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Reproductive Health Projects

Louisiana Admitting Privileges Project

Principal Investigator: Kari White
Funded by: University of California San Francisco

In Louisiana there are only three facilities that provide abortion care, and state laws regulating the delivery of care may make services difficult to obtain. One of these regulations, which requires abortion providers to have admitting privileges at a hospital within 30 miles of the facility where they provide care, was initially blocked from going into effect since it is nearly identical to a Texas law that the US Supreme Court ruled was unconstitutional in 2016. The State of Louisiana has challenged a lower court’s decision, and in February 2019, the US Supreme Court issued a stay that has temporarily halted the law from going into effect. If the admitting privileges law is enforced, at least two, if not all three, of Louisiana’s remaining abortion clinics may close. By examining the current landscape of access to abortion care in Louisiana, we will be able to assess the potential impact of the law if it does go into effect. This research also would enable us to leverage the infrastructure we create to evaluate quickly the actual impact of the law on women’s access to care.

Interagency Collaboration on Maternal and Child Wellbeing

Principal Investigator / Mentor: Robert Crosnoe
Co-Principal Investigator /  Mentee:
Haley Stritzel
Funded by: National Science Foundation

The majority of child maltreatment reports received by child protective service agencies in the United States come from professionals such as teachers, healthcare providers, and social workers. Data sharing between the child welfare system and other institutions thus facilitates the investigation of and intervention in cases of child maltreatment. One consequence of this collaboration, however, is that families may avoid institutions that provide necessary resources out of fear of coming into contact with the child welfare system. This project analyzes under what circumstances institutional engagement is associated with a greater likelihood of child protective services involvement, as well as how child protective services involvement is related to future institutional engagement. This project utilizes both quantitative and qualitative methods. The quantitative portion of project will analyze data from the Fragile Families and Child Well-being Study (FFCWS). Currently available FFCWS data follow nearly five thousand children and their families from the focal child's birth to age fifteen, with an oversampling of children born to unmarried mothers. Statistical techniques such as generalized linear models will be used to estimate associations between child welfare system involvement and service utilization. In addition, the project involves in-depth, semi-structured interviews with 40 social service employees.

Contraception in Community Colleges in Texas: A Randomized Control Trial

Prinicpal Investigator: Kristine Hopkins
Funded by: University of California

In the US, young women aged 18–25 experience high rates of unintended pregnancy and
have limited knowledge of contraception or their pregnancy risks. UT Austin will subcontract with UCSF to conduct the Texas component of a cluster randomized trial to test an intervention to increase awareness of contraception and health protective behaviors among students in this age group in community colleges. During the subcontract period, UT Austin will recruit 6 community colleges in Texas to serve as study sites, which will be randomly assigned to intervention or control groups. The intervention group will receive: 1) a one-day, CME-accredited training on contraception for staff and clinicians at the campus health center (if applicable) and at network referral partners, and 2) student education on birth control. The control group will receive student nutritional education on the impacts of sugar on health. UT Austin will recruit 75 students at each site for a total of 450 student participants. Students will be eligible to participate if they are female, aged 18–25, enrolled in the first year of community college, at risk of pregnancy (sexually active, not pregnant and not sterilized), do not want to become pregnant in the next year, and willing to be contacted for follow-up data collection. UT Austin will collect data from student participants through self-administered questionnaires at baseline and will support follow-up data collection efforts, including online surveys every 3 months and home pregnancy tests every 6 months following baseline. UT will also facilitate provider surveys made available by the UCSF team. The UT team will follow up with providers to encourage high response rates.

Reproductive Responses to the Zika Virus Epidemic in Brazil

Principal Investigator: Leticia Marteleto
Funded by: National Institutes of Health

The objective of the proposed research is to provide one of the first in-depth analyses of how the Zika virus (ZIKV) epidemic has affected and potentially continues to affect reproductive processes in Brazil. These analyses will include investigations into how different types of physical and social exposure to the virus shape women’s desires for pregnancy and contraception, contraceptive use and sexual frequency, prenatal healthcare use, abortion, and pregnancy and birth outcomes. Understanding women’s reproductive responses to ZIKV exposure is key to developing a nuanced understanding of the effects of population health shocks on family health and health disparities more broadly, and is especially important to consider in a developing country context where vast inequalities in healthcare access, unintended pregnancy, and morbidity and mortality persist. The specific aims of this project will be to: (1) collect longitudinal data on physical and social ZIKV exposure, reproductive processes, and potential mediators; (2) estimate the extent to which sociodemographic, municipal, and state characteristics affect women’s physical and social experiences of ZIKV exposure; and (3) investigate how and why reproductive intentions, behaviors, and outcomes vary with ZIKV exposure. 

Demography, Health, and Contraceptive Use of Repeat Teenage Mothers

Principal Investigator: Julie Maslowsky
Funded by: National Institutes of Health

Nearly 1/5 of the 230,000 annual births to teen mothers in the US are repeat births (births to a teen mother   who already has one or more children), the large majority of which are unintended. Repeat teen mothers are a high-risk group of adolescents; they are more likely to drop out of high school, are less likely to be employed, and more likely to have mental health problems, and start prenatal care later or receive no prenatal care more frequently compared to first-time teen and older mothers. They also experience higher incidence of preterm birth, low infant birth weight, and infant mortality compared to both first time teen mothers and older mothers. Despite the vulnerability of these mothers and their children, they have been notably understudied compared to first-time teen mothers. The demographic composition of this population, their health profile, their knowledge and attitudes toward contraceptive are not well documented. We also lack understanding of the processes by which teens choose their contraception, knowledge that is necessary to inform appropriate education and facilitate uptake of effective contraception among teen mothers wishing to prevent a repeat birth. The proposed research has 3 aims: 1. Characterize the US repeat teenage mother population with regards to demographic characteristics, reproductive health, and contraceptive use and compare this population to first time teen mothers and older mothers (ages 20-25). 2. Identify individual factors that influence teens’ desire to use long acting reversible contraceptives (LARCs) in high- and low-access states, Colorado and Texas. 3. Identify knowledge, attitudes, intentions, and perceived accessibility regarding postpartum contraception, particularly LARCs, among teens.

Texas Policy Evaluation Project

Principal Investigator: Joseph E. Potter
Additional Investigators: Kristine Hopkins, Co-Investigator; Daniel Powers, Co-Investigator; Daniel Grossman, Principal Investigator, Ibis Reproductive Health Subcontract; Kari White, Principal Investigator, Unversity of Alabama at Birmingham subcontract
Funded by: Anonymous foundation

Begun in Fall 2011, Texas Policy Evaluation Project (TxPEP) is a collaborative group of investigators who evaluate the impact of legislation in Texas related to women’s reproductive health passed in the 82nd and 83rd legislative sessions. Study areas include policy changes related to the provision of family planning and abortion care in Texas. Our current research projects include studying the impact of the Supreme Court decision on abortion access in Texas, the effects of HB 3994 in restricting judicial bypass for teens seeking abortion care without parental consent, as well as the impact of the new and reorganized state family planning programs and the Medicaid rule change permitting reimbursement for immediate postpartum provision of long-acting reversible contraception.

The Effects of Stressful Exposures on Pregnancy Among Late Adolescents

Principal Investigator: Abigail Weitzman
Funded by: National Institutes of Health

The proposed research will be one of the first in-depth investigations of the effects of an extreme form of neighborhood violence, specifically homicide exposure, on adolescent pregnancy in the United States. The analysis will examine how homicide exposure affects the risk of pregnancy and will further identify underlying mechanisms including changes in aspirations for and expectations about the future, perceived behavioral control, relationship dynamics, and sexual behavior and contraceptive use. The specific aims of this project will be to: (1) assess how young women’s aspirations, expectations, and perceived behavioral control evolve alongside their exposure to homicide (2) examine how young women’s relationship dynamics, sexual activity, and contraceptive use, evolve with homicide exposure and (3) investigate how the risk of adolescent pregnancy changes following homicide exposure. To achieve these aims, the proposed study will integrate geo-referenced administrative data on the date and location of homicides with time-varying information from RDSL panel data on young women’s aspirations for and expectations about future education, employment, and family formation; relationship dynamics; sexual activity and contraceptive use; and pregnancy status.

Collaborative Research: International Migration and Fertility: Towards a Multidimensional Understanding

Principal Investigator: Julia Behrman
Co-Principal Investigator: Abigail Weitzman
Funded by: Institute of Education Sciences

Migration and fertility are two major components of social and demographic change; the proposed research represents one of the first efforts to explore the association between international migration and fertility that combines data from both sending and receiving countries using a propensity score matching approach. To date, most studies have been limited to the use of data sources collected primarily in receiving countries and have typically compared migrants to native-born residents of the receiving country, rather than to residents of their country of origin with whom they share a common background. Because migrants often have higher fertility than native-born populations of low-fertility countries, it may appear that there is little association between migration and fertility. However, this may only be the result of comparing migrants to native-born women in receiving countries rather than women in sending countries who are similar in observed characteristics. Moreover, limited research explores whether migrant fertility is high due to high desired fertility, high unmet need for family planning, or other factors. In contrast, the proposed project integrates cross-sectional data from the Trajectories et Origines (TeO) survey and the Demographic and Health Surveys (DHS) to create a novel data set that allows for matching highly similar African and Asian respondents who did and did not migrate from sending countries to France. This enables us to: (1) Investigate the association between international migration and fertility by comparing migrants in receiving countries to similar non-migrants in sending countries; and (2) Explore the association between international migration and underlying reproductive desires and behaviors that could help explain why migration is associated with fertility, including fertility desires, contraceptive use and unmet need for family planning, employment, and partnership formation.


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