State-level factors and maternal and child health outcomes

项目总结 该项目使用尖端的法律流行病学技术来检查人口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 体验不良后果和缓冲后果的条件。中老年妇女终止妊娠 在美国很常见，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 关于终止妊娠对公共健康影响的政策重点是法律地位的关系 与非法妊娠和合法妊娠相关的终止妊娠和孕产妇发病率和死亡率 终止。然而，在今天的美国，大多数终止妊娠的政策并不能使所有的怀孕 堕胎是非法的；相反，它们为人们能够终止怀孕制造了障碍。大多数州 至少有一项这样的政策，一些州已经有超过40年的一些终止妊娠政策 好几年了。然而，最近，此类政策的数量、力度、类型和同时发生的情况戏剧性地 改变；其中一些政策和政策组合导致 终止妊娠。在接下来的几年里，这些政策可能会发生更大的变化。是这样的 政策变化可能会对继续怀孕和分娩的人产生公共健康影响- 特别是关于孕产妇发病率和死亡率、婴儿死亡率和难产等妇幼保健结果 结果。关于无法怀孕的影响的方法论严谨研究 随后的妇幼保健终止是在个人一级进行的。然而，只有非常有限的研究， 其中大部分研究都是在人口层面进行的，方法上有明显的局限性。这限制了我们的 了解终止妊娠政策对人群的影响。在这个项目中，我们评估 2005年至今的州级终止妊娠政策影响妇幼保健结果。我们还检查了是否 影响因种族/族裔和社会经济地位以及其他州级特征而有所不同，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(产妇发病率 以及死亡率、早产、低出生体重和婴儿死亡率)。结果数据将来自保险公司 索赔数据、生命统计数据和怀孕风险评估监测系统。我们将使用这两种方法 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。发现 将提供关键证据，以准备公共卫生和医疗保健系统，以最大限度地照顾人群 受怀孕终止政策的影响，以及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。

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.