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.
