Time-Sensitive Research to Assess the Effects of Reproductive Health Policy on the Health Outcomes of People with Chronic Diseases

摘要 2022年6月，美国最高法院对多布斯诉杰克逊妇女健康案的裁决推翻了罗诉韦德案， 在全国范围内取消对堕胎准入的联邦保护。多布斯的决定迅速颠覆了五十年的历史 法律先例和医疗政策。州立法机构提出，已有14个州禁止堕胎 85项保护或限制堕胎机会的法案，8个州的法院暂时阻止了 堕胎禁令。目前有3360多万有生育能力的人生活在禁止堕胎的州 或者很可能受到严格的限制。这些迅速变化的政策对堕胎机会的影响将是 然而，这些政策对公共卫生指数的影响尚不清楚。患有慢性病的人 而复杂的医疗条件特别容易受到以下不利健康后果的影响 堕胎政策。在基线水平上，这些人罹患严重孕产妇发病率和孕产妇死亡率的风险很高。 死亡率与其他分娩的人相比。在多布斯决定之前，堕胎护理允许终生- 改变那些潜在健康状况使健康怀孕复杂化的人的护理。然而，几乎没有人 研究描述了堕胎对慢性病患者的健康和福祉的影响； 因此，目前还不清楚Dobbs的决定将如何影响他们的临床结果。我们的研究，调查时间- Dobbs后对慢性病患者的敏感生殖健康公平性(无畏)，将评估 不断演变的堕胎政策对患者的健康和福祉具有时间敏感性的影响，特别是 患有慢性病的人会增加严重孕产妇发病率和孕产妇死亡率的风险(例如， 心血管疾病、癌症、系统性红斑狼疮)； 慢性病患者；以及人口一级的下游临床结果。我们将使用调查- 基于定性和流行病学的方法，以实现我们的特定目标，即：1)评估， 在寻求堕胎的人中，能够或不能够获得通缉堕胎，并评估他们的 与健康和福祉有关的纵向结果；2)在医生中评估堕胎的影响 关于医疗决策和实践的政策；以及3)提供关于堕胎影响的新证据 关于基于人口的妊娠结局的政策(例如，严重的孕产妇发病率、孕产妇死亡率)和 与医疗保健相关的结果(例如，避孕和开出致畸药物处方)。无畏的人 研究团队在医学、产科、计划生育研究、卫生公平、 卫生政策和流行病学。我们的项目旨在为健康政策提供信息，以优化生殖 后多布斯时代的医疗保健和临床结果。

ABSTRACT In June 2022, the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health overturned Roe v. Wade, eliminating federal protections for abortion access nationwide. The Dobbs decision rapidly upended fifty years of legal precedent and health policy. Fourteen states have banned abortion, state legislatures have introduced 85 bills to protect or restrict abortion access, and courts in eight states have temporarily blocked the passage of abortion bans. Over 33.6 million people with childbearing capacity now live in states where abortion is banned or likely to be heavily restricted. The effect of these rapidly changing policies on abortion access will be profound, yet the consequences of these policies on public health indices are unknown. People with chronic and complex medical conditions are particularly vulnerable to adverse health consequences as a result of abortion policy. At baseline, these individuals are at high risk for severe maternal morbidity and maternal mortality as compared to other birthing people. Prior to the Dobbs decision, abortion care allowed for life- altering care among people whose underlying health conditions complicated healthy pregnancy. However, few studies had described the impact of abortion on the health and well-being of individuals with chronic diseases; thus, it is unclear how the Dobbs decision will impact their clinical outcomes. Our study, Investigating Time- sensitive Reproductive Health Equity Post-Dobbs for Patients with ChronIc Disease (INTREPID), will evaluate the time-sensitive impact of evolving abortion policies on the health and well-being of patients, particularly those with chronic diseases that increase the risk of severe maternal morbidity and maternal mortality (e.g., cardiovascular disease, cancer, systemic lupus erythematosus); the clinical practice of physicians who care for people with chronic diseases; and downstream clinical outcomes at a population level. We will use survey- based, qualitative, and epidemiologic approaches to realize our Specific Aims, which are to: 1) Evaluate, among people who are seeking abortion, who is able or not able to obtain a wanted abortion, and to assess their longitudinal outcomes related to health and well-being; 2) Assess, among physicians, the impact of abortion policy on medical decision-making and practice; and 3) Generate new evidence about the impact of abortion policy on population-based pregnancy outcomes (e.g., severe maternal morbidity, maternal mortality) and healthcare-related outcomes (e.g., contraception and teratogenic medication prescribing). The INTREPID research team has multidisciplinary expertise in medicine, obstetrics, family planning research, health equity, health policy, and epidemiology. Our project seeks to inform health policy that will optimize reproductive healthcare and clinical outcomes in the post-Dobbs era.