限制州法律实施后，妊娠中期堕胎的变化。
Change in Second-Trimester Abortion After Implementation of a Restrictive State Law.
机构信息
Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama; Ibis Reproductive Health, Oakland, California; Population Research Center, University of Texas at Austin, Austin, Texas; and Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California.
出版信息
Obstet Gynecol. 2019 Apr;133(4):771-779. doi: 10.1097/AOG.0000000000003183.
OBJECTIVE
To assess whether indicators of limited access to services explained changes in rates of second-trimester abortion after implementation of a restrictive abortion law in Texas.
METHODS
We used cross-sectional vital statistics data on abortions performed in Texas before (November 1, 2011-October 31, 2012) and after (November 1, 2013-October 31, 2014) implementation of Texas' abortion law. We conducted monthly mystery client calls for information about abortion facility closures and appointment wait times to calculate distance from women's county of residence to the nearest open Texas facility, the number of open abortion facilities in women's region of residence (facility network size), and days until the next consultation visit. We estimated mixed-effects logistic regression models to assess the association between obtaining abortion care after the law's implementation and having a second-trimester abortion (12 weeks of gestation or more), after adjustment for distance, network size, and wait times.
RESULTS
Overall, 64,902 Texas-resident abortions occurred in the period before the law was introduced and 53,174 occurred after its implementation. After implementation, 14.5% of abortions were performed at 12 weeks of gestation or more, compared with 10.5% before the law (P<.001; unadjusted odds ratio [OR] 1.45; 95% CI 1.40-1.50). Adjusting for distance to the nearest facility and facility network size reduced the odds of having a second-trimester abortion after implementation (OR 1.17; 95% CI 1.10-1.25). Women living 50-99 miles from the nearest facility (vs less than 10 miles) had higher odds of second-trimester abortion (OR 1.24; 95% CI 1.11-1.39), as did women in regions with less than one facility per 250,000 reproductive-aged women compared with women in areas that had 1.5 or more facilities (OR 1.57; 95% CI 1.41-1.75). After implementation, women waited 1 to 14 days for a consultation visit; longer waits were associated with higher odds of second-trimester abortion.
CONCLUSION
Increases in second-trimester abortion after the law's implementation were due to women having more limited access to abortion services.
目的
评估在德克萨斯州实施限制堕胎法后，服务获取受限指标是否能解释中期堕胎率的变化。
方法
我们使用了在德克萨斯州实施该堕胎法之前（2011 年 11 月 1 日至 2012 年 10 月 31 日）和之后（2013 年 11 月 1 日至 2014 年 10 月 31 日）进行的横断面上的堕胎统计数据。我们每月进行神秘客户电话，以获取有关堕胎设施关闭和预约等待时间的信息，计算女性所在县到最近开放的德克萨斯州堕胎设施的距离、女性所在地区的开放堕胎设施数量（设施网络规模）以及到下一次咨询就诊的天数。我们估计了混合效应逻辑回归模型，以评估在法律实施后获得堕胎护理与进行 12 周妊娠或以上的中期堕胎（妊娠 12 周或以上）之间的关联，调整了距离、网络规模和等待时间的影响。
结果
总体而言，在引入该法律之前，有 64902 名德克萨斯州居民进行了堕胎，而在该法律实施之后，有 53174 名居民进行了堕胎。在该法律实施后，有 14.5%的堕胎是在 12 周妊娠或以上进行的，而在该法律实施前为 10.5%（P<.001；未调整的优势比[OR]1.45；95%置信区间[CI]1.40-1.50）。调整到最近设施的距离和设施网络规模后，实施后的中期堕胎的可能性降低（OR 1.17；95%CI 1.10-1.25）。与距离最近的设施不到 10 英里的女性相比，距离设施 50-99 英里的女性进行中期堕胎的可能性更高（OR 1.24；95%CI 1.11-1.39），与每 25 万育龄妇女设施少于 1 个的地区相比，设施每 25 万育龄妇女 1.5 个或以上的地区的女性（OR 1.57；95%CI 1.41-1.75）。在该法律实施后，女性等待 1 至 14 天进行咨询；等待时间越长，中期堕胎的可能性就越高。
结论
该法律实施后中期堕胎率的上升是由于女性获得堕胎服务的机会受到更多限制。
Zotero 插件