The impact of new state restrictions on abortion incidence and safety in the United States

由于美国最高法院2022年6月对多布斯诉杰克逊妇女健康组织案的裁决， 美国生殖健康保健的格局正在发生巨大而迅速的变化。 在裁决的100天内，14个州禁止或严格限制堕胎条款； 在接下来的几个月里，可能会有更多的人效仿。在美国，堕胎途径的突然变化是 在受影响的个人数量和受影响的州的数量方面是前所未有的 在不久的将来颁布进一步的限制措施仍然存在很大的不确定性。这个项目 解决对基线数据的迫切需要，以捕捉预期将于 关于孕妇健康的未来几个月，以及对堕胎的高质量估计的必要性 正规保健系统内外的发病率都很高。如果没有这些数据，初级公共卫生 国家的指标将不可用，政策制定者、程序开发商、服务提供商、 研究人员和公众拥有了解这些影响所需的基于研究的证据 堕胎政策现在和未来。 为了满足这一迫切需要，我们提出了四个相互关联的目标。从R61阶段(目标1)的第一个月开始， 我们将开始数据收集活动，以衡量正规医疗保健内外堕胎的变化 在预期的国家一级政策变化迅速的时期，这一领域将继续发展。在目标1a中，我们将收集有关堕胎的数据 在正规卫生部门内使用新的适应性月度堕胎监测系统， 对提供堕胎护理的卫生机构的代表性样本进行调查。我们将制作面向公众的节目 利用数十年设施水平的历史数据，对全国基于设施的堕胎发生率进行每月估计 在贝叶斯分层模型中提供堕胎数据，以提高精度。在目标1b中，我们将收集以下数据 在正规医疗保健部门以外发生的堕胎，衡量与堕胎相关的并发症和 通过调查自我管理堕胎(SMA)的使用者和提供者，了解SMA使用者和提供者的医疗需求。 在目标1中收集的数据将用于R33阶段，以衡量国家政策变化的影响并向 估计正规医疗保健部门以外的堕胎发生率。在目标2中，我们将评估 国家在项目第1年期间对获得设施的人数实施的堕胎限制 堕胎和怀孕的孕周，以及州际旅行以获得医疗设施的发生率- 以堕胎为基础的护理。在目标3中，我们将采用在美国以外广泛使用的方法来估计 在限制性条件下估计非正规健康条件下的自我管理流产发生率 扇区。最后，在目标4中，我们将结合基于设施的堕胎和自行管理的堕胎的数据来估计 全国堕胎发生率和与堕胎相关的健康后果。

As a result of the US Supreme Court's June 2022 decision in Dobbs v. Jackson Women's Health Organization, the landscape of reproductive health care in the United States is in the midst of seismic and rapid change. Within 100 days of the ruling, fourteen states either banned or severely restricted abortion provision; over the coming months, many more are likely to follow suit. The abrupt changes in access to abortion in the US are without precedent in terms of the number of individuals who are affected and the number of states in which there remains substantial uncertainty around enactment of further restrictions in the near future. This project addresses the urgent need for baseline data to capture the impact of state abortion restrictions expected over the coming months on the health of pregnant people, as well as the need for high quality estimates of abortion incidence both within and outside of the formal health care system. Without these data, primary public health indicators for the nation will not be available, nor will policy makers, program developers, service providers, researchers and the public have the research-based evidence needed to understand the impact of these abortion policies now and going forward. To address this critical need, we propose four linked aims. Starting in the first month of the R61 phase (Aim 1), we will begin data collection activities to measure change in abortion within and outside the formal health sector during a period of anticipated rapid state-level policy change. In Aim 1a, we will collect data on abortions occurring within the formal health sector using a new and adaptive monthly abortion surveillance system, surveying representative samples of health facilities providing abortion care. We will produce public facing monthly estimates of facility-based abortion incidence nationally, leveraging decades of historical facility-level abortion data in a Bayesian hierarchical model to improve precision. In Aim 1b, we will collect data on abortions occurring outside of the formal health care sector, measuring abortion-related complications and the healthcare needs of people self-managing abortions (SMA) by surveying SMA users and providers. Data collected in Aim 1 will be used in the R33 phase to measure the impact of state policy change and inform estimation of abortion incidence outside the formal health care sector. In Aim 2, we will assess the impact of state abortion restrictions implemented during project year 1 on the number of people obtaining facility-based abortions and the gestational age of their pregnancies, and the incidence of interstate travel to obtain facility- based abortion care. In Aim 3, we will adapt a methodology used extensively outside of the US to estimate abortion under restrictive conditions to estimate self-managed abortion incidence outside of the formal health sector. Finally, in Aim 4, we will combine data on facility-based and self-managed abortions to estimate the national incidence of abortion and abortion-related health outcomes.