Unintended pregnancy occurs in a variety of contexts with multiple influences acting on individuals' risk. Primary evidence-based interventions for reducing unintended pregnancy are removal of cost-barriers and increase in contraceptive coverage. Policies and programs on the federal, state, and local level have the potential to affect the accessibility and affordability of family planning services and thus rates of unintended pregnancy. These programs may have differential effects on individuals depending on where people live and other social determinants of health. The overarching research goals of this proposal are to Aim 1) Determine population-level impacts of HER SL on unintended pregnancies and birth outcomes, Aim 2) Identify regional differences in family planning service utilization and outcomes using the UPDBs' linked all-payer claims, electronic medical records, geospatial markers, demographic profiles, and birth certificates, and, Aim 3) Establish linked-data infrastructure for timely evaluation of contraception policy and programs on short- and long-term impacts.
For Aim 1, I will examine impacts from a county-level contraceptive initiative, HER Salt Lake (n=11,498), using a matched-control design. Using a difference-in-difference design, I will compare unintended pregnancy rates and birth outcomes between the exposed cohort and the matched controls.
In Aim 2, I will employ geographic information systems (GIS) methods and hierarchical regression methods for causal inferences to evaluate associations between region (metropolitan, micropolitan, rural, and frontier areas) and family planning utilization and pregnancy related outcomes. Understanding regional variation in contraception access and outcomes, will elucidate regional disparities that can be targeted with evidence-based policy and programs. Finally, in Aim 3, I will establish a linked-data infrastructure using multiple data sources to pinpoint changes in family planning service access and uptake, transitions of where individuals seek family planning care, contraceptive use and need, and pregnancy and birth outcomes moving forward in relation to policy changes. I will use this research platform in combination with an exceptional mentorship and advisory team to become a national expert in linked-data approaches to contraception and reproductive health access program and policy evaluations. During this award period, I will engage in selected training activities in 1) linking primary data to multiple administrative data sources; 2) geographical information systems methodology; 3) applied health policy evaluation; and 4) leadership and mentorship. This work aligns with the Agency for Healthcare Research and Quality's (AHRQ) mission to produce evidence that makes healthcare more accessible and more equitable. This work has potential benefits for AHRQ's priority populations specifically, women, adolescents, low income, and rural residents.
/ RELEVANCE TO PUBLIC HEALTH Barriers in access to quality family planning services are a persistent public health problem. Public policies can expand coverage and privately-funded implementation programs may serve as additional safety nets to individuals falling through coverage gaps. This research uses linked-data approaches to evaluate family planning programs and identify social and regional disparities in family planning access and outcomes.
