Health providers navigating murky waters after abortion ruling

Health

A woman holds a packet of contraceptive pills. (AP Photo/Tsvangirayi Mukwazhi)

(NewsNation) — The Supreme Court opinion overturning Roe v. Wade has impacted more than abortion access, resulting in confusion in other areas of health care.

On Thursday, the House approved a plan to protect certain types of contraception nationwide, including emergency contraception, according to The Hill.

But since the ruling last month, providers and patients have had to navigate new restrictions as the laws in states change with varying levels of clarity.

Access to other treatment

Bans on abortion have complicated treatment options available to people living with autoimmune conditions.

In the wake of the Supreme Court ruling, patients reported issues refilling their prescriptions for the drug methotrexate. The Arthritis Foundation cites the medication as “one of the most effective and widely used” treatments for inflammatory types of arthritis.

In much higher doses, methotrexate can be used to treat some forms of cancer. Also in higher doses, it can cause a miscarriage, although it’s rarely used to electively end a pregnancy, according to the Mayo Clinic. The medication is often reserved for ectopic pregnancies, which develop outside the uterus and can be life-threatening.

The American College of Rheumatology (ACR) said in an official statement that it “opposes any action which interferes with the practice of evidence-based medicine” or “intrudes upon the doctor-patient relationship.”

“Pregnancy often complicates the management of women with rheumatic diseases and may threaten the life of the mother,” the ACR said in its statement. “Rheumatologists and other rheumatology professionals must be able to provide the best evidence-based care and guidance for all of their patients.”

According to The Arthritis Foundation, prescriptions that include a “diagnosis code” indicating what the medication will be used for could help patients access their prescriptions. 

Unintended teen pregnancies

The overturning of Roe v. Wade could also exacerbate inequalities related to teen pregnancy, according to Julie Maslowsky, an associate professor of public health at the University of Illinois at Chicago.

“The truth is that the states that have banned abortion, or restricted abortion or plan to ban abortion as a result of the Supreme Court ruling are also the states that in general offer less comprehensive sex education, less access to contraception, and already have higher rates of teen pregnancy and teen births,” Maslowsky said.

A CDC youth behavior survey determined there were 158,043 teen births in 2020 by mothers ages 15-19 for a birth rate of 10 births per 1,000 teens. That’s down 9% from 2019 and 76% from the peak of teen pregnancies in 1991.

Marginalized populations also are likely to be disproportionately affected. According to the CDC, rates were highest among women under 24, women living in poverty, and those who did not complete high school. It also disproportionality affected Black women.

Maslowsky said it wouldn’t be unusual for restricted access to abortion to cause a “chilling effect” in related behaviors.

“All things sex and reproductive health can become stigmatized,” she said. “Then you get youth who feel less able to seek help, talk to adults about this, talk to health care providers about this.”

That could lead to riskier sex, unintended pregnancies and overall less access to support and resources.

“Whether it gets to the point of you actually needing an abortion or not, these are all very related sort of downstream consequences that are absolutely going to happen, and that are going to be compounded for LGBTQ youth and youth of color and immigrant youth and youth with disabilities,” Maslowsky said.

Emergency contraception availability

Although the Supreme Court’s ruling wasn’t directly tied to contraception, the decision has led to confusion about emergency contraceptives such as Plan B.

Several big box retailers, including Target, CVS and Amazon, temporarily limited the sales of contraceptives —mainly Plan B — after sales went up dramatically following the Supreme Court ruling.

A health system in Missouri previously announced it would stop providing emergency contraception to patients at its Missouri hospitals and clinics until the state’s trigger laws were “better defined.”

Abortion is banned in Missouri except in cases of medical emergencies.

Several hours later, the same health system said it re-evaluated and changed course.

Some of that confusion could be rooted in a general misunderstanding of how the pill works, Maslowsky said.

“(Plan B) stops ovulation so that the egg can never get fertilized in the first place,” she said. “But that’s not clear and many people don’t know that. And so they think that maybe it is aborting a fertilized egg in some way and therefore is covered by the law.”

The House-approved proposal would protect emergency contraceptives as well as oral medication, intrauterine devices and condoms.

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