Policy Changes and Pregnancy Outcomes

政策变化和怀孕结果

• 批准号: 7591124
• 负责人: THEODORE J JOYCE
• 金额: $ 8.02万
• 依托单位: BERNARD M. BARUCH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7591124
• 关键词: Abortion Rates; Address; Affect; Age; Area; Arizona; Arkansas; Birth; Colorado; County; Data; Data Aggregation; Demography; Drops; Economics; Ethnic Origin; Federal Government; Gestational Age; Goals; Grant; Hospitals; Individual; Laws; Life; Louisiana; Measures; Minority; New Mexico; Oklahoma; Operative Surgical Procedures; Physicians; Policies; Pregnancy; Pregnancy Outcome; Pregnant Women; Procedures; Provider; Publishing; Race; Regulation; Reproduction; Resolution; Risk; Second Pregnancy Trimester; Services; Statutes and Laws; Supreme Court Decisions; Texas; Time; Travel; Withdrawal; Woman; Women' s Rights; abortion; austin; base; cost; court; meetings; metropolitan; residence; response; restoration

DESCRIPTION (provided by applicant): Policy Changes and Pregnancy Outcomes A long-standing issue in the demography of reproduction is whether the availability of abortion services affects how pregnancies are resolved. The standard economic argument is that increased availability lowers the time cost associated with accessing abortion services and thereby increases demand. Although numerous studies have demonstrated a strong correlation between abortion rates and the number of abortion providers in an area, most lack a convincing identification strategy with which to overcome the simultaneous determination of the supply and demand of abortion services. In this study we take advantage of a sudden withdrawal of abortion services in Texas and their partial restoration 12 to 20 months later to identify the effect of the availability of abortion services on pregnancy resolution. Beginning January, 2004, Texas law required that all abortions 16 or more weeks' gestation be performed in an ambulatory surgical center. In January, 2004, not one of Texas's 54 non- hospital abortion providers met the requirements of a surgical center. The effect was immediate and dramatic. The published number of abortions performed in Texas at 17 weeks of gestation or later dropped from 3066 in 2003 to only 403 in 2004, a decline of 87 percent or 2663 abortions. How, therefore, were these pregnancies resolved? Did women adjust to the law by obtaining abortions earlier in pregnancy? Was there an increase in abortions 16 weeks or later to Texas residents in neighboring states? Were abortions to Texas residents obtained out of state associated with age, race, ethnicity and travel distance? How do the answers to each of these questions change as late-term services were partially restored in Dallas, Austin and Houston? The study is possible because we have unique individual-level data on all abortions that occurred in Texas, Arizona, Arkansas and Oklahoma from 2001 to 2006 and all births to residents in the same states over the same period. Not only do we have demographic information on each pregnant woman, but we can measure distance in miles from the woman's county of residence to the nearest county with an abortion provider that offers late-term services within and outside of Texas. The sudden withdrawal of services within Texas provides an exogenous change in our distance measure. Another unique aspect of is that we have individual-level data on all abortions to residents of Texas performed in Arkansas and Oklahoma that will enable us to characterize Texas residents who travel to these states in response to the law. We also have aggregate data on abortions to Texas residents in New Mexico, Louisiana and Colorado. Thus, we can describe in more detail than has been possible previously the response by pregnant women to unanticipated changes in the availability of late-term abortion services. There are approximately 50,000 abortions performed after 15 weeks gestation annually in the U.S. The requirement that these abortions be performed in an ambulatory surgical center greatly reduces the availability of late-term abortion services as relatively few facilities can afford to meet these standards. The result may be an increase in abortions performed later in pregnancy as women take longer to arrange and finance the procedure. Abortions performed later in pregnancy are at greater risk of complications.

描述（由申请人提供）：政策变化和怀孕结果 生殖人口统计学中的一个长期存在的问题是堕胎服务的可用性是否会影响怀孕的解决方式。标准的经济学论点是，可用性的提高降低了与获得堕胎服务相关的时间成本，从而增加了需求。尽管大量研究表明，一个地区的堕胎率与堕胎提供者的数量之间存在很强的相关性，但大多数研究缺乏令人信服的识别策略来克服堕胎服务供应和需求的同时确定。在这项研究中，我们利用德克萨斯州突然取消堕胎服务并在 12 至 20 个月后部分恢复的机会来确定堕胎服务的可用性对妊娠解决的影响。从 2004 年 1 月开始，德克萨斯州法律要求所有妊娠 16 周或以上的堕胎手术必须在门诊手术中心进行。 2004 年 1 月，德克萨斯州 54 家非医院堕胎服务提供者中没有一家符合外科中心的要求。效果是立竿见影的。德克萨斯州公布的妊娠 17 周及以后实施的堕胎数量从 2003 年的 3,066 例下降到 2004 年的 403 例，下降了 87%，即 2,663 例堕胎。那么，这些怀孕是如何解决的呢？女性是否通过在怀孕早期堕胎来适应法律？ 16 周或之后德克萨斯州邻州居民的堕胎率是否有所增加？德克萨斯州居民在州外堕胎是否与年龄、种族、民族和旅行距离有关？随着达拉斯、奥斯汀和休斯顿部分恢复后期服务，这些问题的答案有何变化？这项研究之所以可行，是因为我们拥有 2001 年至 2006 年德克萨斯州、亚利桑那州、阿肯色州和俄克拉荷马州发生的所有堕胎以及同一时期同一州居民的所有出生的独特个人数据。我们不仅拥有每位孕妇的人口统计信息，而且还可以测量从该妇女的居住县到最近的提供堕胎服务的县（在德克萨斯州内外提供后期服务）的距离（以英里为单位）。德克萨斯州境内服务的突然取消使我们的距离测量发生了外生变化。另一个独特的方面是，我们拥有德克萨斯州居民在阿肯色州和俄克拉荷马州进行的所有堕胎的个人数据，这将使我们能够描述根据法律前往这些州的德克萨斯州居民的特征。我们还有新墨西哥州、路易斯安那州和科罗拉多州德克萨斯州居民堕胎的汇总数据。因此，我们可以比以前更详细地描述孕妇对晚期堕胎服务可用性意外变化的反应。在美国，每年大约有 50,000 例妊娠 15 周后进行的堕胎手术。这些堕胎手术必须在门诊手术中心进行，这大大降低了晚期堕胎服务的可用性，因为能够满足这些标准的设施相对较少。结果可能是怀孕后期堕胎的数量增加，因为女性需要更长的时间来安排和资助堕胎手术。怀孕后期进行的堕胎发生并发症的风险更大。