Time sensitive research on barriers to pregnancy care

Recent and seismic policy shifts in the Midwest of the United States have abruptly restricted access to abortion and other pregnancy-related care for millions of people. Following the June 2022 Supreme Court opinion in the Dobbs vs Jackson Women’s Health Organization case, Midwestern states immediately reinstated 150+ year

old abortion bans, legislated the first new abortion ban in the country, and saw widespread clinic closures. To understand the barriers faced by pregnant people seeking abortion in the Midwest amidst these rapidly changing political shocks and to quantify the impact of these restrictions on their health and lives, unbiased,

locally relevant data are urgently needed. Yet, most abortion access research has recruited participants from clinics—participants who, by virtue of having gotten to an abortion clinic, represent a population that was able to overcome many barriers to care, and further, excludes people who use telemedicine or self-manage their

abortions, and those who continue their pregnancies. A clinic-based sampling mechanism thus induces selection bias, resulting in research that misses or underestimates barriers to care. To address these methodological limitations, prospective research is needed that (1) expands recruitment to the full population of

people seeking abortion, not just those who make it to a clinic, (2) sensitively measures barriers and facilitators to abortion care, (3) captures the full set of possible pregnancy pathways (including miscarriage, birth, clinical abortion, telemedicine abortion, self-managed abortion) and their sequelae over time, and (4) is sufficiently

powered to answer nuanced questions at the regional level. To address this time-sensitive need in an underserved region, we propose four linked aims in a two-phase study. In the first six months of the R61, we will recruit 500 pregnant people searching for information about abortion online to identify (via surveys; Aim 1)

and characterize (via 30 in-depth interviews; Aim 2) the barriers people face while seeking abortion in all 12 Midwest states. In the second (R33) phase of the study, we will follow these participants forward in time with additional surveys at 4, 10, and 18 months to measure who succeeds in obtaining abortion and who does not,

and the implications of their pregnancy outcome on broader physical, mental, and socioeconomic health across restrictive versus permissive states (Aim 3). Finally, we will implement a human-centered design approach to engage abortion fund leaders and Midwesterners who have sought abortions to develop and test

messages to address knowledge barriers or belief gaps identified in the R61 phase that limit access to abortion (Aim 4). This will result in a health communication intervention that we will launch in the Midwest. At the study’s completion, our expected outcomes are to have demonstrated the value of online recruitment for abortion

research, identified locally specific barriers to abortion care in the Midwest, and engaged stakeholders to develop and launch a health communication intervention to facilitate abortion access. Findings from this study will drive more informed, geography-specific interventions to address urgent access challenges in the Midwest.