Dissertations and Theses

Date of Degree

6-4-2019

Document Type

Dissertation

Degree Name

Doctor of Public Health (DPH)

Department

Epidemiology and Biostatistics

Advisor(s)

Heidi Jones

Committee Members

Luisa Borrell

Sandra Echeverria

Mary Huynh

Subject Categories

Public Health | Women's Health

Keywords

abortion, immigrants, Asian Americans, United States

Abstract

Background: Abortion is common in the United States (U.S.) and a critical component of comprehensive reproductive health care. Yet, little research has documented patterns of abortion use among Asian populations or potential barriers to abortion care among immigrants in the U.S., two rapidly growing but understudied populations. In response, this dissertation aims to examine use of and access to abortion services among individuals obtaining abortions in the U.S., focusing specifically on Asians in New York City (NYC), immigrants in the U.S., and individuals living in high immigrant concentration neighborhoods in the U.S.

Methods: Using vital statistics data from the New York City Department of Health and Mental Hygiene and population data from the American Community Survey (ACS), pregnancy rates, abortion rates, and abortion ratios are calculated for Asian women overall, Indian, Chinese, Japanese, Korean, and Vietnamese women, and other racial/ethnic groups, by nativity status, from 2007-2015, and compared over time and between groups. Data from the Guttmacher Institute’s 2008 and 2014 Abortion Patient Surveys (APS) are analyzed to examine differences in distance traveled to obtain an abortion and gestation at the time of abortion comparing immigrants to non-immigrants and recent to non-recent immigrants. Finally, linking together APS and ACS data, we assess the influence of neighborhood immigrant density on these same outcomes, across racial/ethnic groups.

Results: Compared to the abortion rate for Asian women overall in NYC (11.0 per 1,000 women), Japanese and Indian populations had higher rates of abortion (14.7 and 26.5 per 1,000 women, respectively), whereas Chinese and Korean groups had lower rates (7.6 and 4.5, respectively). When data were further disaggregated by nativity status, the abortion rate and ratio were generally higher for U.S.-born compared to immigrant women, among Asians overall and within each country of origin subgroup. Rates and ratios for immigrant groups generally declined between 2008 and 2015, whereas they appeared to increase for U.S.-born groups. At a national level, immigrant abortion patients were less likely to travel 50 miles or more (aOR: 0.74; 95% CI: 0.62, 0.88) and less likely to have an abortion in the second trimester (aOR: 0.80; 95% CI: 0.68, 0.95). Abortion patients, across most racial/ethnic groups, living in neighborhoods with a higher compared to lower concentration of immigrants were less likely to travel 50 or more miles for their abortion and more likely to have a second-trimester abortions, after accounting for individual-level demographics. Both immigrant and non-immigrant abortion patients in higher density neighborhoods were less likely to travel 50 or more miles for services compared to their counterparts living in lower density neighborhoods.

Conclusions: Findings from this dissertation serve as a scientific anchor for future research and policies that seek to advance reproductive health for Asian and immigrant populations in the U.S. Future research should continue to monitor patterns of abortion within subgroups of the Asian population in the U.S., focus on elucidating the apparent protective effect observed in immigrant women, and further examine the impact of neighborhood composition on abortion access.

Available for download on Wednesday, November 11, 2020

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