Public health standards for women


By Joycelyn Elders - Contributing Columnist



As Americans, we strive for safety — the safest medicines, cars and toys. But when it comes to women’s reproductive health, state legislatures have passed about 250 laws since 2011 that put women’s health at risk. And they do it under the guise of “women’s safety.” Women of color are disproportionately affected by these policies throughout the Southern states where I live and spend much of my time mentoring young physicians and health professionals.

Politicians are cutting access to family planning services and telling doctors how to practice medicine, especially concerning procedures that terminate pregnancies.

Clinic licensing standards, invasive ultrasound procedures and mandatory waiting periods are unnecessary because legal abortion is one of the safest surgical procedures. Nearly 90 percent are done in the first trimester, when abortion is safest.

Texas is one battleground in this war on women’s bodies. A few years ago, Texas had 41 abortion clinics but a recent court decision to uphold restrictions may mean only nine will stay open. The public health community knows what’s likely to happen: more unintended pregnancies, since many of these clinics also provide contraceptive services.

Guttmacher Institute research shows unintended pregnancy is highest among the poor, youth and women of color. Eliminating barriers to culturally and linguistically appropriate health information and services would help reduce these disparities, as would age-appropriate sexual health education in our schools. Yet funding for these programs is being cut. Again, it’s politicians making these decisions, not health professionals.

The Affordable Care Act resolves disparities by requiring that preventive services, including contraception, be provided at no cost. Congress’ attacks on Obamacare, coupled with the Supreme Court’s pending decision concerning access to insurance plans, stand to jeopardize these gains.

Ironically, some legislators talk about the “sanctity of life,” while railing against affordable contraception and prenatal care, which serve to enhance women’s quality of life.

Consider a young woman making minimum wage who finds herself pregnant and not yet ready to raise a child. Or an older woman with health conditions that could become life-threatening if she stays pregnant. Because at least 93 percent of Texas counties do not have an abortion provider, she may have to travel long distances, take time off work that likely has no paid sick leave and arrange transportation. With Texas’ waiting period, she will have to find a place to stay overnight. Once at the clinic, she will hear state-mandated pseudo-science about the “risks” of abortion.

Research shows that 42 percent of women obtaining abortions have incomes below the poverty level. And because of the federal Hyde Amendment, Medicaid funding for abortions is prohibited under most circumstances and in most states.

The irony is that the U.S. ranks 47th among 183 countries for maternal deaths from 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.

Before the 1973 Supreme Court decision in Roe vs. Wade, the public health community expressed concern about high rates of maternal deaths in the U.S. and the need for universal access to a full range of reproductive health services, including abortion.

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 risk.

As a nation, I hope we take a hard look at how our public policies stand to jeopardize the health of women and prevent this from happening.

We must have healthy mothers and healthy babies if we expect to have a healthy nation.

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.

By Joycelyn Elders

Contributing Columnist

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