Health and economic consequences of changing federal and state policies on reproductive health.

PROJECT SUMMARY In June 2022, a decision by the U.S. Supreme Court ended the federally protected right to abortion established by Roe v Wade almost 50-years ago. In response to this decision, 26 states are poised to limit abortion access, affecting approximately 36 million women of reproductive age and an unknown number of trans men and non-

binary people capable of pregnancy. The consequences of this dramatic shift in access to legal abortion in the U.S. are unknown, and comparisons to circumstances before Roe are insufficient for understanding the potential implications of the momentous policy change. Today, residents of states that do not offer legal abortion services

are faced with the following options: travel to an out-of-state abortion clinic, potentially experiencing considerable logistic and financial burdens; order medication abortion pills online to safely self-manage their abortions; attempt less safe abortion methods; or carry their pregnancies to term.

This study is uniquely positioned to document these pregnancy outcomes and the immediate and long-term effects of this shift in policy. Using rapid-response funds from private sources, we have launched a longitudinal observational study to examine the health and economic consequences faced by individuals who sought

abortions immediately following the implementation of a statewide abortion ban compared with those who were legally served just prior to ban implementation. Within days of the Supreme Court decision, we began collecting data from both groups through self-administered online surveys and invited participants to complete follow-up

surveys every 2 months for 2-years. This proposal seeks support for an expanded mixed-methods study design that will include longitudinal survey data analysis, expanded recruitment to from clinics and abortion-access helplines that provide information and resources to people in states with abortion bans, and the integration of

qualitative in-depth interviews seeking to understand the nuances of people’s experiences and decisions in this new legal landscape. We will address three aims. In Aim 1, we will examine the long-term consequences of state abortion bans, using multilevel multivariable regression models to compare health and economic outcomes

among individuals who received an abortion prior to ban implementation, sought an abortion at an out-of-state clinic, sought an abortion outside of the legal medical system, or carried a pregnancy to term. In Aim 2, we will assess the effectiveness of abortion-access helplines for mitigating negative outcomes by examining

associations between participants’ reported helpline experiences and their decisions to continue seeking an abortion, their success in obtaining an abortion elsewhere, and the timing of successful abortion attempts. In Aim 3, we will deepen our understanding of people’s abortion ban experiences by conducting in-depth interviews

and integrating findings with survey responses, focusing on populations especially vulnerable to poor outcomes. Achieving these aims will provide valuable evidence that can inform state abortion policy decisions and the development of harm-reduction strategies for pregnant people in states without access to legal abortion.