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09/27/2024 | News release | Distributed by Public on 09/27/2024 20:53

Reproductive Health Experts Outline Key Abortion Issues at Stake in November Election at SPH Public Health Conversation

Reproductive Health Experts Outline Key Abortion Issues at Stake in November Election at SPH Public Health Conversation

Event panelists: abortion bans continue to threaten the health of pregnant people across the nation

"Millions of women, transgender, and nonbinary people are living in states that ban abortions. The numbers are staggering, but behind each statistic is a person, a family, and a community," said panelist Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts.

Public Health

Reproductive Health Experts Outline Key Abortion Issues at Stake in November Election at SPH Public Health Conversation

Event panelists: abortion bans continue to threaten the health of pregnant people across the nation

September 27, 2024
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No one should have to fight for their life because of where they live. But that is the devastating reality for many people experiencing severe pregnancy complications in the US post-Roe era, during which 25 states have passed near or total abortion bans. That was the takeaway at the Public Health Conversation "A Vote for Health: Reproductive Rights" at the School of Public Health September 25.

These restrictive laws "are not only a policy failure, but a humanitarian failure," said Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts (PPLM) during the Conversation.

The hybrid event, which drew more than 1,000 people, was held in conjunction with PPLM and the BU Program on Reproductive Justice. It was the second installment of the SPH "A Vote for Health" fall election series, which convenes scholars to discuss health issues at stake in the 2024 US presidential election. The event gathered legal experts, clinicians, and health advocates to discuss the ongoing threat to reproductive health-and reproductive rights-more than two years after the Supreme Court ended the federal right to abortion, leaving individual states to set their own abortion laws.

The program featured two keynote speeches, as well as two panel discussions, moderated by Nicole Huberfeld, Edward R. Utley Professor of Health Law at SPH and a School of Law professor of law, and Eleanor Klibanoff, women's health reporter for the Texas Tribune.

Participants in the SPH September 25 Public Health Conversation, "A Vote for Health: Reproductive Rights": moderator Eleanor Klibanoff, The Texas Tribune (from left); Vanessa Nicholson-Robinson, Tufts University School of Medicine; Janelle Palacios, Encoded 4 Story and SquareRoot Stories; Payal Srinivasa (CAMED'06), Fenway Health; and Ushma Upadhyay, University of California, San Francisco.

"Every person, no matter where they live, deserves the right to make decisions around their own bodies and futures, free from political interference," said Lee, the first keynote speaker. "This upcoming election isn't just about voting. It's about defending the future of our society, of our families, and our ability to thrive."

The overturning of Roe v. Wade in 2022 thrust millions of pregnant people and clinicians into a state of confusion and fear as conservative states began to pass a patchwork of restrictive or ambiguous laws that criminalized abortion. About two in five reproductive-age women and transgender and nonbinary people currently live in states with these restrictive laws, and one in five people seeking abortion care is forced to travel out of state to receive this service.

This reproductive health issue is also a racial justice issue, as abortion bans disproportionately affect Black and Latino communities already burdened by a maternal mortality crisis in the United States. About 57 percent of Black reproductive-age women, or 6.7 million people, live in restrictive abortion states. Black reproductive-age women in Florida, Texas, and Georgia-all states that have above-average mortality rates-account for 44 percent of all Black women in states with abortion bans.

The guest speakers frequently referred to two Black women from Georgia, who both died from complications from abortion medication soon after the state passed its six-week abortion ban in 2022, one of the most restrictive bans in the nation. Amber Thurman died at age 28 when she did not receive timely care at a hospital after she took an abortion pill. The state's maternal mortality review committee later ruled her death preventable. Candi Miller, 41, who had lupus, hypertension, and diabetes, unintentionally became pregnant and was not eligible for an abortion under the new law. While Georgia's ban includes exemptions for life-threatening conditions, it does not have exemptions for chronic conditions. So Miller tried terminating the pregnancy on her own with abortion medication and experienced fatal complications.

"Both deaths were preventable, yet predictable, especially for Black women who have had a long documented history of health disparities and lack of access," said the second keynote speaker, Benita Miller, vice president of US Programs at the Center for Reproductive Rights. "It is my hope, prayer, and deep wish that we use all of our energy and best thinking to honor their lives and center their families in our struggle to build a world where access to care is not dictated by geography."

Despite these tragic incidents involving abortion pills, telehealth abortion grew during the COVID-19 pandemic and continues to increase in the United States: telehealth medicine comprised about 20 percent of all abortion care in the first quarter of 2024, according to #WeCount, a national abortion reporting effort launched by the Society of Family Planning after the Supreme Court's 2022 Dobbs decision. Notably, the data actually show that abortions have increased since Roe v. Wade was overturned: the monthly total of abortions exceeded 100,000 for the first time since the group began tracking this data.

Panelist Ushma Upadhyay, a University of California, San Francisco, professor of obstetrics, gynecology, and reproductive sciences, cochairs #WeCount and cited two factors for this surprising finding.

"Our database has found that telehealth is significantly less costly for patients, and cost has always been the greatest barrier to abortion care," Upadhyay said. "Obtaining a telehealth abortion is about $150, compared to the national average of $600 for an in-person medication abortion."

But the most impactful policy in support of abortion, she said, are telemedicine abortion shield laws. Shield laws and shield executive orders refer to emerging legislation or orders that are making abortion more accessible to pregnant people who live in states with near or total abortion bans by refusing to penalize doctors or healthcare providers in those states who prescribe and provide abortion pills to patients in states where abortion is illegal. These laws particularly benefit patients who are low-income or who have difficulty traveling to states where it is legal.

Telehealth shield laws, specifically, are enacted in eight states, and Massachusetts was the first state to pass this legislation.

"Regardless of whether the patient gets pills in a clinic or in the mail, the patient will have their abortion at home privately, and four weeks later, they will take a pregnancy test to confirm success," Upadhyay said about the process, adding that #WeCount research in 20 states has shown that telehealth dispensing is just as safe and effective as in-person abortion care.

Shield laws are so novel, they have not been tested in courts yet, but this legislation is a promising and powerful example of how states can preserve reproductive rights, said panelist David Cohen, a professor of law at the Drexel University Thomas R. Kline School of Law. A very small number of Massachusetts, New York, and California providers "are providing a very large number of abortions, mostly into states where abortion is banned," Cohen said. "So it's a large part of the story of why abortion has continued post-Dobbs."

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