ABSTRACT In June 2022, the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health overturned Roe v. Wade, eliminating federal protections for abortion access nationwide. The Dobbs decision rapidly upended fifty years of legal precedent and health policy. Fourteen states have banned abortion, state legislatures have introduced 85 bills to protect or restrict abortion access, and courts in eight states have temporarily blocked the passage of abortion bans. Over 33.6 million people with childbearing capacity now live in states where abortion is banned or likely to be heavily restricted. The effect of these rapidly changing policies on abortion access will be profound, yet the consequences of these policies on public health indices are unknown. People with chronic and complex medical conditions are particularly vulnerable to adverse health consequences as a result of abortion policy. At baseline, these individuals are at high risk for severe maternal morbidity and maternal mortality as compared to other birthing people. Prior to the Dobbs decision, abortion care allowed for life- altering care among people whose underlying health conditions complicated healthy pregnancy. However, few studies had described the impact of abortion on the health and well-being of individuals with chronic diseases; thus, it is unclear how the Dobbs decision will impact their clinical outcomes. Our study, Investigating Time- sensitive Reproductive Health Equity Post-Dobbs for Patients with ChronIc Disease (INTREPID), will evaluate the time-sensitive impact of evolving abortion policies on the health and well-being of patients, particularly those with chronic diseases that increase the risk of severe maternal morbidity and maternal mortality (e.g., cardiovascular disease, cancer, systemic lupus erythematosus); the clinical practice of physicians who care for people with chronic diseases; and downstream clinical outcomes at a population level. We will use survey- based, qualitative, and epidemiologic approaches to realize our Specific Aims, which are to: 1) Evaluate, among people who are seeking abortion, who is able or not able to obtain a wanted abortion, and to assess their longitudinal outcomes related to health and well-being; 2) Assess, among physicians, the impact of abortion policy on medical decision-making and practice; and 3) Generate new evidence about the impact of abortion policy on population-based pregnancy outcomes (e.g., severe maternal morbidity, maternal mortality) and healthcare-related outcomes (e.g., contraception and teratogenic medication prescribing). The INTREPID research team has multidisciplinary expertise in medicine, obstetrics, family planning research, health equity, health policy, and epidemiology. Our project seeks to inform health policy that will optimize reproductive healthcare and clinical outcomes in the post-Dobbs era.

NARRATIVE On June 24, 2022, the U.S. Supreme Court ruled to eliminate federal protections for abortion access through the Dobbs v. Jackson Women’s Health decision. Our study will evaluate the evolving, time-sensitive impact of the Dobbs decision on people with childbearing capacity, particularly those with chronic diseases. This project will examine: 1) experiences of people seeking abortion, to understand the immediate and long-term consequences of abortion receipt or denial on health and well-being; 2) experiences of physicians who provide care for people with chronic diseases, to describe ways in which evolving abortion policy affects medical decision-making and practice; and 3) population-level data, to generate new evidence about the impact of abortion policy on clinical outcomes, including severe maternal morbidity and maternal mortality.