德克萨斯州2021年对早孕堕胎的禁令可能会证明，在美国最高法院2022年6月推翻罗伊诉韦德案的裁决后，堕胎模式可能会发生怎样的变化。研究旨在评估德克萨斯州参议院8号法案(sb8)实施后，禁止在检测到胚胎心脏活动后堕胎的前6个月内，怀孕12周或以上的德克萨斯州居民中堕胎数量的变化和州外堕胎百分比的变化。

数据包括在2020年9月1日至2022年2月28日的研究期间，德克萨斯州居民在德克萨斯州的68 820例机构内堕胎和11 287例州外堕胎。德克萨斯州居民中记录在案的在德克萨斯州设施内和州外堕胎的总数从5673例显著下降到3501例(绝对变化量，-2172例[95% CI， -2083至-2265];实施sb8后第一个月的IRR为0.67 [95% CI, 0.56-0.79]，与前一个月相比。在2021年9月至2022年2月期间，怀孕12周或以上的德克萨斯州居民的州外堕胎率从17.1%(221/1291)上升至31.0%(399/1289)(差异178 [95% CI, 153-206]) (P ＜0.001)

在一个堕胎设施样本中，2021年德克萨斯州禁止早孕堕胎的法律(sb8)与实施后第一个月的德克萨斯州设施堕胎记录总数相比前一个月的下降显著相关。在sb8实施后的6个月里，在怀孕12周或更长时间的德克萨斯州居民中，州外堕胎的百分比显著增加。

Abstract

Importance: Texas' 2021 ban on abortion in early pregnancy may demonstrate how patterns of abortion might change following the US Supreme Court's June 2022 decision overturning Roe v Wade.

Objective: To assess changes in the number of abortions and changes in the percentage of out-of-state abortions among Texas residents performed at 12 or more weeks of gestation in the first 6 months following implementation of Texas Senate Bill 8 (SB 8), which prohibited abortions after detection of embryonic cardiac activity.

Design, setting, and participants: Retrospective study of a sample of 50 Texas and out-of-state abortion facilities using an interrupted time series analysis to assess changes in the number of abortions, and Poisson regression to assess changes in abortions at 12 or more weeks of gestation. Data included 68 820 Texas facility-based abortions and 11 287 out-of-state abortions among Texas residents during the study period from September 1, 2020, to February 28, 2022.

Exposures: Abortion care obtained after (September 2021-February 2022) vs before (September 2020-August 2021) implementation of SB 8.

Main outcomes and measures: Primary outcomes were changes in the number of facility-based abortions for Texas residents, in Texas and out of state, in the month after implementation of SB 8 compared with the month before. The secondary outcome was the change in the percentage of out-of-state abortions among Texas residents obtained at 12 or more weeks of gestation during the 6-month period after the law's implementation.

Results: Between September 2020 and August 2021, there were 55 018 abortions in Texas and 2547 out-of-state abortions among Texas residents. During the 6 months after SB 8, there were 13 802 abortions in Texas and 8740 out-of-state abortions among Texas residents. Compared with the month before implementation of SB 8, the number of Texas facility-based abortions significantly decreased from 5451 to 2169 (difference, -3282 [95% CI, -3171 to -3396]; incidence rate ratio [IRR], 0.43 [95% CI, 0.36-0.51]) in the month after SB 8 was implemented. The number of out-of-state abortions among Texas residents significantly increased from 222 to 1332 (difference, 1110 [95% CI, 1047-1177]; IRR, 5.38 [95% CI, 4.19-6.91]). Overall, the total documented number of Texas facility-based and out-of-state abortions among Texas residents significantly decreased from 5673 to 3501 (absolute change, -2172 [95% CI, -2083 to -2265]; IRR, 0.67 [95% CI, 0.56-0.79]) in the first month after SB 8 was implemented compared with the previous month. Out-of-state abortions among Texas residents obtained at 12 or more weeks of gestation increased from 17.1% (221/1291) to 31.0% (399/1289) (difference, 178 [95% CI, 153-206]) during the period between September 2021 and February 2022 (P < .001 for trend).

Conclusions and relevance: Among a sample of abortion facilities, the 2021 Texas law banning abortion in early pregnancy (SB 8) was significantly associated with a decrease in the documented total of facility-based abortions in Texas and obtained by Texas residents in surrounding states in the first month after implementation compared with the previous month. Over the 6 months following SB 8 implementation, the percentage of out-of-state abortions among Texas residents obtained at 12 or more weeks of gestation significantly increased.

文章连接：

jamanetwork.com/journals/jama/article-abstract/2798216?resultClick=1

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