Time sensitive research on barriers to pregnancy care

Recent policy shifts in the Midwest of the United States have abruptly restricted access to pregnancy-related care for millions of women. Since June 2022, Midwestern states reinstated 150+ year old laws banning types of care, legislated the first new ban in the country, and saw widespread clinic closures. To understand the barriers faced by pregnant women seeking pregnancy-related care in the Midwest amidst these rapid policy changes and to quantify the impact of these changes on women’s health and lives, unbiased, locally relevant data are urgently needed. Yet, most reproductive healthcare access research has recruited participants from clinics—participants who, by virtue of having gotten to a clinic, represent a population that was able to overcome many barriers to care, and further, excludes women who use telemedicine and those who continue their pregnancies. A clinic-based sampling mechanism thus induces selection bias, resulting in research that misses or underestimates barriers to care. To address these methodological limitations, prospective research is needed that (1) expands recruitment to the full population of women seeking pregnancy-related healthcare, not just those who make it to a clinic, (2) sensitively measures barriers and facilitators to care, (3) captures the full set of possible pregnancy pathways (including miscarriage; birth; and clinical, telemedicine, and self-managed pregnancy care) and their sequelae over time, and (4) is sufficiently powered to answer nuanced questions at the regional level. To address this time-sensitive need in an underserved region, we propose four linked aims in a two-phase study. In the first year of the R61, we will recruit 500 pregnant women searching for information online and receiving support from community-based organizations to identify (via surveys; Aim 1) and characterize (via 30 in-depth interviews; Aim 2) the barriers women face while seeking pregnancy-related care in all 12 Midwest states. In the second (R33) phase of the study, we will follow these participants forward in time with additional surveys at 4, 10, and 18 months to measure pregnancy outcomes and the implications of their pregnancy outcomes on broader physical, mental, and socioeconomic health across states with different policy environments (Aim 3). Finally, we will implement a human-centered design approach to engage community-based organization leaders and Midwesterners who have sought pregnancy-related care to develop and test messages to address knowledge and information barriers (Aim 4). Findings from this study will drive more informed, geography-specific interventions to address urgent access challenges in the Midwest.