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.

美国最高法院 2022 年 6 月对多布斯诉杰克逊妇女健康组织案做出的裁决结果， 美国的生殖保健领域正处于剧烈而快速的变化之中。 裁决后 100 天内，14 个州禁止或严格限制堕胎；超过 未来几个月，可能会有更多的企业效仿。美国堕胎机会的突然变化是 受影响的个人数量和受影响国家的数量都是史无前例的 在不久的将来颁布进一步的限制措施仍存在很大的不确定性。本项目 解决了对基线数据的迫切需要，以反映国家堕胎限制预期的影响 未来几个月孕妇的健康状况以及对堕胎情况进行高质量评估的必要性 正规医疗保健系统内外的发病率。如果没有这些数据，初级公共卫生 国家的指标将无法获得，政策制定者、项目开发商、服务提供商、 研究人员和公众拥有了解这些影响所需的基于研究的证据 现在和未来的堕胎政策。 为了满足这一迫切需求，我们提出了四个相互关联的目标。从 R61 阶段（目标 1）的第一个月开始， 我们将开始数据收集活动，以衡量正规卫生部门内外堕胎的变化 预计国家级政策将发生快速变化。在目标 1a 中，我们将收集有关堕胎的数据 使用新的自适应每月堕胎监测系统在正规卫生部门内进行， 对提供堕胎护理的卫生机构的代表性样本进行调查。我们将制作面向公众的 利用数十年历史设施水平对全国设施堕胎率进行每月估计 贝叶斯分层模型中的堕胎数据以提高精度。在目标 1b 中，我们将收集以下数据 发生在正规医疗保健部门之外的堕胎，衡量与堕胎相关的并发症和 通过调查 SMA 用户和提供者，了解人们自我管理堕胎 (SMA) 的医疗保健需求。 目标 1 中收集的数据将用于 R33 阶段，以衡量国家政策变化的影响并提供信息 对正规医疗保健部门之外的堕胎发生率进行估计。在目标 2 中，我们将评估 项目第一年期间实施的国家堕胎限制，限制获得基于设施的堕胎人数 堕胎及其怀孕孕龄，以及跨州旅行以获得设施的发生率 基于堕胎护理。在目标 3 中，我们将采用在美国以外广泛使用的方法来估计 限制性条件下的堕胎，以估计正规医疗之外的自我管理堕胎发生率 部门。最后，在目标 4 中，我们将结合设施堕胎和自我管理堕胎的数据来估计 全国堕胎发生率和与堕胎相关的健康结果。