Healthcare Denied: The perilous path of abortion bans in the U.S. (Part 2)

On By RH ZOOMIn Abortion, Abortion Ban, abortion restrictions, birth control, Fertility, healthcare, IVF, Pregnancy, public health, reproductive health, reproductive rights, womens health
Photo by Colin Lloyd on Unsplash

Women’s Health at Risk

Banning abortion services does not eliminate the need for abortions but rather drives women to seek unsafe procedures, endangering their lives. Denial of abortion care disproportionately affects vulnerable groups, exacerbating existing health inequities.

Research indicates that pregnant women facing denial of abortion encounter greater risks of complications compared to those receiving abortion care. Findings from the Turnaway Study ‎1), reveal that pregnant women denied abortion are more susceptible to complications such as hemorrhage, hypertension, diabetes, and mental health problems.

Many women resort to unsafe abortion, which could lead to hemorrhage, pelvic injuries, sepsis, and even death 2).

Black women are particularly more vulnerable due to differences in socioeconomic status, access to healthcare, racial discrimination, and the elevated prevalence of chronic diseases such as hypertension and heart disease. These factors increase their vulnerability to pregnancy complications, underscoring why many women resort to abortion services initially ‎3).

Impact During Pregnancy

Most women seeking abortion live below the federal poverty line, lacking access to federal funds for abortion services. Moreover, they often struggle to afford contraceptives that are not fully covered by insurance in states with restrictive policies, which makes low-income women 5 times more likely to have an unintended pregnancy, and subsequently, heightened risk of maternal mortality and morbidity ‎4).

The impact of abortion bans and restrictions reached beyond the denial of abortion care; it also impedes the management of complicated pregnancies, Such as ectopic pregnancy and premature membrane rapture, in states with restrictive policies. Providers encounter dilemmas regarding prioritizing the health versus the life of pregnant individuals due to ambiguous policies, leading to fear of criminal prosecution, large fines, or loss of medical licenses 5).

Furthermore, Women with nonviable pregnancies may face denial of abortion. Stein, Katz, and Chervenak (2023) ‎5), highlight cases where pregnancies with chromosomal or genetic fetal malformations resulting in stillbirth are not permitted to have an abortion. For instance, a Texas woman was denied a medical exemption for abortion when her fetus was diagnosed with a fatal malformation, compelling her to seek abortion services out of state last year. Additionally, pregnant individuals requiring cancer treatment encounter challenges, as they are advised to postpone treatments that may interfere with their pregnancies in states with restrictive abortion policies ‎6).

Impact on Autoimmune diseases

Abortion bans and restrictions extend beyond reproductive healthcare, as evidenced by reports from the Arthritis Foundation and Lupus Foundations. These reports highlight the challenges faced by individuals with autoimmune conditions, as medications utilized for both autoimmune diseases and abortion induction are restricted in certain pharmacies and face significant hurdles in obtaining insurance approval ‎5).

Impact on Assisted Reproductive Technology

The overturning of the constitutional right to abortion also affects assisted reproductive technology (ART), notably in states where embryos are recognized as persons from the moment of conception. This stance exerts control over the IVF process and related services such as cryopreservation, disposal, and genetic testing ‎7). For instance, in Alabama this year, a Supreme Court decision recognizing frozen embryos as persons led to the suspension of all IVF services until the governor signed a bill to safeguard these services in the state.

Impact on Access to Contraceptives

Contraception, a vital aspect of reproductive health, is susceptible to the effects of restrictions. The Guttmacher Institute (2023) ‎8) reports that nine states have implemented various restrictions on Plan B contraceptives, including exclusion from insurance coverage and allowing pharmacists to refuse to dispense them.

For a Better Reproductive Health Future

Ensuring the protection of abortion services is paramount, especially in an election year where collaboration among politicians and legislators is crucial to safeguarding people’s health and well-being. Advocating for revisions to existing abortion policies to uphold women’s health is crucial. Meanwhile, implementing various measures can mitigate some of the adverse effects of abortion care bans such as improved access to birth control, enhanced sex education in schools, provision of early medication abortion by mail, protect safety and privacy of women and healthcare providers, and increase funding to maternal and child healthcare to address disparities in healthcare access.

References

  1. Spitzer E., Weitz T., Buchanan M. J. (2022). Abortion Bans Will Result in More Women Dying. The Center of American Progress. Available from: https://www.americanprogress.org/article/abortion-bans-will-result-in-more-women-dying/
  2. Wong, C. A., Galley, H. F., and Leslie, K. (2022). Maternal mortality, safe abortion, and the anesthetist. British Journal of Anaesthesia, 129(6), 833–835. Available from:10.1016/j.bja.2022.08.020.
  3. Fitzsimmons, E., Arany, Z., Howell, E.A. et al. (2020). Differential Outcomes for African-American Women with Cardiovascular Complications of Pregnancy. Curr Treat Options Cardio Med. https://doi-org.eux.idm.oclc.org/10.1007/s11936-020-00863-5.
  4. Hoffman L., Ahmed O., and Salas-Betsch I. (2022). State Abortion Bans Will Harm Women and Families’ Economic Security Across the U.S. [online], available from:  https://www.americanprogress.org/article/state-abortion-bans-will-harm-women-and-families-economic-security-across-the-us/.
  5. Stein R. A., Katz A., and Chervenak F. A. (2023). The far-reaching impact of abortion bans: reproductive care and beyond, The European Journal of Contraception & Reproductive Health Care, 28:1, 23-27. Available from: 10.1080/13625187.2022.2140008.
  6. Ponce, S. B., Bajaj, A., Banieel, C., Seldon, C., Sim, A., Franco, I., Pinnix, C., Fields, E., Jimenez, R. B. (2022). Protecting our Patients and Trainees: The Complex Consequences of the Dobbs v. Jackson Women’s Health Organization Ruling. International Journal of Radiation Oncology, Biology, Physics. https://doi.org/10.1016/j.ijrobp.2022.07.1846.
  7. Daar J. (2023). The Impact of Dobbs on Assisted Reproductive Technologies: Does It Matter Where Life Begins, Bill of Health. Available from: https://blog.petrieflom.law.harvard.edu/2023/05/09/the-impact-of-dobbs-on-assisted-reproductive-technologies-does-it-matter-where-life-begins/.
  8. Guttmacher Institute, the (2023). Emergency Contraception. Available from: https://www.guttmacher.org/state-policy/explore/emergency-contraception.


Healthcare Denied: The Perilous Path of Abortion Bans in the U.S. (Part 1)

On By RH ZOOMIn Abortion, Abortion Ban, abortion restrictions, healthcare, Pregnancy, public health, reproductive health, reproductive rights
Photo by Colin Lloyd on Unsplash

When I embarked on exploring the impact of abortion bans and restrictions in the United States for my MPH student-led course, I faced initial hesitance. This topic is deeply contentious, igniting passionate debates across political, religious, and cultural divides. Despite my reservations and relative unfamiliarity with the subject, I felt compelled to approach it from a public health perspective. 

During my four-year tenure in the U.S., I witnessed notable shifts in policy and healthcare accessibility, especially following the Supreme Court’s decision to overturn the longstanding constitutional right to abortion (known as Roe v. Wade) in June 2022. This pivotal ruling triggered a series of transformations nationwide, revealing deep-seated political struggles and underlying ethnic and racial disparities.

Narrowing down my focus for the coursework proved challenging given the complexity and multifaceted nature of the issue. Ultimately, I chose to examine the health implications of abortion bans and restrictions on women in the U.S.

In the aftermath of the Supreme Court Ruling 

Following the Court’s decision, individual states gained authority over abortion access regulation. This led to the enforcement of bans and restrictions in 26 states ‎1). Trigger laws in 13 states, activated post-ruling, ranged from total abortion bans to restrictions based on gestational limits, albeit with exceptions for life-threatening circumstances ‎2).

The Pre-Ruling Landscape

Even before the Supreme Court ruling, healthcare in the U.S. faced significant challenges. Despite its status as a high-income, developed nation, access to healthcare remained financially out of reach for many, with disparities exacerbated by socioeconomic factors and racial discrimination.

The scarcity of community care resources in the United States disproportionately affects marginalized communities, particularly Black and Brown individuals, those with low incomes, Indigenous peoples, adolescents, and LGBTQ individuals. These groups encounter various racial, socioeconomic, and structural obstacles when seeking healthcare services. Factors such as income levels, access to health insurance, and provider biases contribute significantly to health disparities, which are further intensified by abortion bans and restrictions ‎3).

According to the Centers for Disease Control and Prevention (CDC) (2021) ‎4), The United States has the highest maternal mortality among high-income countries with a rate of 32.9 deaths per 100,000 live births.

Researchers estimated that around 58% of women of reproductive age live in states with restrictive abortion policies, which increases their risk of maternal mortality and morbidity ‎5).

Ethnic and racial minorities, particularly Black women, bore the brunt of these disparities, facing higher rates of pregnancy-related complications and mortality ‎6). Statistics showed that black women are three times more likely to die from pregnancy complications than white women ‎3).

Thus, abortion bans and restrictions have far-reaching effects on women’s lives, spanning health, social, and economic domains. Furthermore, they also diminish the quality of reproductive care by limiting opportunities for medical professionals to gain proficiency in managing patients seeking abortion services. However, the focus of Part 2 of this blog remains solely on the health implications of these bans and restrictions for women in the United States.

References

  1. Williams, A. M., Chaturvedi, R., Pollalis, I., Ibarra-Cobarru, J., Aaronson, J. A., and White, R. S. (2022). Associations between state policies, race, ethnicity, and rurality, and maternal mortality and morbidity following the United States Supreme Court Dobbs v. Jackson Women’s Health Organization ruling. British Journal of Anaesthesia, 129(6), e145–e147. Available from: https://doi.org/10.1016/j.bja.2022.08.016.
  2.  Guttmacher Institute, the (2023a). The State Abortion Policy Landscape One Year Post-Roe. Available from: https://www.guttmacher.org/2023/06/state-abortion-policy-landscape-one-year-post-roe. 
  3. Commonwealth Fund, the (2023). Limiting Abortion Access for American Women Impacts Health, Economic Security: An International Comparison. [online], available from: https://www.commonwealthfund.org/blog/2023/limiting-abortion-access-american-women-impacts-health-economic-security
  4. Centers for Disease Control and Prevention (CDC) (2021). Maternal Mortality Rates in the United States, 2021. Available from: https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm.
  5.  Guttmacher Institute, the (2022). Roe v. Wade Overturned: Our Latest Resources: Abortion Rights and Access in the Post-Roe Era. Available from: https://www.guttmacher.org/abortion-rights-supreme-court.
  6. Lantz P.M., Michelmore K., Moniz M.H., Mmeje O., Axinn W.G. and Spector-Bagdady K. (2023), Abortion Policy in the United States: The New Legal Landscape and Its Threats to Health and Socioeconomic Well-Being. Milbank Quarterly., 101: 283-301. Available from: 10.1111/1468-0009.12614

Reproductive Rights At Risk: is IVF protected in Alabama?

On By RH ZOOMIn Abortion Ban, Fertility, healthcare, infertility, IVF, Pregnancy, reproductive health, reproductive rights

The Recent Alabama Supreme Court Ruling on Frozen Embryos

In a significant ruling on 16th February 2024, the Alabama Supreme Court determined that frozen embryos are to be legally regarded as minor children. This decision stemmed from lawsuits initiated by couples whose frozen embryos were inadvertently destroyed by a hospital patient in 2020. The ruling allows these couples to pursue legal action for the wrongful death of their minor children. Consequently, IVF clinics across the state have halted their services, leaving individuals seeking fertility assistance with limited options due to apprehensions about potential prosecution.

Understanding IVF and Implications of the New Legislation

In Vitro Fertilization (IVF) stands as a pivotal assisted reproductive technology, facilitating the conception process for numerous couples struggling with infertility. This procedure involves the fertilization of an egg and sperm in a laboratory setting, followed by the implantation of one of the resulting embryos into the uterus. Typically, multiple embryos are created through IVF, with surplus embryos either frozen for future use or discarded. However, the recent ruling has presented couples with challenging decisions: either conceiving all embryos available, donating them, or incurring ongoing storage costs to preserve them indefinitely.

This ruling echoes arguments supporting anti-abortion measures in Alabama, known for its stringent abortion bans, which prohibit abortion at any stage of pregnancy and grant embryos the legal status of a person. Beyond reproductive rights, this issue underscores the imposition of legal obstacles on individuals making decisions about their bodies and futures.

Governor’s Initiative to Safeguard IVF Providers

In response to the Supreme Court ruling, the Governor of Alabama enacted legislation aimed at shielding IVF providers from legal liabilities. However, concerns have arisen regarding the bill’s failure to afford mothers recourse in cases of medical negligence. The legislation falls short in addressing the ramifications of the Supreme Court ruling on IVF and other reproductive rights affected by the recognition of embryo personhood. These rights include access to abortion, emergency contraception, and the management of complex pregnancies.

Advocating for Evidence-Based Policy

Amidst these developments, there remains a pressing need for evidence-based policymaking to safeguard reproductive rights while striking a balance between the rights of embryos and prospective parents. Health policy should prioritize individual autonomy and offer patient-centered care, ensuring access to equitable and quality healthcare services.

Motivation, Hesitation, and the Way Forward

On By RH ZOOMIn Abortion, Abortion Ban, abortion restrictions, birth control, Fertility, healthcare, IVF, Pregnancy, public health, reproductive health, reproductive justice, reproductive rights, womens health3 Comments

“I write because I don’t know what I think until I read what I say.” – A quote by Flannery O’Connor

To be honest, starting a public blog never crossed my mind. I’ve never been particularly a reflective person, nor do I readily disclose my thoughts or feelings in public. However, there comes a moment for change and growth.

Motivation

As I enter my final year as a Master of Public Health (MPH) student, while also working on my Student-Led, Individually Created Course (SLICC), I felt compelled to break out of my professional isolation and share my project with a wider audience. Balancing the responsibilities of being a stay-at-home mom to a one-year-old limited my professional interactions, narrowing my professional circle significantly. Initially, the idea of starting a public blog was to share my project work, my insights into public health, my academic journey, and my life in New York. But that inner voice urged me to delve deeper into my greatest passion—Reproductive Health.

My fascination with reproductive health dates back to my earlier years as a medical doctor in Yemen. There, I witnessed firsthand the complex interplay of culture, poverty, traditions, and education levels in determining women’s access to reproductive health services. Subsequently, as I transitioned into a career in public health, my interest in this field only intensified.

Inspired by my university coursework, I decided to revisit my longstanding interest and offer my perspectives on various reproductive health issues. Through this blog, I aspire to share knowledge, foster understanding, and embark on a journey of self-discovery.

Hesitation

My foremost concern revolved around the question: “Do my words truly matter?” I grappled with doubts about the potential readership of my blog, I’m not the most eloquent writer. This uncertainty stemmed from my reluctance to share my innermost thoughts and experiences, which I had always kept guarded. Despite my struggles with putting my thoughts into words, this challenge has been instrumental in shaping my worldview and maintaining my focus. In opening up through this blog, I am sharing a part of myself—my identity as a woman, a healthcare professional, a mother, and an introvert. I aim to find meaning beyond my individual experiences and hopefully resonate with others on similar journeys.

The Way Forward

In this space, I endeavor to explore a wide array of reproductive health topics alongside my SLICC project. Navigating through sensitive issues, I aim to cultivate empathy, broaden perspectives, and spark meaningful conversations. As you accompany me on this personal journey, I hope to offer glimpses into my life while also learning from your insights and experiences.