New Title X Regulations: Assessing the Impact on Reproductive Health

项目摘要/摘要 第十条计划生育计划是我们医疗保障网络的重要组成部分，为联邦政府提供- 自1970年以来，为妇女提供资助的低成本避孕和生殖健康服务。2019年8月，《健康》 和人类服务(HHS)为该计划实施了重要的新法规-包括那些 禁止由TITLE X资助的医疗中心提供堕胎服务，即使患者提出要求- 导致五分之一的受赠者退出该计划。因为TITLX客户不成比例地 种族/少数民族和第十条保健中心往往是农村生殖保健的唯一来源 在这些地区，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 差距。例如，在美国，大约45%的怀孕是意外的，但它们更常见 在低收入和少数族裔妇女中，她们不良妊娠结局的风险也更高， 包括产妇发病率和死亡率。我们建议将这一政策变化的影响描述为 在获得保健服务和健康结果方面存在种族和地理差异。回答关键问题 知识差距，我们建议利用在密歇根州进行的自然实验，那里有超过一半的人 第X章的资金将需要重新分配给不同的组织，否则将被闲置。我们将以 以下目标：(1)描述TITLE X受让人概况、支出和地理位置的变化 2017年至2022年期间的密歇根州社区。在这一目标中，我们将具体检查是否发生了变化 对农村或少数族裔社区产生不同影响。(2)表征标题X客户特征的变化，以及 2017年至2022年期间密歇根县的医疗服务提供率。在这一目标中，我们还将通过和 审查生殖健康服务可获得性的新衡量标准，并确定农村社区或 少数族裔受到变化的影响不同。(3)确定标题X政策更改是否关联 随着密歇根州社区女性生殖健康结果的变化。在这个最终目标中，我们将 检查地理、收入和种族群体内部和跨群体的健康结果。我们将公开使用 密歇根州卫生与公众服务部、HHS和密歇根州政府收集的可用数据 住院患者样本观察性传播感染/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密歇根州社区的严重孕产妇发病率 (2017-2022)。

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).