The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions

Issue: In response to the U.S. Supreme Court's overturning of Roe v. Wade, a number of states have passed, or are planning to pass, partial or complete bans on abortion. A key question is whether these restrictions will result in reduced overall access to maternal and infant care, as well as worse health outcomes, in these states.Goals: Compare the current status of maternal and infant health in states that have or are likely to have bans or restrictions on abortion access with states that will preserve abortion access and consider how new abortion restrictions could affect maternal and infant health in the future.Methods: We drew on public data sources such as the CDC WONDER birth and death files, Area Health Resources Files, and the March of Dimes maternity care deserts report. We stratified states based on Guttmacher Institute ratings of the restrictiveness of state abortion policies.Key Findings and Conclusions: Compared to states where abortion is accessible, states that have banned, are planning to ban, or have otherwise restricted abortion have fewer maternity care providers; more maternity care "deserts"; higher rates of maternal mortality and infant death, especially among women of color; higher overall death rates for women of reproductive age; and greater racial inequities across their health care systems

A case study and proposal for publishing directed acyclic graphs: The effectiveness of the quadrivalent HPV vaccine in perinatally HIV infected girls

Background: Developing a causal graph is an important step in etiologic research planning and can be used to highlight data flaws and irreparable bias and confounding. As a case study, we consider recent findings that suggest human papillomavirus (HPV) vaccine is less effective against HPV-associated disease among girls living with HIV compared to girls without HIV. Objectives: To understand the relationship between HIV status and HPV vaccine effectiveness, it is important to outline the key assumptions of the causal mechanisms before designing a study to investigate the effect of the HPV vaccine in girls living with HIV infection. Methods: We present a causal graph to describe our assumptions and proposed approach to explore this relationship. We hope to obtain feedback on our assumptions prior to data analysis and exemplify the process for designing causal graphs to inform an etiologic study. Conclusion: The approach we lay out in this paper may be useful for other researchers who have an interest in using causal graphs to describe and assess assumptions in their own research prior to undergoing data collection and/or analysis