The impact of new state restrictions on abortion incidence and safety in the United States

新的州限制对美国堕胎发生率和安全的影响

• 批准号: 10738649
• 负责人: Elizabeth Anne Sully
• 金额: $ 59.42万
• 依托单位: GUTTMACHER INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-05 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10738649
• 关键词: Address; Affect; Bayesian Modeling; Caring; Collection; Data; Data Collection; Decision Making; Dedications; Elements; Face; Family; Family Planning; Foundations; Future; Gestational Age; Health; Health Care Sector; Health care facility; Healthcare; Healthcare Systems; Incidence; Individual; Infrastructure; Legal; Legal Status; Link; Measurement; Measures; Methodology; Methods; Morbidity - disease rate; Outcome; Persons; Phase; Policies; Policy Maker; Population Surveillance; Pregnancy; Procedures; Provider; Public Health; Publishing; Reporting; Reproductive Health; Research; Research Personnel; Risk; Safety; Sampling; Self Management; Societies; Surveys; System; Testing; Travel; Uncertainty; United States; Update; Women' s Health; abortion; court; critical period; design; evidence base; experience; flexibility; health organization; improved; innovation; mortality; novel; novel strategies; population health; pregnant; programs; service providers

As a result of the US Supreme Court's June 2022 decision in Dobbs v. Jackson Women's Health Organization, the landscape of reproductive health care in the United States is in the midst of seismic and rapid change. Within 100 days of the ruling, fourteen states either banned or severely restricted abortion provision; over the coming months, many more are likely to follow suit. The abrupt changes in access to abortion in the US are without precedent in terms of the number of individuals who are affected and the number of states in which there remains substantial uncertainty around enactment of further restrictions in the near future. This project addresses the urgent need for baseline data to capture the impact of state abortion restrictions expected over the coming months on the health of pregnant people, as well as the need for high quality estimates of abortion incidence both within and outside of the formal health care system. Without these data, primary public health indicators for the nation will not be available, nor will policy makers, program developers, service providers, researchers and the public have the research-based evidence needed to understand the impact of these abortion policies now and going forward. To address this critical need, we propose four linked aims. Starting in the first month of the R61 phase (Aim 1), we will begin data collection activities to measure change in abortion within and outside the formal health sector during a period of anticipated rapid state-level policy change. In Aim 1a, we will collect data on abortions occurring within the formal health sector using a new and adaptive monthly abortion surveillance system, surveying representative samples of health facilities providing abortion care. We will produce public facing monthly estimates of facility-based abortion incidence nationally, leveraging decades of historical facility-level abortion data in a Bayesian hierarchical model to improve precision. In Aim 1b, we will collect data on abortions occurring outside of the formal health care sector, measuring abortion-related complications and the healthcare needs of people self-managing abortions (SMA) by surveying SMA users and providers. Data collected in Aim 1 will be used in the R33 phase to measure the impact of state policy change and inform estimation of abortion incidence outside the formal health care sector. In Aim 2, we will assess the impact of state abortion restrictions implemented during project year 1 on the number of people obtaining facility-based abortions and the gestational age of their pregnancies, and the incidence of interstate travel to obtain facility- based abortion care. In Aim 3, we will adapt a methodology used extensively outside of the US to estimate abortion under restrictive conditions to estimate self-managed abortion incidence outside of the formal health sector. Finally, in Aim 4, we will combine data on facility-based and self-managed abortions to estimate the national incidence of abortion and abortion-related health outcomes.

由于美国最高法院2022年6月在多布斯案案杰克逊妇女健康组织的裁决， 在美国，生殖保健的景观正处于地震和快速变化之中。 在裁决后的100天内，有14个州被禁止或严格限制堕胎条款；在 接下来的几个月，还有更多可能会效仿。美国的突然发生堕胎的可能发生变化是 没有先例，就受影响的个人数量和 在不久的将来颁布进一步限制的情况下仍然存在很大的不确定性。这个项目 解决了对基线数据的迫切需求，以捕获预期的国家堕胎限制的影响 未来几个月关于孕妇的健康以及对堕胎的高质量估计的需求 正式医疗保健系统内外的发病率。没有这些数据，初级公共卫生 国家的指标将不可用，决策者，计划开发人员，服务提供商也不会有 研究人员和公众拥有基于研究的证据来了解这些影响 现在堕胎政策并继续前进。 为了满足这一关键需求，我们提出了四个链接的目标。从R61阶段的第一个月开始（AIM 1）， 我们将开始数据收集活动，以衡量正式健康内外的堕胎变化 在预期的快速国家政策变更时期内部门。在AIM 1A中，我们将收集有关堕胎的数据 使用新的和适应性的每月堕胎监视系统在正规卫生部门内发生， 调查提供堕胎护理的医疗机构的代表样本。我们将建立公众面对面 每月估算全国设施的堕胎发生率，利用数十年的历史设施级别 贝叶斯分层模型中的堕胎数据以提高精度。在AIM 1B中，我们将收集数据 堕胎发生在正式的医疗保健部门之外，测量与堕胎有关的并发症和 通过调查SMA用户和提供者，自我管理堕胎（SMA）的医疗保健需求。 AIM 1收集的数据将在R33阶段使用，以衡量国家政策变更的影响并告知 估计正式医疗保健部门以外的堕胎发生率。在AIM 2中，我们将评估 在项目第1年实施的国家堕胎限制对获得基于设施的人数的人数 堕胎和怀孕的胎龄以及州际旅行的发生率以获得设施 - 基于堕胎护理。在AIM 3中，我们将适应美国以外的广泛使用的方法来估算 在限制条件下堕胎以估计正式健康之外的自我管理的堕胎发生率 部门。最后，在AIM 4中，我们将结合有关基于设施和自我管理的堕胎的数据，以估算 堕胎和与堕胎有关的健康成果的国家发病率。