The Spring of Reproductive Health Policy Struggles
I once heard a quote along the lines of, “Humans aren’t equipped to carry the weight of the whole world.” I think about that often. We are constantly bombarded with crises in the news and it can be hard to figure out where to focus your attention and how to act. In the last few years, I’ve chosen to dedicate some of my writing and my charitable contributions to reproductive justice causes. As a woman, a mother, and a researcher with an MPH in Maternal and Child Health, I feel a sense of both personal and professional urgency about human rights being under attack since the Dobbs decision that overturned Roe v. Wade.
Here in North Carolina, abortion policy has been sitting on quicksand. On May 5, 2023, I wrote What a 12 week abortion ban in North Carolina means for people that want to be parents, right after the state legislature passed the limiting ban. Within two weeks, Governor Roy Cooper had vetoed the bill, and then on May 16th, the state legislature approved the 12 week limit, a significant reduction from the original 20-week statute.
“The ban, known as Senate Bill 20, would restrict most abortions in North Carolina to 12 weeks, with exceptions for rape, incest, certain fetal abnormalities and the life of the mother. The ban also mandates that detailed information about abortion procedures be reported to state health regulators and institutes longer waiting periods and more in-person medical visits to obtain an abortion.” - The New York Times
What I have a hard time wrapping my head around is that we have state and federal policies limiting ANY kind of healthcare. Abortion is more regulated than any other health care service. I’m also baffled that the legislation of the last few years, led by Republican lawmakers, is in contrast to the national sentiment — 61% of U.S. adults say abortion should be legal in all or most cases. The article I wrote examines some of the nuances of restrictive policies, how they align with clinical ultrasound schedules, and what this means in reality for pregnancies. I hope you read it as you consider your stance on the issue.
On April 12, 2023, HHS proposed a new ruling to protect the confidentiality of reproductive healthcare data. Former colleagues from Duke, Eric Perakslis, Jessilyn Dunn, and I responded to the well-meaning policy in an article for STAT news: Proposed rules to protect health data in an era of abortion bans fall short. The intention of the ruling is to expand HIPAA to add additional protections to reproductive health data. Our biggest qualm is that “While well-intentioned, this rulemaking will further codify the rapidly growing reproductive health disparities at the state level and do little in abortion ban states that already have the weakest support for maternal health.” Read to learn what this means in a practical sense.
Commentary on the ruling is open until June 16, 2023 (here)and I encourage you to provide feedback for a more inclusive federal policy without state policy loopholes.
Here is some draft text to get you started:
I agree with this text from the draft ruling, “A positive, trusting relationship between individuals and their health care providers is essential to an individual's health and well-being. The prospect of releasing highly sensitive PHI can result in medical mistrust and the deterioration of the confidential, safe environment that is necessary to quality health care, a functional health care system, and the public's health generally. That is even more true in the context of reproductive health care, given the potential for stigmatization and other adverse consequences to individuals resulting from disclosures they do not want or expect.”
Just as HIPAA provides extra protections to mental health information, reproductive health data deserves heightened confidentiality and privacy protections.
I encourage HHS to adopt an equal federal privacy policy and supersede any state laws that would attempt access to reproductive healthcare records for criminal prosecution of patients and healthcare providers without the consent of the patient.
As always, I hope that my writing encourages thought and discussion. It’s up to us to create the world we want.
