Deputy director of Provide, Cambridge, MA.
Associate professor, Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston.
Perspect Sex Reprod Health. 2018 Dec;50(4):165-172. doi: 10.1363/psrh.12079. Epub 2018 Sep 20.
Studies of how women's individual characteristics and place of residence are related to variability in gestational age at the time of abortion have not examined county of residence and county-level characteristics. The county level is potentially meaningful, given that county is the smallest geographic unit with policy implications.
Data on 38,611 abortions that took place in North Carolina, Virginia and West Virginia in 2012 were used to study the relationship between gestational age and county-level attributes (e.g., metropolitan status and poverty). Three-level hierarchical linear models captured individuals nested in county of residence, clustered by state of residence, and adjusted for individual characteristics and distance traveled to care.
Eight percent of the variation in gestational age at abortion was attributable to county-level characteristics. Residents of counties characterized by persistent poverty obtained abortions 2.3 days later in gestation than those from counties not characterized by that level of economic hardship. Women living in nonmetropolitan counties obtained abortions 1.7 days later than those living in metropolitan counties, even after distance traveled and county-level poverty were controlled for.
County of residence is relevant to gestational age at the time of abortion for women in these three states. Evidence that county-level attributes are related to access adds insight to the consequences for women when the landscape of abortion service delivery shifts. Integrating county of residence into research on access to abortion services may be critical to capturing disparities in access.
研究女性个体特征和居住地与堕胎时孕龄变化的关系的研究尚未考察居住地县和县级特征。鉴于县是具有政策意义的最小地理单位，县一级具有潜在意义。
利用 2012 年在北卡罗来纳州、弗吉尼亚州和西弗吉尼亚州进行的 38611 例堕胎数据，研究孕龄与县级属性（如大都市地位和贫困状况）之间的关系。三级层次线性模型捕捉了个体在居住地县的嵌套情况，按居住地州聚类，并对个体特征和护理距离进行了调整。
8%的堕胎孕龄差异归因于县级特征。与那些没有经济困难特征的县相比，处于持续贫困状态的县的居民堕胎时孕龄晚 2.3 天。与生活在大都市县的妇女相比，生活在非大都市县的妇女堕胎时孕龄晚 1.7 天，即使考虑到旅行距离和县级贫困因素也是如此。
在这三个州，妇女居住地的县与堕胎时的孕龄有关。关于县一级属性与获得堕胎服务之间关系的证据，为了解堕胎服务提供方式发生转变对妇女产生的后果提供了新的认识。将居住地县纳入对堕胎服务获得情况的研究中，对于发现获得服务方面的差异可能至关重要。
