New Title X Regulations: Assessing the Impact on Reproductive Health

项目总结/摘要 标题X计划生育计划是我们的医疗保健安全网的一个重要组成部分，提供联邦- 自1970年以来，为妇女提供有资金的低成本避孕和生殖健康服务。2019年8月，健康 和人类服务部（HHS）为该计划实施了重要的新规定，包括那些 禁止标题X资助的医疗中心转介堕胎服务，即使是在病人要求的情况下- 导致五分之一的受助者退出该计划。因为Title X客户不成比例地 种族/少数民族，和标题X卫生中心往往是唯一的来源，生殖保健在农村 人们担心，这一政策变化将加剧现有的种族和地理相关的健康问题。 差距。例如，在美国，大约45%的怀孕是意外的，但它们更常见。 在低收入和少数民族妇女中，她们也面临更高的不良妊娠结果风险， 包括产妇发病率和死亡率。我们建议描述这一政策变化对以下方面的影响 在获得保健服务和保健结果方面存在种族和地域差异。回答批评 知识差距，我们建议利用自然实验发生在密歇根州，其中超过一半的 第十条资金将需要重新分配给不同的组织或闲置。我们将遵循 以下目标：（1）描述标题X受助人概况，支出和地理位置的变化， 2017年至2022年之间的密歇根州社区。为此，我们将具体研究是否发生变化， 对农村或少数民族社区产生不同影响。(2)描述Title X客户特征的变化， 2017年至2022年密歇根州各县的医疗服务提供率。为此，我们亦会采纳及 审查生殖健康服务提供的新措施，并确定农村社区或 少数种族受到变化的不同影响。(3)确定Title X策略更改是否与 密歇根州社区妇女生殖健康结果的变化。在这个最终目标中，我们将 检查健康结果内和跨地理，收入和种族群体。我们将公开使用 密歇根州卫生与公众服务部，HHS和密歇根州卫生和公众服务部收集的可用数据 住院病人抽样，观察性传播感染/艾滋病毒、低出生体重和 政策改变前两年和政策改变后两年， （2017-2022年）。

Project Summary/Abstract The Title X Family Planning Program is a critical component of our health care safety net, providing federally- funded, low-cost contraceptive and reproductive health services for women since 1970. In August 2019, Health and Human Services (HHS) implemented significant new regulations for the program—including those that prohibit Title X-funded health centers from referring for abortion services even when requested by the patient— resulting in 1 in 5 grantees withdrawing from the program. Because Title X clients are disproportionately racial/ethnic minorities, and Title X health centers are often the only source of reproductive health care in rural areas, there is concern that this policy change will exacerbate existing racial- and geographic-related health disparities. For instance, about 45% of all pregnancies in the U.S. are unintended, but they are more common among low-income and minority women, who are also at higher risk for adverse pregnancy outcomes, including maternal morbidity and mortality. We propose to characterize the impact of this policy change on racial and geographic disparities in access to health services and health outcomes. To answer critical knowledge gaps, we propose to leverage the natural experiment occurring in Michigan, where more than half of Title X funding will need to be reallocated to different organizations or go unused. We will be guided by the following aims: (1) Characterize changes in Title X grantee profiles, spending, and geographic location in Michigan communities between 2017 and 2022. In this aim, we will specifically examine if changes differentially impact rural or minority communities. (2) Characterize changes in Title X client characteristics and health service delivery rates in Michigan counties between 2017 and 2022. In this aim, we will also adopt and examine a novel measure of reproductive health service availability and determine if rural communities or racial minorities are differentially impacted by changes. (3) Determine if the Title X policy change is associated with changes in women’s reproductive health outcomes in Michigan communities. In this final aim, we will examine health outcomes within and across geographic, income, and racial groups. We will use publicly available data collected by the Michigan Department of Health and Human Services, HHS, and the Michigan Inpatient Sample to observe changes in rates of sexually transmitted infection/HIV, low birth weight, and severe maternal morbidity in Michigan communities two years before and two years after the policy change (2017-2022).