Development of methods to assess geographic variation in reproductive health behaviors and outcomes over the life course

堕胎在美国是一种常见的生殖健康经历。每年的堕胎率是 已知因社会人口特征和国家背景而异。年发病率 随着时间的推移，堕胎的比例发生了很大的变化，而且各州的情况也不同。鲜为人知的是， 然而，关于累积终生堕胎发生率及其社会人口统计关系 在州一级。这项研究的主要实质目标是用以下方法填补这些知识空白 截至2019年的六个州的数据，这些州随后经历了截然不同的政策和 多布斯诉杰克逊妇女健康组织裁决后的法律变化。这项研究 位于大西洋中部的两个州拥有相对宽松的堕胎政策 (特拉华州和马里兰州)，以及四个分别具有更多限制性法律和政策的 中西部(爱荷华州和俄亥俄州)和东南部(阿拉巴马州和南卡罗来纳州)。第一次 方法论的目标是成功地开发和测试间接问题方法， “堕胎清单实验”，从而克服了#年关于堕胎的严重调查漏报问题。 直接自我报告问题。第二个方法论目标是估计状态水平。 真实队列的终生累计流产发生率。真实队列的衡量标准是 当水平随着时间的推移而变化时，尤其重要，因为它们在美国已经 近几十年来，而且很有可能在后多布斯时代的新政策和法律背景下这样做。 这项研究的目的是增进对以下问题的理解：1)累积终生流产发生率 到州一级真正队列的生育年龄结束；2)州特有的 有可靠外部分母数据的变量的流产差异 例如种族/民族、教育和收入；3)特定于州的堕胎 不存在可靠外部变量的理论上重要变量的差值 可获得的分母数据，例如感知到的和经历过的获得医疗保健的障碍 以及参加医疗补助和其他医疗保险类型的情况；以及4)各州的情况， 法律和政策与社会-人口和健康模式的差异有关- 各州的医疗保健差距。这项研究将开发和验证方法，以 随后适用于后多布斯诉杰克逊妇女健康组织州一级 数据，并将制定前多布斯估计，以评估生命历程和社会- 多布斯时代后各州和各州组堕胎的人口水平和差异。

Abortion is a common reproductive health experience in the U.S. Annual abortion rates are known to vary by both socio-demographic characteristics and state contexts. Annual incidence of abortion has changed substantially over time and differentially by state. Little is known, however, about cumulative lifetime abortion incidence and its socio-demographic associations at the state level. The main substantive goal of this study is to fill these knowledge gaps using data through 2019 for six states that subsequently experienced radically different policy and legal changes after the Dobbs versus Jackson Women’s Health Organization decision. The study states consist of two with relatively liberal abortion policies, located in the Mid-Atlantic (Delaware and Maryland), and four with more restrictive laws and policies respectively in the Midwest (Iowa and Ohio) and the Southeast (Alabama and South Carolina). A first methodological goal is the successful development and testing of an indirect question method, the “abortion list experiment”, thereby overcoming severe survey underreporting of abortion in direct self-report questions. A second methodological goal is the estimation of state level cumulative lifetime abortion incidence of abortion for real cohorts. Real-cohort measures are especially important when levels are changing over time, as they have been in the U.S. over recent decades, and are very likely to do so under the new policy and legal context post-Dobbs. The aims of the study are to advance understanding: 1) of cumulative lifetime abortion incidence through the end of the reproductive ages for real cohorts at the state level; 2) of state-specific abortion differentials by variables for which there are reliable external denominator data available such as for race/ethnicity, education, and income; 3) of state-specific abortion differentials by theoretically-important variables for which there are no reliable external denominator data available, such as for perceived and experienced barriers to health care access and enrollment in Medicaid and other health insurance types; and 4) of how state contexts, laws, and policies are associated with differences in patterns of socio-demographic and health- care disparities by state. This research will develop and validate methodologies that can subsequently be applied to post-Dobbs v. Jackson Women’s Health Organization state-level data, and will develop pre-Dobbs estimates against which to evaluate life-course and socio- demographic levels and differentials of abortion by state and groups of states post-Dobbs.