By Carol Roye
Monday, October 14, 2013
Contraception and abortion need to be understood in a public health context. As access comes under heavier attack in this country we can expect higher maternal and infant mortality, more teen anemia and higher risks of child abuse and neglect.
Credit: Jess Hamilton/vociferous on Flickr, under Creative Commons (CC BY-NC-SA 2.0)
(WOMENSENEWS)-- Access to contraception is under attack.
The Affordable Care Act says that women with insurance must be able to obtain a birth control method with no cost sharing or co-pay. Seems fair, but some extremists are doing what they can to prevent this reform.
House Republicans went so far during the shenanigans preceding the government shutdown to sneak in a provision to a bill they sent to the Senate that would kill the contraceptive mandate by allowing employers to deny women birth control coverage for what they refer to as moral reasons.
At the same time, anti-abortion laws coming out of state legislatures are making it much more difficult for women, especially low-income women, to access the range of needed reproductive health services, including contraception and abortions.
I would love to ask the lawmakers passing these to consider how absolutely intrusive and outrageous it would be to limit access to care for any other bodily system.
"I'm sorry ladies, but you can't see a cardiologist. We've decided we don't like the type of care cardiologists provide, so we've made it impossible for them to take care of women in your state."
Unimaginable! But that is what is happening to care for the one system in the body that is unique to women: their reproductive system.
Abortion policy in the past has helped reduce U.S maternal mortality, but that is changing. The U.S. maternal mortality rate, instead of declining, has actually increased in the last 25 years and as of 2010 stood at 21 deaths per 100,000 live births.
Currently 41 states have imposed some limitations on abortion. These come on top of the 1977 Hyde Amendment that barred federal funding of abortion except in cases of rape, incest or threat to the life of the mother. Some states do allow Medicaid, which is a joint federal-state insurance program for those with low income, to pay for abortion in situations that do not meet these requirements. For many women in many states, however, Medicaid will not cover abortion.
I am a nurse and I know too well what happens when women cannot get reproductive health care. I look at these laws from my clinical perspective as a nurse practitioner who provides reproductive health care to young women.
Hormonal contraceptives, such as birth control pills, have many other health benefits for women, which have nothing to do with preventing pregnancies. For example, it is not unusual for teenagers to have very, very heavy periods which last for days or weeks. Without treatment they can become dangerously anemic. The treatment for this problem is birth control pills.
My patients are adolescents, so many of them can get Medicaid insurance for children. Those who are over 18, however, are not so lucky.
Rather than bleeding out, uninsured adult women can go to Planned Parenthood for treatment. Well, they can right now, but many states are imposing such rigorous and unnecessary requirements for Planned Parenthood and other clinics that provide reproductive health care services that they may have to close. Young women in those states should stock up on iron pills for anemia because they soon may not be able to have their bleeding diagnosed and treated with birth control pills.
There are many other non-contraceptive benefits of hormonal contraception. Some women don't get their periods for months on end. They are at increased risk of uterine cancer. Some women have very severe menstrual cramps and miss school or work. The treatment for those problems is birth control pills.
Some women are at increased risk for ovarian cancer because of family history. There is a way to reduce their risk; it is birth control pills.
These are just a few of the health problems that can be addressed by hormonal contraceptives. And I haven't even mentioned the grave health risks that pregnancy poses to women with certain health conditions.
In many states now women have inadequate access to birth control. That is defined as whether a state pays for comprehensive contraceptive services for poor women through Medicaid. A state's failure to allow Medicaid to pay for these services is a statistically significant predictor of a higher infant mortality rate in that state.
This is not surprising because predictors of infant mortality include women having: children very early or late in their reproductive lives; pregnancies too closely spaced; or more than four children.
Access to abortion can defend against all these. Researchers in the 1980s noticed that in previous years there had been a dramatic decrease in infant mortality. They examined the steep decline by analyzing the role of four public policies: Medicaid, subsidized family planning services for poor women, maternal and infant care projects and the legalization of abortion. They found that the increase in legal abortions was the most important factor in reducing infant mortality rates. Again, this should not surprise anyone, given the clear relationship between the ability to limit family size and the infant mortality rate.
Older children may also face hazards when a woman can't control her own fertility, since studies show that large family size and unplanned births can put children at risk for physical abuse and neglect.
We have known for years that providing contraception to women in developing countries greatly improves the health of women and children. The data suggest that this is true also in the United States, as it decreases the maternal and infant mortality rates and improves women's and teens' health.
Recent laws aimed at blocking women's access to contraception and abortion have no health benefits, not to women, infants or to children. All they do is jeopardize their health. Isn't it about time for all of us to say to our legislators: these laws are hurting women and infants in your district?
Carol Roye is professor of nursing and assistant dean for research at Hunter-Bellevue School of Nursing and professor at the City University of New York Graduate Center. Her research focuses on HIV prevention in young women and she is a pediatric nurse practitioner, with a clinical practice in adolescent reproductive health. She is also the author of the upcoming book, "A Woman's Right to Know: How Women's Health Became a Political Pawn - and the Surprising Alliances Working to Reclaim It," due out in November.
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