Jocelyn Elders: Bring back public health standards for women’s reproductive health
As Americans, we strive for safety – the safest medicines, safest cars, safest toys. But when it comes to women’s reproductive health, our state legislatures are passing laws putting women’s health at risk – about 250 since 2011. And now they do it under the guise of “women’s safety.” Women of color, especially African-American women, are disproportionately being affected by these policies throughout the Southern states where I live and spend much of my time mentoring young physicians and health professionals.
The most serious health risks for women are coming from politicians cutting back access to family planning services and telling doctors how to practice medicine especially around procedures related to terminating a pregnancy.
Costly clinic licensing standards, invasive ultrasound procedures and lengthy mandatory waiting periods (as if women haven’t already thought about this decision) are unnecessary because legal abortion is one of the safest surgical procedures available. In the United States, nearly 90% are done in the first trimester when abortion is safest.
Once again Texas is the battleground in the war over women’s bodies. Whereas just a few years ago there were 41 abortion clinics, the recent federal appeals court decision to uphold restrictions will likely close about half of Texas’ remaining 18 clinics. Those of us in the public health community know what is likely to happen as a result: more unintended pregnancy since many of these clinics also provide contraceptive services and more unintended births since abortion will become less available.
According to the Guttmacher Institute, unintended pregnancy is highest among poor women, young women and women of color. Addressing institutional barriers to culturally and linguistically appropriate health information and services would help reduce these disparities, as would more and better age-appropriate sexual health education programs in our public schools. Yet funding for these programs is being cut. Again it is politicians making many of these decisions, not public health professionals.
The Affordable Care Act addresses disparities by requiring that certain preventive services including contraception be provided at no cost. The Republican—mostly male– Congress’ constant attacks on Obamacare, coupled with the US Supreme Court’s pending decisions concerning access to insurance plans, stand to jeopardize any gains that have been made.
Ironically, some legislators and courts talk about the “sanctity of life” while railing against affordable contraception, prenatal care and a living wage, which all serve to enhance the quality of life for women.
Consider a young woman who finds herself pregnant and working for minimum wage, unmarried and not yet ready to raise a child because she wants to stay in school. Or an older woman with serious health conditions which could become life threatening if she stays pregnant. Since at least 93% of Texas counties do not have an abortion provider, a woman may have to travel long distances, take time off from a job that likely has no paid sick leave, find childcare for her child(ren) and arrange transportation. And, due to Texas’ waiting period, she will have to find a place to stay overnight, adding to her costs. Once at the clinic, she will hear state-mandated pseudo-science about the “risks” of abortion, much of which is not based on scientific evidence.
Research shows that 42% of women obtaining abortions have incomes below the federal poverty level ($11,770 for a family of one in 2015). And due to the federal Hyde Amendment, Medicaid funding for abortions is prohibited under most circumstances and in most states.
The irony is that the United States ranks 47th, among 183 countries, in the world for maternal deaths due to pregnancy-related conditions. And, childbirth is 14 times more likely to result in death than an abortion. These rates go up for women with diabetes and other health conditions, which are more prevalent among women of color.
Before the 1973 Supreme Court decision in Roe v. Wade, the public health community publicly expressed concern about the high rates of maternal deaths in the United States and the need for universal access to a full range of reproductive health services including abortion. The big drop in maternal deaths came in the mid-1970s soon after Roe when illegal back-alley abortions gave way to safe and accessible procedures along with a wider range of contraceptive services available under government programs and private insurance.
The recent restrictions, rollbacks and de-funding of reproductive health services will inevitably drive up maternal morbidity and mortality rates, again placing women’s health at serious risk. As a nation, I do hope we take a hard look at how our public policies stand to jeopardize the safety and health of women and prevent this from happening.
We must have healthy mothers and healthy babies if we expect to have a healthy nation.
Dr. Elders is a professor at the School of Public Heath, University of Arkansas and served as Surgeon General of the United States from 1993 to 1994.
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