As the country careens toward a presidential election in the midst of a raging pandemic, the dueling headlines on public health and politics are a stark indication that, no matter who wins in November, this election will have profound, far-reaching consequences for your physical health and well-being. All this week, Elemental is running a series of stories detailing what’s at stake, from insurance coverage to plans for a pandemic still in progress. Here’s what you should know about the implications of the election on reproductive health and family planning.
The influence of politics over reproductive rights and sexual health is long, complicated, and mostly frustrating, but data shows that the more reproductive rights women have, and the more family planning services they’re able to access, the healthier they and their children are.
A study published in October by researchers at UCLA looked at data from every birth in all 50 states and the District of Columbia during 2016, and found that women who lived in states with less restrictive policies around reproductive rights had healthier babies.
Restrictive policies include things like waiting periods (25 states require women to wait a specific amount of time, usually 24 hours, between abortion counseling and the procedure), mandatory parental consent for minors to receive certain treatments or medications, and living in counties without an abortion provider. “Our study found that women who lived in states with less restrictive policies have lower risks of low-birth-weight babies,” says May Sudhinaraset, PhD, an associate professor of population policy at UCLA.
Birth weight, Sudhinaraset explains, is an important marker of population health. “Low-birth-weight babies are more at risk for health problems,” she says, “and more likely to have delayed development or a social disability.”
Overall, the risk of low birth weight was 7% lower among women living in states with the least restrictive policies, which Sudhinaraset and her fellow researchers hypothesize is due to “reductions in unintended pregnancies resulting in birth. We know from past studies that restrictive policies result in higher levels of unintended pregnancies, which are connected to adverse birth outcomes.”
Although the legality of abortion is a majorly visible and divisive topic between presidential candidates (Trump says he is pro-life, and that he expects after “appointing pro-life judges,” the Supreme Count would “automatically” overturn Roe v. Wade, while Biden says he wants to secure abortion access through a federal law), it’s far from the only way politics influences reproductive care.
The 2010 passage of the Affordable Care Act (ACA) significantly expanded access to sexual and reproductive health care. The law, also known as Obamacare, included maternity care under its “essential health benefits,” requiring that all private insurance plans cover health care costs associated with pregnancy and delivery. The National Women’s Law Center estimates that before the ACA went into effect, 80% of insurance plans completely excluded maternity care.
The ACA also requires most insurers to cover a range of contraceptive methods, plus services related to contraception, in addition to covering preventative care such as HPV vaccination and HIV, STI, and cervical cancer screening. However, the law’s opponents — including President Donald Trump — have sought to weaken many of those coverages, and a challenge set to be heard by the Supreme Court in early November could potentially overturn the ACA in its entirety.
State policy has as substantial an effect on reproductive health as federal legislation. Despite what Sudhinaraset calls “a good amount of evidence that comprehensive sex education leads to increased family planning and lower levels of unintended pregnancy,” in many states, the curriculum falls far short. In fact, according to the Brown Political Review, just 20 states (and Washington, D.C.) require their schools’ sex-ed programs to include information about contraception. There are 29 states whose curricula center on “abstinence until marriage,” leaving young people at far greater risk for unintended, less healthy pregnancies.
Even policies which seem totally unrelated to reproduction can have deleterious effects on it. In their study of 2016 births, Sudhinaraset says, she and her team found that women living in a state where police collaborate with federal immigration authorities were associated with a 20% increased risk of low birth weight.
Sudhinaraset’s ongoing research will focus on how immigration policies impact maternal and fetal health. “Past studies have found that sociopolitical stressors resulted in higher preterm births,” says Sudhinaraset. “Following the presidential election in 2016, anti-immigrant rhetoric was tied to preterm birth outcomes.”
That study, published in the Journal of Epidemiology & Community Health, found that preterm birth rates in the United States among foreign-born Hispanic women and women from the Middle East and North Africa spiked just after President Trump was inaugurated.
“We’re living at this really crucial moment in time when we see that women’s reproductive rights are being attacked on all fronts, and we’re also having a national reckoning on race,” Sudhinaraset says. “I think the bottom line is it shows that enacting policies that impact women’s rights lead to better outcomes not just for women, but for their babies, too.”
And what’s good for women and babies is ultimately good for entire communities, which, she adds, is even more reason to vote for candidates whose platforms and policies support maternal health and access to reproductive care.
“Birth outcomes are a really important marker of population health,” she says. “It’s a really interesting time for our study to come out, and hopefully the information is helpful in some of the discussions and debates. Policies aren’t always evidence-based — they’re changing all the time — and more than anything right now we need evidence-based policies that actually protect and improve our health.”