State-level factors and maternal and child health outcomes

项目摘要 该项目使用最先进的法律的流行病学技术， 美国终止妊娠政策对妇幼健康的影响，包括确定哪些群体 经历不利的后果和缓冲后果的条件。终止妊娠 美国是很常见的，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卫生的影响，重点是法律的地位之间的关系 与非法怀孕和法律的怀孕有关的终止妊娠和产妇发病率和死亡率 终止然而，在今天的美国，大多数终止妊娠政策并不使所有的怀孕 终止妊娠是非法的;相反，它们为人们能够终止妊娠设置了障碍。大多数州 至少有一个这样的政策，有些州已经有一些终止妊娠政策超过40年 年然而，最近，此类政策的数量、力度、类型和同时出现的情况大大增加了 其中一些政策和政策组合有助于减少 终止妊娠。未来几年，这些政策可能会发生更剧烈的变化。等 政策变化可能会对继续怀孕和生育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 在随后的妇幼保健院终止妊娠是在个人一级进行的。然而，只有非常有限的研究， 其中大部分是在人口一级进行的，方法上有明显的局限性。这限制了我们 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年至今州一级终止妊娠政策影响妇幼保健结果。我们还研究了是否 影响因种族/民族和社会经济地位以及其他州一级的特征而异， 经济、性别平等和结构性种族主义。这项研究涉及最先进的编码我们的接触- 从2005年至今的州一级终止妊娠政策，包括政策通过和生效日期。 结果包括出生和出生构成的变化，以及妇幼保健结果（产妇死亡率 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、生命统计数据和妊娠风险评估监测系统。我们将使用两者 流行病学和计量经济学数据分析方法，以便对调查结果进行因果解释。结果 将提供关键证据，使公共卫生和医疗保健系统做好准备，以照顾最受欢迎的人群。 受终止妊娠政策的影响，并确定其他国家一级的政策和特点， 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。

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.