Current Research

Mandatory counseling and waiting periods are one of the most common ways that states have restricted abortion access. While supporters claim these laws ensure that patients can make informed care decisions, mandatory counseling often forces pregnant people to listen to misinformation about abortion. Waiting periods and two-visit requirements also lead to delays in abortion care, higher costs of care, and overall decreases in abortion. Yet, we know little about the causal impacts of these policies on the full spectrum of reproductive health outcomes. Understanding these impacts, particularly among marginalized groups who face heightened structural barriers to care, is vital to achieving reproductive equity in a post-Dobbs abortion environment.

To address these knowledge gaps, we examine the impacts of state-level variation in required counseling and waiting periods for abortions on racial/ethnic disparities in reproductive health outcomes. First, using rigorous legal epidemiology methods, we have created a comprehensive historical database of state-level abortion restrictions related to mandatory counseling and waiting periods. We find significant increases over the past decade in such restrictions, particularly in the Midwestern and Southern United States. We are working to integrate these data with nationally representative data on pregnancy- and birth-related outcomes to estimate the causal impacts of these laws, particularly among non-Hispanic Black, Hispanic, and non-Hispanic Asian pregnant people.

Birth Cost Recovery (BCR) is a policy that holds some unmarried, non-custodial fathers responsible for paying back Medicaid costs from labor and delivery of their child. Wisconsin is the top enforcer of BCR in the United States, having collected $106 million between 2011 and 2015. Importantly, BCR disproportionately affects Black families, who are more likely than non-Black families to access prenatal BadgerCare (Wisconsin Medicaid) and also experience among the worst pregnancy-related outcomes. While supporters of BCR argue that this policy promotes paternal responsibility, others contend that BCR causes financial strain, decreases paternal involvement, and leads to delays in prenatal care access. Yet, we have not established how BCR is impacting the health and wellbeing of Wisconsin families, nor centered the perspectives of the Black families disproportionately affected by this policy. 

This is a community-engaged pilot study to better understand how BCR affects Black families in Wisconsin. Specifically, we will be talking to Black parents about their experiences with healthcare, child support, and BCR. We will use their perspectives to develop, refine, and test a survey to rigorously study the impacts of BCR. Specifically, we will:

• Invite Black parents in Wisconsin who have ongoing or past experience with prenatal Medicaid and/or BCR to participate in individual interviews or focus groups.
• Develop and refine a survey to capture the effects of BCR on Black parents and their families, including mental and physical health and relationships.
• Pilot test the survey and compare outcomes between Black families at risk of experiencing BCR and those who are not at risk.

Ultimately, our goal is to provide new information for decision-makers weighing Birth Cost Recovery’s impacts on constituents and for communities to implement asset and evidence-based strategies to improve outcomes.

The goal of this research is to investigate how reproductive-aged Black people value abortion method (medication vs. procedure) relative to other care attributes and to identify the structural and legal barriers that can shape those preferences. Medication abortion use has increased substantially in the two decades since the US Food and Drug Administration approved the use of mifepristone, now accounting for over half of US abortions. This proportion will likely grow, given COVID-related changes in medical care provision and the 2021 changes to the mifepristone Risk Evaluation and Mitigation Strategy, which now allows for remote dispensing of the medication. Further, many experts predict that the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, which dismantled Roe v. Wade and Planned Parenthood v. Casey is likely to increase pregnant people’s reliance on self-managed abortion, including medication abortion.

We will use a mixed-methods design to investigate: 1) abortion method preferences among Black people who can get pregnant and 2) how structural and legal barriers affect these preferences. Our proposed data collection is national in scope but also respondents from the US Midwest; this allows our work to have both national implications and to capture the experience of Midwestern Black people, who experience uniquely high levels of socioeconomic inequality and wide state-level variation in structural and legal barriers to abortion. Only by filling these gaps will we be able to serve the preferences and needs of Black people seeking abortions, whose access to desired care will be more constrained than ever in the post-Dobbs landscape. 

We will use a sequential mixed-methods study design. Specifically, we will first collect qualitative data using individual interviews with abortion facilitators (i.e., abortion providers, clinical support staff, research scholars, abortion doulas, abortion fund and practical support workers) and Black abortion seekers. We will use these qualitative data to inform the care attributes and levels embedded in our survey and discrete choice experiment.

Across U.S. history, social norms, governmental policies, and public health programs have promoted the reproduction of some groups, such as affluent white women, and restricted that of others, such as poor women and women of color. In addition, public health excitement over the promise of highly effective and long-term contraceptive methods has bolstered the promotion of long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and implants in ways that sometimes prioritize providers’ concerns and those of medical governing bodies over patients’ preferences.

Despite growing concerns over coercion in contraceptive care—that is, pressure from a healthcare provider to use or not use birth control, few studies have described the frequency and manifestations of contraceptive coercion. Moreover, there is no established method of measuring contraceptive coercion. We begin to fill this gap by debuting and testing a novel measure of contraceptive coercion and using it to: (1) describe the frequency of contraceptive coercion, (2) explore contraceptive coercion across groups, and (3) examine correlates of contraceptive coercion. Additionally, we highlight nuances in contraceptive coercion experiences through participants’ open-ended survey responses.

In the spring of 2023, we surveyed reproductive-aged people in the United States who were assigned female at birth. We oversampled racial, ethnic, gender, and sexual minorities to ensure a diverse sample that included groups often underrepresented in survey research who are theorized as more likely to experience contraceptive coercion. 

We are currently working to analyze these data and disseminate the findings. So far, our findings show that contraceptive coercion is relatively common, with over one in seven participants reporting coercion during their last contraceptive counseling and one in three reporting it at some point in their lifetime. Groups facing structural oppression, especially Black participants and gay/lesbian participants appear to be particularly at risk of experiencing contraceptive coercion. Additionally, contraceptive coercion is associated with preferred contraceptive use and mental health and well-being. Findings provide critical information about contraceptive coercion and highlight opportunities for continued research and intervention to improve patient autonomy.

Our team, with partners at The Urban Institute and SisterSong Women of Color Reproductive Justice Collaborative are conducting a research study to rigorously assess the impact of the post-Dobbs health policy environment on abortion and broader reproductive health access and experiences, health outcomes, and social and economic wellbeing. We are committed to centering the experiences and expertise of communities that have historically been excluded from reproductive health research and policy conversations.

This research project includes 13 study states (AZ, CA, FL, GA, IA, IL, MD, MS, NC, NJ, OH, SC, and WI) and a national sample. The project will be conducted from 2023-2027 and includes a survey of more than 45,000 people, follow-up interviews with a small number of survey participants, and case studies including focus groups with people affected by recent changes in reproductive health and abortion access in each study state. 

The goals of this research project are to:

1. Support positive policy changes by providing key stakeholders with evidence and tailored products to support their on-the-ground work to improve access to high quality sexual and reproductive health care for all.
2. Establish new evidence documenting the effects of post-Dobbs abortion restrictions on abortion and broader reproductive health access and experiences, health outcomes, and social and economic wellbeing.
3. Understand how barriers to abortion and reproductive health care access may be compounded by factors such as economic oppression, discrimination in health care and other systemic oppression based on disability, sexual orientation, gender identity, race, ethnicity, socioeconomic background, age, and other factors.
4. Document experiences, barriers, and needs of historically excluded groups to support community-led targeted interventions that improve experiences and outcomes for these groups.

Prior research links in utero exposure to violent conflicts such as terrorism and war to adverse birth outcomes like preterm birth and low birth weight, as well as later-life disability and mortality. Black Americans disproportionately experience both premature mortality and structural violence (e.g., excessive use of police force in their neighborhoods). However, the presence of racialized disparities in exposure to violence, coupled with data limitations, make it difficult to establish causal links between violence and later-life health inequities.

In this proposal, we aim to establish the causal impacts of in utero exposure to one common form of 20th century violence—racial riots on racial inequities in life expectancy. Racial riots were instances of widespread violence and unrest that often erupted in cities across the United States, driven by underlying racial tensions and inequalities. While not exclusively targeting Black Americans, these riots frequently occurred in predominantly Black neighborhoods and resulted in significant harm to Black communities, both in terms of physical destruction and loss of life. Estimating the detrimental consequences of racial riots on health is empirically challenging because we lack individual data on life expectancy linked to the time and place of birth. Existing studies often rely on county-level life expectancy data, which can obscure vital variation in experiences within counties and overlook the long-term impact of violence during individuals’ lives.

We address these knowledge gaps by integrating racial riots data with individual-level data on birth month-year and place of birth to examine the long-term effects of in utero exposure to racial riots on later-life longevity. We posit that in-utero exposure to traumatic events can have enduring impacts on individuals’ physiological and psychological health, socioeconomic outcomes, and longevity. Our specific aims are:

Aim 1: To assemble a comprehensive database on racial riots (1900-1940) by county and year.

Aim 2: To quantify the causal impacts of in-utero exposure to racial riots on differences in life expectancy among Black Americans (measured as old age longevity).

Aim 3: To quantify the causal impacts of in-utero exposure to racial riots in educational attainment and socioeconomic status among Black Americans.