Abortion and postpartum care in the context of new governmental policies: Quantitative assessments of barriers and facilitators to equitable, quality care

Abstract

While pregnant, individuals are susceptible to specific pregnancy-related health outcomes, and at the same time pregnancy can exacerbate pre-existing health conditions and cause other long-term, chronic conditions. Pregnancies can end in many ways, and ensuring people can access the pregnancy-related care they need, whether it be to end their pregnancy, monitor it, or receive care after the pregnancy, supports pregnant people in achieving their desired long-term health outcomes. While there is ample medical attention focused on healthy pregnancies, pregnancy-related care outside of this period receives less attention yet is also crucial for the pregnant person’s health and well-being. This dissertation focuses on two pregnancy-related topics that receive less attention: abortion care and postpartum care. Despite this lack of attention, not accessing these services can have long-term health effects. The overall purpose of this research is to examine patterns of abortion and postpartum care access in the context of governmental policies. I use a Reproductive Justice framework as a guide for envisioning better care, and both Ecosocial Theory and the Reproductive Justice framework to guide how I examine inequities in care and the role of government policies in that care. In each chapter I examine an outcome related to postpartum or abortion care and test an exposure in a policy context, which may include contexts where there are a lack of policies. I aim to understand, within those current policy contexts, how people are accessing care, and sociodemographic patterns of that care. Chapter 1 aims to understand the dynamics of parental leave-taking and postpartum care across sociodemographic groups, and to assess how leave duration is associated with postpartum care. I find significant differences in the prevalence of not accessing care stratified by leave duration, and disparities in utilization by race, ethnicity, and income. Less leave was associated with a higher risk of not accessing care, but the absolute risk of not accessing care was highest in the lower income group regardless of leave duration. In chapter 2, I use data collected in partnership with the feminist activist group Colectiva La Revuelta, located in Neuquén, Argentina, to understand people’s preferences, experiences, and choices about abortion care when contacting an accompaniment hotline after abortion was legalized in Argentina. I find that the main reasons people continued to seek accompaniment for abortion outside of the healthcare system are because they trusted the accompaniment model, and because they wanted to avoid the healthcare system. The objective of chapter 3 is to assess trends in abortion care utilization in Massachusetts after the Jackson Women’s Health Organization vs. Dobbs Supreme Court Decision when the federal right to abortion was revoked. I find that in the first four months after the decision, there was a slight increase in the total number of abortion patients overall and a large and significant increase in the number of patients from out of state. There was also a significant increase in the percentage of out-of-state residents receiving abortion care compared to in-state residents.