Decision making in the setting of congenital anomalies (NATAL) study
Awarded 2024
Traveling to abortion care, post-Dobbs
Ashish Premkumar, MD, PhD
University of Chicago

One out of every 2,500-5,000 births are affected by twin-to-twin transfusion syndrome, fetal myelomeningocele, or congenital diaphragmatic hernia, which are associated with a high risk of perinatal morbidity and mortality. Pregnant people faced with these anomalies proceed with either an abortion, expectant management, or maternal-fetal surgery (MFS). Due to the limited number of fetal care centers (FCCs) providing MFS, people travel significant distances to seek consultation. Similarly, people seeking abortion care often experience significant travel burdens. However, some individuals face “double travel”: namely, traveling to an FCC and again to seek abortion care. This may have burdensome financial and psychosocial effects on the pregnant individual. There are scant data to evaluate the frequency of and factors associated with double travel, especially the role of state-level antiabortion policies. Understanding this phenomenon is paramount to improving the quality of care of FCCs and streamlining access to abortion care. We propose the decisioN mAking in the setting of congenital AnomaLies (NATAL) study, a prospective study of individuals with pregnancies affected with congenital anomalies amenable to MFS (n=400) seeking care at 9 FCCs in the U.S. The expected outcome of this study is high-quality data on the relationship between MFS and abortion care in a rapidly-changing reproductive health landscape. These data will be used to design a novel reproductive health bundle, made up of unique workflows and assessment tools for patient interest in abortion care at the level of an FCC, aimed at facilitating access to comprehensive reproductive health services.