2020, 43 081 births (17%) were to birthing parents residing in zip codes where right-to-counsel was available during pregnancy. Exposure to right-to-counsel during pregnancy was associated with statistically significant reductions in infants’ probability of adverse birth outcomes, with reductions of 0.73 (95% CI, 0.06-1.41) percentage points in low birth weight, 0.91 (95% CI, 0.10-1.71) percentage points in preterm birth, and 0.96 (95% CI, 0.09-1.84) percentage points in the composite outcome in treated vs untreated zip codes.Conclusions and RelevanceThis cohort study found that right-to-counsel was associated with reduced risk of adverse birth outcomes among Medicaid-insured birthing parents. These findings suggest that eviction prevention via right-to-counsel may have benefits that extend beyond the courtroom and across the life-course.

中文翻译：

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纽约州纽约市的租户律师权和不良出生结果


重要性2017 年，纽约州纽约市启动了美国第一个律师权计划，为选定邮政编码的低收入租户提供律师服务，这与将驱逐风险降低一半有关。鉴于怀孕期间驱逐与不良分娩结局之间的关联记录在案，咨询权计划可能与分娩结局的改善有关。目的测量 Medicaid 保险分娩父母所生婴儿的邮政编码级律师权与不良出生结局风险之间的关联，包括早产和低出生体重。设计、设置和参与者这项回顾性队列研究利用 2016 年 1 月至 2020 年 2 月纽约州律师权计划的交错推出作为一项自然实验，使用基于人群的样本，将居住在纽约州纽约市的医疗补助保险分娩父母的活产婴儿样本。数据分析了 2022 年 2 月至 2024 年 9 月的数据。主要结局和措施使用纽约人口统计局的个体出生记录来测量不良出生结局。结局包括低出生体重的二分类指标 （<2500 g）、早产 （<妊娠 37 周），以及两者的复合体。双重差分中的差分线性概率模型控制了年、月和邮政编码，并包括聚类标准误差。结果在 2016 年 1 月至 2020 年 2 月的 260 493 例活产婴儿 （平均 [SD] 生育父母年龄，29 [6] 岁） 中，43 081 例 （17%） 出生的出生父母居住在怀孕期间有律师权的邮政编码地区。 怀孕期间接触咨询权与婴儿不良出生结局概率的统计学显著降低相关，低出生体重降低 0.73 （95% CI，0.06-1.41） 个百分点，早产降低 0.91 （95% CI，0.10-1.71） 个百分点，治疗与未治疗的邮政编码复合结局降低 0.96 （95% CI，0.09-1.84） 个百分点。结论和相关性该队列研究发现，在 Medicaid 保险的分娩父母中，获得律师的权利与不良分娩结局风险降低有关。这些发现表明，通过律师权防止驱逐的好处可能超越法庭并贯穿整个生命历程。