The impact of new state restrictions on abortion incidence and safety in the United States - Abstract: This project addresses the urgent need for baseline data to capture the impact of state reproductive health policy changes on the health of pregnant women, as well as the need for rigorous estimates of abortion incidence both within and outside of the formal health care system. Without these data, policy makers, program developers, service providers, researchers and the public will not have the research-based evidence needed to understand reproductive health needs 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 care within and outside the formal health sector using a new and adaptive monthly measurement system by surveying representative samples of health facilities providing care. We will produce public-facing, national monthly estimates of facility-based incidence, leveraging decades of historical facility-level 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 complications and the healthcare needs of women by surveying them 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 reproductive health policy changes implemented during project year 1 on the number of women obtaining facility-based abortions and the incidence of interstate travel to obtain care. In Aim 3, we will adapt a methodology used extensively outside of the US to estimate abortion incidence outside of the formal health sector. Finally, in Aim 4, we will combine data to estimate the national incidence of abortion and related health outcomes.
