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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.4266

摘要内容如下：

重要性

最高法院在多尔蒂诉杰克逊妇女健康组织一案中的裁决推翻了美国选择堕胎的权利，至少16个州随后实施了堕胎禁令或6周妊娠限制。先前的研究表明，在多尔蒂之后的6个月里，美国正规卫生保健机构提供的堕胎服务减少了约32360例。然而，尚未研究在正规卫生保健环境之外为自我管理堕胎提供药物的趋势。

目的

确定在多尔蒂手术后6个月内，在正规卫生保健机构之外为自我管理堕胎提供的药物是否增加。

设计、设置和参与者

横断面研究使用的数据来自2022年3月1日至12月31日期间向美国人提供正规医疗保健机构以外的堕胎药物的来源，包括在线远程医疗组织、社区网络和在线供应商。使用分层贝叶斯模型，我们从不提供数据的来源中估算缺失值。我们估计了多尔蒂案判决后自我管理流产药物供应的变化。然后，我们通过考虑并非所有提供的药物都被接受者使用的可能性来估计这些药物的实际使用情况。

曝光

多尔蒂裁决后的堕胎限制。

主要成果和措施

自我管理流产的药物供应和使用。

结果

在多尔蒂之后的6个月期间（2022年7月1日至12月31日），与基于多尔蒂之前水平的预期相比，自我管理堕胎的药物供应总数增加了27838（95%可信区间[CRI]，26374-29175）。排除估算数据对结果的影响很小（27145；95%CRI，25747-28246）。考虑到不使用药物，实际的自我管理药物流产估计增加了26055例（95%CRI，24739-27245），而如果多尔蒂决定没有发生，预期会增加多少。

结论和相关性

在多尔蒂案裁决后的6个月内，为自我管理堕胎提供的药物有所增加。结果表明，尽管实施了州一级的禁令和限制，但仍有大量寻求堕胎者获得了服务。

英文原文如下：

Abstracts

Importance  The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32 360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied.

Objective  To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs.

Design, Setting, and Participants  Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients.

Exposure  Abortion restrictions following the Dobbs decision.

Main Outcomes and Measures  Provision and use of medications for a self-managed abortion.

Results  In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27 838 (95% credible interval [CrI], 26 374-29 175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27 145; 95% CrI, 25 747-28 246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26 055 (95% CrI, 24 739-27 245) vs what would have been expected had the Dobbs decision not occurred.

Conclusions and Relevance  Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions.

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