Introduction
In 1973, the U.S. Supreme Court decided the groundbreaking case Roe v. Wade. The Court, in a 7-2 decision, struck down a Texas statute that prohibited women from exercising their fundamental right to choose whether to terminate a pregnancy. At its core, the decision in Roe meant that women in the United States had the right to make choices about their bodies, their health, and their futures. In legal terms, the Court employed a three-tiered approach to analyze laws restricting abortion: in the first trimester, no state could regulate abortion; in the second trimester, states could regulate abortion only for the protection of the mother’s health; and in the third trimester, states could prohibit abortion except when it was necessary to preserve the life or health of the mother.
There is little controversy over the fact that Roe v. Wade was a groundbreaking case in women’s rights. Starting in the 1960s, the United States saw the establishment of a broader women’s rights movement that was advocating for equal rights for women and a more liberal, permissive society. Abortion rights were an important part of this larger movement. Even if Roe were to be overturned, there would likely still be some states with relatively permissive abortion laws. However, religious and social conservatives argue that legalizing abortion has created the impression that women who do not take easily to motherhood can simply “abort” their way to parenthood when it is most convenient. There have been serious clashes throughout the centuries over the availability of legal early elective abortion. Critics argue, sometimes persuasively, that the availability of those and other health services can be the result of more general policies and should not determine the legislative landscape.
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Women's Health Care in the United States
Women's health care in the United States consists of both general health and reproductive health care services and acts as a component of an evolving women's right to health care in general. The 1973 Supreme Court decision established the right to obtain an abortion, though the case was couched in concepts of women's health. Abortion, while legal, is restricted by numerous policies that limit funding and increase procedures such as waiting periods or parental notification requirements. Women in general are more likely than men to have health insurance and seek health care from providers, but many still go without needed health services. Both geographic and sociodemographic factors impact the availability of insurance and access to health care.
Almost half of all women in the United States get their health care through publicly funded programs since women are less likely to have private insurance than men. Programs provide preventive health care services to many women in the United States. The aim of women's service programs is to ensure that women have adequate access to health services in accordance with their ability to pay. Over half of all patients in the United States are women, who receive services such as Pap/HPV tests, arthritis examinations, and contraceptive services. Fewer programs that still serve millions of women in the United States focus on reproductive health services. A study noted that within a decade of implementation of provisions, women no longer paid a premium for an IUD in independent and state-level insurance plan analyses. A separate study noted how state policies long blocked insurance coverage of in vitro fertilization, IUDs, and egg freezing, but states passed new laws to limit access to family planning services since 2011, with state policies also contributing to a decline in the number of facilities providing abortions. The played a part in the taxonomy of the women's health sector from service programs to the integration of prevention and chronic disease management along with primary care for all ages based on numerous federal rules and policies. Within the taxonomical evolution, public awareness of women's health service integration is further indicated by the explosion in research on coordination positions. Meanwhile, women's health has begun to receive its own independent critique. An article was inspired by the passage of the ACA and praised the expansion of the scientific base of health services for women.
Health Effects of Overturning Roe v. Wade
If Roe v. Wade is overturned and states are free to decide reproductive health policy free of federal interference, the range of abortion access in the U.S. will likely vary by state, and the situation could differ greatly across the South. Given the trends of many southern states moving to restrict access to abortion, it is likely that the availability of safe, legal abortion would decrease across the southern region. The situation would be different for states in the North. The implications for maternal health would depend on where women’s access to abortion is restricted. In states with reduced access to abortion, there could be impacts on contraception, counseling, and comprehensive reproductive health education, leading to increased teen pregnancy. There could also be possible economic impacts for clinics, abortion providers, the women they serve, and for affected states. It is likely that laws regarding abortion would vary from state to state across the U.S. However, little research has been done over the past decade to examine how variations in abortion policy impact the health of women who seek abortion care and the broader social consequences.
Half of the women who are of reproductive age (15-44) who seek abortions are usually low-income, making up to 199% of the federal poverty level. African American and Hispanic women are disproportionately represented among this group. Fifty-nine percent of women who have abortions already have one or more children. These statistics suggest that African American and Hispanic women might also be more affected if abortion becomes less available.
It is likely that fewer low-income women would have abortions in states where abortions are more difficult to obtain. In 2015, there were only 800 women in the U.S. who were able to choose adoption over abortion. Public health resources for prevention and overall women’s health efforts could be reallocated to address complications and possible suicide attempts that these women might have in states where obtaining a wanted abortion is not available. Why does it matter if women who seek abortions can’t get them? In the past five years, there has been a marked reduction in teenage pregnancy due to comprehensive sex education. Sexual violence, sexual harassment, and the risks of having an unwanted pregnancy have been documented worldwide for women and girls.
Challenges for Minority Women in Health Care
The notion of intersectionality – the combination of racial, gender, and other forms of bias – also helps us to more finely appreciate and understand minority women when considering the issue of access to health care, including more broadly the effects of overturning certain legal precedents on women’s health services. Minority women face challenges not only as a result of their gender but of their multiple social identities. The percentage of Black women of reproductive years enrolled in Medicaid or living below the poverty level is larger than that of white women. Despite access, minority women are disproportionately affected by a host of conditions such as obesity, hypertension, diabetes, and high cholesterol. Similarly, Hispanic women of reproductive ages are also more likely to live below the poverty level and be on Medicaid, but for unknown reasons, they are twice as likely to have an unintended pregnancy compared to non-Hispanic whites.
Owing to systemic biases, rural access to care is frequently compromised for entire communities, where the sole provider may have ethical or moral considerations proscribing the full range of reproductive health services. In addition, regional differences for those with unique reproductive health needs may result from socio-economic and lifestyle factors. Similarly, if less confidence is placed in the provider and the health care system by minority women due to racial discrimination, then they are less likely to be forthcoming about their concerns and more likely to have poorer outcomes. In fact, formal recognition of this difficulty has arisen; by a certain time, it was determined that the U.S. health care system is not adequately trained in cultural competence. Health care professionals regularly demonstrate a lack of understanding of diseases in addition to a reluctance to discuss intimate conditions and the likely greater social stress experienced by some forms of diabetes. The care needs of all groups are not uniform, and minorities view the cultural tailoring of services as a means to ensure a voice. Use of language associated with specific groups is also necessary; for example, the highest rates of women who identify themselves as multicultural rather than non-white must be addressed. Proposed changes in laws and the manner in which these changes might impact diverse groups further justify clarification of the distinct ethnic and reproductive health care needs of women. For these reasons, the practice of a health care policy that seeks to limit the voice of the multifaceted experience of women in consideration and treatment is unacceptable.
Policy Solutions for Health Care Equity
The results of the present poll signal the importance of, first and foremost, being concerned with one's own health, followed by health care access and population health care measures. Other aspects indicate policies that urban women, minority or not, should be required to overcome significant burdens to attain the same level of access to health as rural women or women located in other geographic areas. Overturning Roe would exacerbate existing area disparities.
As the fight for Roe seems poised to move out of judicial chambers and back to the political arena, such a fight provides an opportunity to work for comprehensive legislation that will benefit all women in need of obstetric care, including but going beyond abortion needs. While individual grassroots groups will be unable to pledge this and must focus their efforts primarily on maintaining access to abortions, national organizations can take the time to issue policy papers recommending what, in an equitable society, women's comprehensive health access should be.
Enlarge the Health Service. Our polling numbers indicate that participants were interested in legislation that would make the kind of access we currently guarantee urban poor women more widely enjoyed. While this could involve a host of reforms, two seem most critical: increased funding for reproductive health services and a legal requirement that schools educate their female students about their guaranteed access to maternal health services as early in their education as possible. The best time for such announcements is likely after the school children receive information on basic contraceptive care and the development of the fetus. Each observer will have different opinions on the best ways to produce such educational materials, but our poll results indicate that explicit legislation requiring this announcement is widely appealing.
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