State-level factors and maternal and child health outcomes

州级因素和妇幼健康结果

• 批准号: 10708173
• 负责人: Sarah C.M. Roberts
• 金额: $ 53.08万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708173
• 关键词: Achievement; Address; Adoption; Adverse effects; Adverse event; Affect; Age; Birth; Buffers; Caring; Characteristics; Child; Code; Country; Data; Data Analyses; Data Set; Databases; Development; Disparity population; Economics; Epidemiologic Methods; Epidemiology; Ethnic Origin; Exposure to; Funding; Future; Geography; Healthcare Systems; Hearing; Heterogeneity; Income; Individual; Inequity; Infant Mortality; Infrastructure; Legal; Legal Status; Licensing; Low Birth Weight Infant; Maternal Mortality; Maternal and Child Health; Measures; Methodology; Methods; Modification; Monitor; National Institute of Child Health and Human Development; Neonatal Mortality; Outcome; Persons; Policies; Population; Pregnancy; Premature Birth; Prevention approach; Prevention strategy; Public Health; Race; Reduce health disparities; Research; Risk; Risk Assessment; Services; Severities; Socioeconomic Status; Structural Racism; Subgroup; Surveys; System; Termination of pregnancy; Testing; Time; Vital Statistics; Woman; Women' s Health; adverse birth outcomes; adverse outcome; court; econometrics; epidemiology study; gender equality; improved; innovation; insurance claims; maternal morbidity; meetings; physical conditioning; pregnant; public policy on alcohol; response; severe maternal morbidity; trend

PROJECT SUMMARY This project uses cutting-edge legal epidemiology techniques to examine population-level maternal and child health (MCH) impacts of pregnancy termination policies in the U.S., including identifying which groups experience adverse consequences and the conditions that buffer consequences. Pregnancy termination in the U.S. is common, with about one out of five pregnancies ending in a termination. Historically, most research about public health impacts of pregnancy termination policies focused on the relationship between legal status of pregnancy termination and maternal morbidity and mortality related to illegal versus legal pregnancy termination. In the U.S. today, however, most pregnancy termination policies do not make all pregnancy terminations illegal; rather, they create barriers to people being able to terminate their pregnancy. Most states have at least one such policy and some states have had some pregnancy termination policies for more than 40 years. Recently, though, the number, strength, types, and co-occurrence of such policies have dramatically changed; some of these policies and policy combinations have contributed to a decrease in the number of pregnancy terminations. The next few years could bring even more drastic changes in these policies. Such policy changes could have public health impacts on people who continue their pregnancies and give birth – particularly on MCH outcomes such as maternal morbidity and mortality, infant mortality, and adverse birth outcomes. Methodologically rigorous research about impacts of being unable to obtain a pregnancy termination on subsequent MCH has been conducted at the individual-level. Yet, only very limited research, much of it with notable methodological limitations, has been conducted at the population-level. This limits our understanding of population-level impacts of pregnancy termination policies. In this project, we assess whether state-level pregnancy termination policies from 2005-present affect MCH outcomes. We also examine whether effects differ by race/ethnicity and socioeconomic status as well as by other state-level characteristics such as economic, gender equality, and structural racism. This study involves state-of-the art coding of our exposure - state-level pregnancy termination policies from 2005-present, including policy adoption and effective dates. Outcomes include births and changes in composition of births, as well as MCH outcomes (maternal morbidity and mortality, preterm birth, low birthweight, and infant mortality). Outcome data will come from insurance claims data, vital statistics data, and the Pregnancy Risk Assessment Monitoring System. We will use both epidemiologic and econometric data analysis approaches to allow for causal interpretation of findings. Findings will provide key evidence to prepare public health and health care systems to care for groups of people most affected by pregnancy termination policies, as well as identify other state-level policies and characteristics that might help buffer any adverse MCH impacts of pregnancy termination policies.

项目概要 该项目利用前沿的法律流行病学技术来检查人群层面的孕产妇和儿童 美国终止妊娠政策对健康 (MCH) 的影响，包括确定哪些群体 经历不利后果以及缓冲后果的条件。终止妊娠 在美国这种情况很常见，大约五分之一的怀孕以终止妊娠告终。从历史上看，大多数研究 关于终止妊娠政策对公共健康的影响，重点是法律地位之间的关系 非法妊娠与合法妊娠相关的终止妊娠以及孕产妇发病率和死亡率的影响 终止。然而，在今天的美国，大多数终止妊娠政策并没有使所有怀孕 非法终止；相反，它们为人们终止妊娠设置了障碍。大多数州 至少有一项此类政策，一些州已经制定了针对 40 多名妇女的终止妊娠政策 年。然而，最近此类政策的数量、强度、类型和同时出现都发生了显着变化。 改变了；其中一些政策和政策组合导致了 终止妊娠。未来几年这些政策可能会发生更加剧烈的变化。这样的 政策变化可能会对继续怀孕和分娩的人产生公共卫生影响—— 特别是妇幼保健结果，如孕产妇发病率和死亡率、婴儿死亡率和不良分娩 结果。关于无法怀孕的影响的严格方法研究 随后的妇幼保健院的终止是在个人层面上进行的。然而，只有非常有限的研究， 其中大部分是在人口层面进行的，但方法上存在明显的局限性。这限制了我们的 了解终止妊娠政策对人口的影响。在这个项目中，我们评估是否 2005 年至今的州级终止妊娠政策影响 MCH 结局。我们还检查是否 影响因种族/族裔和社会经济地位以及其他州级特征而异，例如 经济、性别平等和结构性种族主义。这项研究涉及我们暴露的最先进的编码 - 2005年至今的州级终止妊娠政策，包括政策的采用和生效日期。 结果包括出生和出生构成的变化，以及 MCH 结果（孕产妇发病率） 和死亡率、早产、低出生体重和婴儿死亡率）。结果数据将来自保险 索赔数据、生命统计数据和怀孕风险评估监测系统。我们将同时使用 流行病学和计量经济学数据分析方法，以便对研究结果进行因果解释。发现 将为公共卫生和医疗保健系统准备好照顾最重要的人群提供关键证据 受终止妊娠政策的影响，并确定其他州级政策和特征 可能有助于缓冲终止妊娠政策对妇幼保健的任何不利影响。