Department of Health Administration and Policy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
The Lexington Center IVF Inc, Boston, MA, United States.
Front Public Health. 2024 Mar 8;12:1309068. doi: 10.3389/fpubh.2024.1309068. eCollection 2024.
was overturned in 2022. No peer-reviewed evidence exists for the indirect spillover effects of overturning on non-abortion reproductive care access for diverse patient populations.
National data were from 2013-2023 HHS Title X Directory, 2013-2020 CDC Artificial Reproductive Technologies (ART) Surveillance and 2021-2023 manual collection, and Guttmacher Institute. Outcome measures included numbers of ART clinics and Title X entities. Title X entities are those that receive federal funds to establish and operate voluntary family planning projects, especially for low-income patients. We reported pre-and post- changes, associations between changes in measures and abortions, and characteristics of changed measures by region and political geography.
Post- America witnessed national declines of 1.03% in ART clinics and 18.34% in Title X entities, and average state decreases of 0.08 ART clinics ( < 0.05) and 18 Title X entities ( < 0.001). State-level ART clinic closures and abortion reductions had little association except for Texas, Oklahoma, Arizona, New York, and California. Plummets in Title X entities and abortions were positively associated: Reducing 100 abortions was associated with defunding two Title X entities ( < 0.05). The South experienced the largest losses of both, while 83.39% of lost Title X entities were in states that voted Republican in the 2020 presidential election, disproportionate to the 49.02% of states that voted Republican and the 42.52% of US population residing in these states.
We provide one of the first few evidence of spillover impacts of overturning on non-abortion care access for diverse populations: low-income men and women, single parents by choice, and biologically and socially infertile patients. Early evidence warns of worsening challenges of inequities and calls for immediate policy actions.
2022 年，推翻了这一观点。目前尚无同行评议的证据表明，推翻该观点会对不同患者群体的非堕胎生殖保健服务产生间接溢出效应。
国家数据来自 2013-2023 年 HHS Title X 目录、2013-2020 年 CDC 人工生殖技术（ART）监测以及 2021-2023 年的人工收集和古特马赫研究所。结果测量包括 ART 诊所和 Title X 实体的数量。Title X 实体是指那些获得联邦资金以建立和运营自愿计划生育项目的实体，特别是为低收入患者提供服务。我们报告了变化前后的情况、变化前后措施与堕胎之间的关联，以及按地区和政治地理划分的变化措施的特征。
在美国之后，全国的 ART 诊所数量减少了 1.03%，Title X 实体数量减少了 18.34%，平均每个州的 ART 诊所减少了 0.08 个（ < 0.05），Title X 实体减少了 18 个（ < 0.001）。除了德克萨斯州、俄克拉荷马州、亚利桑那州、纽约州和加利福尼亚州外，州一级的 ART 诊所关闭和堕胎减少之间几乎没有关联。Title X 实体和堕胎数量的急剧下降呈正相关：减少 100 例堕胎与取消两个 Title X 实体的资金（ < 0.05）有关。南部地区的损失最大，而失去的 100 个 Title X 实体中有 83.39%位于 2020 年总统选举中投票给共和党的州，这与投票给共和党的州的 49.02%不成比例，也与居住在这些州的 42.52%的美国人口不成比例。
我们提供了推翻该观点对不同人群的非堕胎护理服务的间接溢出效应的首批证据之一：低收入的男性和女性、有选择的单身父母以及生物和社会上不育的患者。早期的证据警告说，不平等现象的挑战正在恶化，并呼吁立即采取政策行动。
